40 types stomach liver intestine gallbladder disease treatment investigation finding differential diagnosis contraindication ICO management OPD prescription

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40 GI Diseases — Clinical Reference

Stomach | Liver | Intestine | Gallbladder

Fields: Treatment · Investigations · Clinical Findings · Differential Diagnosis · Contraindications · ICU Management · OPD Prescription

STOMACH DISEASES (10)

1. PEPTIC ULCER DISEASE (PUD)

Field	Details
Clinical Findings	Epigastric burning/gnawing pain; DU: relieved by food, worsens 2–3 h after meals; GU: worsens with food; Melena/hematemesis if bleeding; Tenderness on palpation
Investigations	Urea breath test / H. pylori stool antigen; Endoscopy (gold standard) with biopsy; Serum gastrin (if ZE syndrome suspected); CBC (anemia), LFTs, coagulation
Differential Diagnosis	GERD, gastritis, gastroparesis, pancreatitis, gastric cancer, functional dyspepsia, cholecystitis
Treatment	H. pylori eradication: Triple therapy — Omeprazole 20 mg + Clarithromycin 500 mg + Amoxicillin 1 g BD × 14 days; PPI 4–8 wks; Avoid NSAIDs
Contraindications	NSAIDs (worsen ulcer); Aspirin without PPI cover; Sucralfate + antacids simultaneously (reduces absorption); Misoprostol in pregnancy (labor induction)
ICU Management	Bleeding PUD: IV PPI bolus 80 mg then 8 mg/h infusion; Urgent endoscopy within 24h; Transfusion if Hb <7 g/dL; FFP if coagulopathy; Surgery (Billroth) if refractory
OPD Prescription	Tab. Omeprazole 20 mg OD AC × 4–8 wks; Tab. Clarithromycin 500 mg BD × 14d; Tab. Amoxicillin 500 mg BD × 14d; Antacid gel 10 mL after meals PRN

2. GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Field	Details
Clinical Findings	Heartburn, regurgitation, waterbrash; Dysphagia (stricture); Chronic cough, hoarseness (atypical); Worsened by lying flat, fatty food
Investigations	Clinical diagnosis; 24-h pH-impedance monitoring (gold standard); Endoscopy for complications (Barrett's, stricture); Manometry; Barium swallow
Differential Diagnosis	PUD, achalasia, esophageal spasm, cardiac chest pain, eosinophilic esophagitis
Treatment	Lifestyle: weight loss, elevate HOB, avoid triggers; Step-up: antacids → H2RA → PPI; Severe/refractory: Fundoplication (Nissen)
Contraindications	Calcium channel blockers (worsen LES tone); Metoclopramide long-term (tardive dyskinesia); Fundoplication in achalasia; PPI in hypochlorhydria
ICU Management	Rarely ICU; Aspiration pneumonia: IV antibiotics, O2, NPO + NGT feed; Barrett's high-grade dysplasia: urgent endoscopic resection
OPD Prescription	Tab. Pantoprazole 40 mg OD AC (30 min before breakfast) × 8 wks; Tab. Domperidone 10 mg TDS AC; Syrup Antacid 10 mL after meals

3. ACUTE GASTRITIS

Field	Details
Clinical Findings	Epigastric pain, nausea, vomiting; Hematemesis (erosive); NSAID/alcohol history; Mild epigastric tenderness
Investigations	Endoscopy (mucosal erosions, hemorrhage); H. pylori testing; CBC (anemia), LFTs; Urea/creatinine (NSAID nephrotoxicity)
Differential Diagnosis	PUD, GERD, pancreatitis, MI (inferior), esophagitis, gastric cancer
Treatment	Remove causative agent; IV/oral PPI; IV fluids if vomiting; Sucralfate for stress ulcer prophylaxis
Contraindications	NSAIDs, alcohol, corticosteroids (perpetuate erosions); Tetracyclines (irritate mucosa); High-dose aspirin
ICU Management	Stress gastritis prophylaxis: IV Pantoprazole 40 mg BD; Monitor Hb; NGT suction if active bleeding; ICU for hemodynamic compromise
OPD Prescription	Tab. Pantoprazole 40 mg OD AC × 4 wks; Syrup Antacid + Alginate 10 mL TDS after meals; Tab. Ondansetron 4 mg BD PRN nausea

4. CHRONIC GASTRITIS (H. pylori / Autoimmune)

Field	Details
Clinical Findings	Often asymptomatic; Vague dyspepsia; Autoimmune: B12 deficiency (pernicious anemia, neurological symptoms); H. pylori: halitosis
Investigations	Endoscopy + biopsy (atrophic gastritis, intestinal metaplasia); H. pylori CLO test; Serum anti-parietal cell antibodies; B12, folate, CBC; Serum gastrin (elevated in autoimmune)
Differential Diagnosis	Functional dyspepsia, GERD, PUD, gastric cancer, eosinophilic gastritis
Treatment	H. pylori: Triple therapy (as above); Autoimmune: B12 IM injections 1000 µg monthly; Iron supplements
Contraindications	Long-term PPIs without indication (mask cancer); NSAIDs; Iron + antacids together (chelation)
ICU Management	Rarely ICU; Pernicious anemia crisis: IV B12 + folate; Neurological monitoring
OPD Prescription	Tab. Omeprazole 20 mg OD × 4 wks (H. pylori); Inj. Cyanocobalamin 1000 µg IM monthly (autoimmune); Tab. Ferrous Sulfate 200 mg BD (if iron deficient)

5. GASTROPARESIS

Field	Details
Clinical Findings	Postprandial fullness, nausea, vomiting undigested food; Weight loss; Fluctuating glycemia (diabetic); Early satiety
Investigations	Gastric emptying scintigraphy (4-h gold standard — retention >10% at 4 h); Endoscopy (exclude obstruction); HbA1c; Gastric emptying breath test
Differential Diagnosis	Pyloric stenosis, gastric outlet obstruction, functional dyspepsia, eating disorders, small bowel obstruction
Treatment	Dietary: small, low-fat, low-fiber meals; Metoclopramide (first-line); Domperidone; Erythromycin (short-term); Gastric electrical stimulation (refractory)
Contraindications	Metoclopramide >12 wks (tardive dyskinesia); Opioids (worsen); GLP-1 agonists (slow gastric emptying); Anticholinergics
ICU Management	Severe dehydration: IV fluids + electrolytes; IV Metoclopramide 10 mg TDS; Nasojejunal feeding; Glucose management (diabetic)
OPD Prescription	Tab. Metoclopramide 10 mg TDS AC × 4–8 wks (max 12 wks); Tab. Domperidone 10 mg TDS AC; Ensure/Peptamen small frequent meals

6. GASTRIC CANCER

Field	Details
Clinical Findings	Progressive dysphagia, weight loss, anorexia; Epigastric mass; Virchow's node (L supraclavicular); Sister Mary Joseph nodule; Hematemesis/melena; Acanthosis nigricans
Investigations	Endoscopy + biopsy (histology gold standard); CT chest/abdomen/pelvis (staging); EUS (T/N staging); PET scan; CEA, CA 19-9; H. pylori testing; Laparoscopy (peritoneal staging)
Differential Diagnosis	Lymphoma, GIST, PUD, gastroparesis, pancreatic cancer, esophageal cancer
Treatment	Curative: Subtotal/total gastrectomy + D2 lymph node dissection; Perioperative FLOT chemotherapy; Palliative: cisplatin + fluorouracil; Trastuzumab (HER2+)
Contraindications	Surgery in M1 disease (unless palliative); Metformin perioperatively; NSAIDs postop
ICU Management	Post-gastrectomy leak: IV antibiotics + drainage; Anastomotic hemorrhage: endoscopy/embolization; Nutritional support via jejunostomy
OPD Prescription	Symptom control: Tab. Omeprazole 40 mg OD; Tab. Metoclopramide 10 mg TDS; Ensure ONS supplementation; Oncology referral

7. ZOLLINGER-ELLISON SYNDROME (ZES)

Field	Details
Clinical Findings	Multiple/refractory/atypical peptic ulcers; Severe diarrhea; Weight loss; GERD symptoms; MEN-1 association
Investigations	Fasting serum gastrin >1000 pg/mL (diagnostic); Secretin stimulation test (>200 pg/mL rise); Endoscopy; CT/MRI/Octreotide scan for tumor localization; BAO (basal acid output >15 mEq/h)
Differential Diagnosis	PUD, antral G-cell hyperplasia, retained antrum, H. pylori gastritis
Treatment	High-dose PPI (Omeprazole 60–120 mg/day); Surgical resection of gastrinoma if resectable; Octreotide for unresectable; Streptozocin + doxorubicin (malignant)
Contraindications	H2 blockers alone (inadequate acid suppression); Standard-dose PPIs
ICU Management	Severe hemorrhage: IV PPI high dose; Endoscopic hemostasis; Nutritional support
OPD Prescription	Tab. Omeprazole 60 mg BD (high-dose); Regular serum gastrin monitoring; MEN-1 workup (Ca2+, PTH, pituitary MRI)

8. GASTRIC OUTLET OBSTRUCTION (GOO)

Field	Details
Clinical Findings	Projectile non-bilious vomiting; Succussion splash; Weight loss; Metabolic alkalosis (hypokalemic, hypochloremic); Dehydration; Visible peristalsis
Investigations	AXR (dilated stomach); Barium meal (delayed emptying); Endoscopy + biopsy (benign vs malignant); CT abdomen; Electrolytes (↓Cl⁻, ↓K⁺, ↑HCO₃⁻)
Differential Diagnosis	Gastroparesis, duodenal ulcer, gastric cancer, pyloric stenosis (infantile), Crohn's disease
Treatment	Benign (PUD-related): NGT decompression + IV fluids, correct electrolytes, then endoscopic balloon dilation or surgery; Malignant: palliative bypass (gastrojejunostomy) or stenting
Contraindications	Oral feeding before decompression; NGT in esophageal varices
ICU Management	Correct alkalosis with IV NaCl + KCl; NGT on free drainage; IV PPI; Monitor UO (Foley catheter)
OPD Prescription	Post-surgery: Soft diet, small meals; Tab. Pantoprazole 40 mg OD; H. pylori eradication if positive

9. STRESS ULCER (CURLING'S / CUSHING'S)

Field	Details
Clinical Findings	Painless upper GI bleeding in critically ill patients; Curling's: burns patients; Cushing's: head injury (vagal stimulation → acid hypersecretion)
Investigations	Endoscopy (multiple superficial erosions in gastric fundus); CBC, coagulation; Nasogastric aspirate for occult blood
Differential Diagnosis	PUD, esophageal varices, Mallory-Weiss tear, AVM
Treatment	IV PPI (Pantoprazole 40 mg BD); Correct coagulopathy; Sucralfate (alternative); Enteral nutrition early
Contraindications	Sucralfate + NGT feeds simultaneously (reduces absorption); Antacids alone in ICU
ICU Management	Prophylaxis: IV PPI or IV Ranitidine in all high-risk ICU patients; Active bleed: urgent endoscopy; transfusion; Consider angiographic embolization
OPD Prescription	Post-ICU: Tab. Pantoprazole 40 mg OD × 4–8 wks; dietary advice

10. MALLORY-WEISS TEAR

Field	Details
Clinical Findings	Hematemesis after forceful vomiting/retching; Alcohol history; Epigastric/chest pain; Usually self-limiting
Investigations	Upper GI endoscopy (longitudinal mucosal tear at GEJ); CBC; Coagulation screen; ABG if severe
Differential Diagnosis	Esophageal varices, Boerhaave syndrome, PUD, esophagitis
Treatment	Supportive (80% self-limiting); IV PPI; Blood transfusion if Hb <7; Endoscopic hemostasis (epinephrine injection/thermocoagulation); Angioembolization if refractory
Contraindications	Vigorous NGT insertion (worsens tear); Anticoagulants unless essential
ICU Management	Active hemorrhage: resuscitation, IV PPI infusion; Urgent endoscopy; Vasopressin IV if endoscopy fails; Surgical repair (rare)
OPD Prescription	Tab. Pantoprazole 40 mg OD × 4 wks; Avoid alcohol; Antiemetics: Tab. Ondansetron 4 mg BD PRN

LIVER DISEASES (10)

11. HEPATITIS A (HAV)

Field	Details
Clinical Findings	Prodrome: fever, fatigue, nausea, anorexia; Jaundice, dark urine, pale stools; Tender hepatomegaly; Fecal-oral transmission; Self-limiting
Investigations	Anti-HAV IgM (acute); LFTs: AST/ALT markedly elevated; Bilirubin ↑; PT/INR; Abdominal USS
Differential Diagnosis	HBV/HCV hepatitis, alcoholic hepatitis, drug-induced hepatitis, CMV, EBV, cholecystitis
Treatment	Supportive: rest, hydration, nutrition; Avoid alcohol and hepatotoxic drugs; Hospitalize if INR >1.5, encephalopathy; Vaccination for prevention
Contraindications	Paracetamol in high doses (hepatotoxic); NSAIDs (worsen liver); Alcohol; Sedatives (may precipitate encephalopathy)
ICU Management	ALF: IV N-acetylcysteine; Lactulose for encephalopathy; FFP for coagulopathy; Liver transplant evaluation if KCC criteria met
OPD Prescription	Syrup ORS for hydration; Tab. Multivitamin OD; Syrup Lactulose 15 mL BD if mild encephalopathy; HAV vaccination post-recovery

12. HEPATITIS B (HBV)

Field	Details
Clinical Findings	Acute: jaundice, fever, arthralgia, urticaria (serum sickness-like); Chronic: often asymptomatic; Cirrhosis/HCC over time; Extrahepatic: polyarteritis nodosa, membranous GN
Investigations	HBsAg, anti-HBs, HBeAg, anti-HBe, HBcAb IgM/IgG; HBV DNA (viral load); LFTs, albumin, PT; Liver biopsy (fibrosis staging); FibroScan; AFP (HCC screening)
Differential Diagnosis	HAV, HCV, HDV co-infection, alcoholic hepatitis, autoimmune hepatitis, Wilson's disease
Treatment	Acute: supportive; Chronic (HBeAg+, DNA >2000 IU/mL, elevated ALT): Tenofovir (TDF) 300 mg OD or Entecavir 0.5 mg OD; HCC surveillance (USS + AFP 6-monthly)
Contraindications	Adefovir (nephrotoxic, inferior); Lamivudine monotherapy long-term (resistance); Immunosuppressants without HBV prophylaxis; Alcohol
ICU Management	Acute liver failure: Lactulose, rifaximin, FFP; Consider NAC; Antiviral: Tenofovir; Liver transplant listing if KCH criteria
OPD Prescription	Tab. Tenofovir 300 mg OD (with food); Monitor LFTs, HBV DNA q3–6 months; AFP + USS q6 monthly; Avoid alcohol

13. HEPATITIS C (HCV)

Field	Details
Clinical Findings	Mostly asymptomatic acute phase (80%); Chronic: fatigue, arthralgia; Extrahepatic: mixed cryoglobulinemia, lichen planus, porphyria cutanea tarda; Cirrhosis in 20–30%
Investigations	Anti-HCV antibody (screening); HCV RNA PCR (confirmatory + monitoring); HCV genotype (guides therapy); LFTs; FibroScan/biopsy; AFP; HCV NS5A/5B resistance testing
Differential Diagnosis	HBV, fatty liver disease, autoimmune hepatitis, alcoholic hepatitis
Treatment	DAAs: Sofosbuvir + Velpatasvir (pan-genotypic) × 12 wks; Sofosbuvir + Ledipasvir (genotype 1/4) × 12 wks; SVR (cure) in >95%
Contraindications	Ribavirin in renal failure; Amiodarone + Sofosbuvir (severe bradycardia); Pregnancy (Ribavirin teratogenic)
ICU Management	HCV-related ALF: supportive; Cryoglobulinemic vasculitis crisis: plasmapheresis; DAA therapy if tolerated
OPD Prescription	Tab. Sofosbuvir 400 mg + Velpatasvir 100 mg OD × 12 wks; Check HCV RNA at wk 12 (SVR12); Monitor renal function

14. ALCOHOLIC LIVER DISEASE (ALD)

Field	Details
Clinical Findings	Fatty liver: asymptomatic; Alcoholic hepatitis: jaundice, fever, tender hepatomegaly, Maddrey DF; Cirrhosis: spider nevi, palmar erythema, gynecomastia, parotid enlargement, Dupuytren's
Investigations	LFTs: AST:ALT ratio >2:1 (characteristic); GGT ↑↑; MCV ↑; Bilirubin, albumin, PT; Maddrey DF = 4.6×(PT-control) + bilirubin; Liver biopsy (Mallory-Denk bodies)
Differential Diagnosis	NASH, viral hepatitis, autoimmune hepatitis, hemochromatosis, Wilson's disease
Treatment	Abstinence (most important); Nutritional support; Alcoholic hepatitis (DF >32): Prednisolone 40 mg OD × 28 days or Pentoxifylline; Liver transplant (selected cases, 6-month sobriety)
Contraindications	Metformin in severe ALD (lactic acidosis); Paracetamol >2g/day; NSAIDs; Methotrexate
ICU Management	Severe hepatitis: IV Methylprednisolone + nutritional support; Treat encephalopathy; SBP prophylaxis; Variceal bleed protocol
OPD Prescription	Tab. Thiamine 100 mg OD; Tab. Prednisolone 40 mg OD × 4 wks (if DF>32); Tab. Folic acid 5 mg OD; Alcohol cessation counseling

15. NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD/NASH)

Field	Details
Clinical Findings	Usually asymptomatic; Fatigue, RUQ discomfort; Hepatomegaly; Associated: obesity, T2DM, dyslipidemia, metabolic syndrome; NASH → fibrosis → cirrhosis
Investigations	LFTs: ALT>AST (early); USS (echogenic liver); FibroScan (CAP + kPa); Liver biopsy (NAS score — gold standard); HOMA-IR; Lipid profile; HbA1c
Differential Diagnosis	ALD (AST:ALT >2 in ALD), drug-induced hepatitis, HCV genotype 3, thyroid disease, celiac disease
Treatment	Weight loss ≥7–10% (most effective); Exercise; Diabetes control; Pioglitazone (NASH with T2DM); Vitamin E 800 IU/day (non-diabetic NASH); Resmetirom (FDA 2024, new NASH drug)
Contraindications	Alcohol; Amiodarone, tamoxifen, methotrexate (cause steatohepatitis); Statins are NOT contraindicated
ICU Management	NASH-cirrhosis decompensation: standard cirrhosis ICU care; Albumin infusions; Treat precipitating factors
OPD Prescription	Lifestyle counseling; Tab. Vitamin E 400 IU BD (non-diabetic NASH); Tab. Pioglitazone 15–30 mg OD (diabetic NASH); Tab. Atorvastatin 10–20 mg OD (dyslipidemia)

16. LIVER CIRRHOSIS

Field	Details
Clinical Findings	Compensated: fatigue, vague abdominal discomfort; Decompensated: jaundice, ascites, splenomegaly, variceal bleeding, encephalopathy, SBP; Signs: caput medusae, spider nevi, gynecomastia, leukonychia, clubbing
Investigations	LFTs, albumin, PT/INR, CBC (thrombocytopenia); USS abdomen (nodular liver, splenomegaly, ascites); Endoscopy (varices); Child-Pugh / MELD score; Ascitic tap (SGA, culture, neutrophil count)
Differential Diagnosis	Cardiac cirrhosis (CCF), Budd-Chiari, Wilson's, hemochromatosis, schistosomiasis
Treatment	Treat underlying cause; Beta-blockers (propranolol/carvedilol) for varices; Diuretics (spironolactone + furosemide) for ascites; Lactulose for HE; Antibiotics for SBP; TIPS; Liver transplant
Contraindications	NSAIDs (↑risk AKI, SBP, bleed); Sedatives; Aminoglycosides; Direct vasodilators (nitrates in portal HTN); High-sodium diet; Opioids
ICU Management	Variceal bleed: IV terlipressin + band ligation; SBP: IV Cefotaxime 2g TDS + IV Albumin; HRS: IV albumin + terlipressin; HE: Lactulose + Rifaximin
OPD Prescription	Tab. Spironolactone 100 mg OD + Tab. Furosemide 40 mg OD; Tab. Propranolol 20–40 mg BD (varices); Syrup Lactulose 30 mL BD (HE prevention); Restrict Na <2g/day

17. ACUTE LIVER FAILURE (ALF)

Field	Details
Clinical Findings	Jaundice, coagulopathy (INR >1.5), encephalopathy in <26 wks of illness; Cerebral edema, hypoglycemia, renal failure (HRS), sepsis; Fetor hepaticus
Investigations	PT/INR, Factor V level; LFTs, glucose, ammonia; Creatinine, electrolytes; ABG; Toxicology screen; Viral serology (HAV/HBV/HSV); Paracetamol level; EEG; CT brain
Differential Diagnosis	Acute-on-chronic liver failure, Budd-Chiari, Wilson's (Kayser-Fleischer rings), HELLP syndrome, sepsis
Treatment	IV N-acetylcysteine (paracetamol + non-paracetamol ALF); Lactulose enemas; Mannitol (cerebral edema); FFP/platelets; Liver transplant (King's College Criteria)
Contraindications	Sedatives; Lactulose by mouth in ileus; Rifaximin in severe encephalopathy alone; Aminoglycosides
ICU Management	Airway protection (Grade III/IV HE); ICP monitoring; Head elevation 30°; IV Mannitol 0.5–1 g/kg; IV NAC; FFP; Vasopressors if hemodynamically unstable; Renal replacement therapy; HVHF
OPD Prescription	Post-transplant: Tacrolimus + MMF; Tab. Prednisolone taper; Liver function monitoring weekly

18. PRIMARY BILIARY CHOLANGITIS (PBC)

Field	Details
Clinical Findings	Pruritus (earliest symptom), fatigue; Jaundice (late); Xanthelasma, xanthoma; Hepatosplenomegaly; Osteoporosis; Associated with Sjögren's, thyroid disease, scleroderma
Investigations	ALP ↑↑, GGT ↑; AMA (anti-mitochondrial antibody) M2 >95% sensitivity; ANA (AMA-negative PBC); Liver biopsy (florid duct lesion); IgM ↑
Differential Diagnosis	PSC, drug-induced cholestasis, autoimmune hepatitis, sarcoidosis, intrahepatic cholestasis
Treatment	Ursodeoxycholic acid (UDCA) 13–15 mg/kg/day (slows progression); Obeticholic acid (2nd line); Cholestyramine for pruritus; Treat osteoporosis; Liver transplant (end-stage)
Contraindications	Fat-soluble vitamin malabsorption (requires supplementation); Cholestyramine + other medications simultaneously (chelation — give 2h apart)
ICU Management	End-stage liver failure: as cirrhosis ICU care; Fat-soluble vitamin IV supplementation
OPD Prescription	Tab. UDCA 500 mg BD (based on weight); Tab. Cholestyramine 4 g OD-BD for pruritus; Tab. Calcium 1g + Vit D 800 IU OD; Liver transplant referral

19. AUTOIMMUNE HEPATITIS (AIH)

Field	Details
Clinical Findings	Young female predominance; Acute or chronic hepatitis; Amenorrhea, acne; Arthralgia; Spider nevi; Extrahepatic: autoimmune thyroiditis, IBD, celiac disease
Investigations	ANA, SMA (smooth muscle antibody), anti-LKM1; Serum IgG ↑↑; LFTs (hepatocellular pattern); Liver biopsy (interface hepatitis, rosette formation, plasma cell infiltrate); AIH score
Differential Diagnosis	Viral hepatitis, DILI, Wilson's, AIH-PBC overlap, NASH
Treatment	Prednisolone 40–60 mg/day (induction) + Azathioprine 1–2 mg/kg/day (maintenance); Budesonide (less SE); Mycophenolate (azathioprine-intolerant); Liver transplant
Contraindications	Azathioprine in TPMT deficiency (severe myelosuppression); Azathioprine in pregnancy (teratogenic — use 6-MP instead); Stopping immunosuppression abruptly
ICU Management	AIH-ALF: IV methylprednisolone 60 mg/day; If no response in 7 days: transplant listing; Treat infections
OPD Prescription	Tab. Prednisolone 20 mg OD (maintenance); Tab. Azathioprine 50 mg OD; Monitor CBC, LFTs monthly; DEXA scan (steroid osteoporosis)

20. HEPATOCELLULAR CARCINOMA (HCC)

Field	Details
Clinical Findings	RUQ pain, weight loss, anorexia; Hepatomegaly (hard, nodular); Jaundice (late); Paraneoplastic: hypoglycemia, erythrocytosis, hypercalcemia; Budd-Chiari (portal vein thrombosis)
Investigations	AFP >400 ng/mL (specific); Dynamic CT/MRI (arterial enhancement + washout); Liver biopsy (not always needed); USS screening (AFP + USS q6 monthly in cirrhosis); Child-Pugh; MELD
Differential Diagnosis	Metastatic liver disease, cholangiocarcinoma, hepatic abscess, hemangioma, FNH
Treatment	BCLC staging: Very early/early (A): Resection or ablation; Intermediate (B): TACE; Advanced (C): Sorafenib/Lenvatinib; Terminal (D): palliative; Liver transplant (Milan criteria)
Contraindications	Sorafenib in Child-Pugh C; TACE in portal vein thrombosis (main trunk); Resection if inadequate FLR
ICU Management	Post-surgical: hemorrhage control; Liver failure post-resection: NAC, nutrition; TACE postembolization syndrome: analgesia, antiemetics, hydration
OPD Prescription	Tab. Sorafenib 400 mg BD (advanced HCC); AFP monitoring monthly; Nutritional support; Palliative care referral (terminal)

INTESTINAL DISEASES (10)

21. CROHN'S DISEASE

Field	Details
Clinical Findings	Abdominal pain (RIF — terminal ileum commonest), diarrhea (non-bloody), weight loss; Skip lesions; Perianal disease (fistula, abscess); Extraintestinal: uveitis, arthritis, erythema nodosum, pyoderma gangrenosum; Cobblestone appearance
Investigations	Colonoscopy + biopsy (transmural inflammation, non-caseating granulomas); MRI enterography (small bowel); CRP, ESR, fecal calprotectin; CBC, B12, folate, iron; CXR (fistula)
Differential Diagnosis	UC, TB ileitis, NSAID enteropathy, Yersinia ileitis, lymphoma, appendicitis
Treatment	Induction: Prednisolone 40 mg/day (taper) or Budesonide (ileocecal); Maintenance: Azathioprine/6-MP; Biologics: Infliximab, Adalimumab (moderate-severe); Vedolizumab (steroid-refractory); Surgery: strictureplasty/resection
Contraindications	Live vaccines in immunosuppressed; Infliximab in active TB/sepsis; NSAIDs (worsen); Long-term steroids (bone loss); Cholestyramine malabsorption
ICU Management	Toxic megacolon: NPO, IV steroids, IV antibiotics, NG suction; Emergency colectomy if no improvement in 72h; Perforation: emergency surgery + antibiotics
OPD Prescription	Tab. Azathioprine 2 mg/kg OD (maintenance); Tab. Prednisolone 40 mg OD (taper over 8 wks); Tab. Folic acid 5 mg OD; Tab. Vit D + Ca; Infliximab infusion 5 mg/kg (0, 2, 6 wks, then q8 wks)

22. ULCERATIVE COLITIS (UC)

Field	Details
Clinical Findings	Bloody diarrhea, mucus, tenesmus; Continuous inflammation from rectum proximally; Extraintestinal: PSC, uveitis, ankylosing spondylitis; Toxic megacolon (severe)
Investigations	Colonoscopy (continuous mucosal inflammation, loss of haustra); Biopsy (crypt abscesses, goblet cell depletion); Stool culture (exclude infective); CRP, fecal calprotectin; AXR (toxic megacolon — >6 cm colon); ANCA positive
Differential Diagnosis	Crohn's disease, infective colitis (C. diff, Salmonella, Shigella), ischemic colitis, radiation colitis
Treatment	Mild-moderate: Mesalazine (5-ASA) oral + rectal; Severe: IV hydrocortisone 100 mg QDS; Rescue: IV Ciclosporin or IV Infliximab; Refractory/dysplasia: Total colectomy
Contraindications	Opioids + antidiarrheals in severe colitis (↑toxic megacolon risk); NSAIDs; Live vaccines; Sulfasalazine in sulfa allergy; 5-ASA in aspirin allergy
ICU Management	Severe attack: IV Hydrocortisone 100 mg QDS; IV fluids + electrolytes; VTE prophylaxis; Stool chart; Abdo X-ray daily; Surgical review if no improvement day 3 (Ciclosporin rescue)
OPD Prescription	Tab. Mesalazine 800 mg TDS (active); Mesalazine 1g suppository nocte (proctitis); Tab. Azathioprine 2 mg/kg OD (maintenance); Iron supplementation if anemic

23. IRRITABLE BOWEL SYNDROME (IBS)

Field	Details
Clinical Findings	Chronic abdominal pain related to defecation; Altered bowel habits (IBS-C, IBS-D, IBS-M); Bloating, flatulence; No alarm features; Rome IV criteria
Investigations	Diagnosis of exclusion; Colonoscopy (if >40 y/alarm features); CRP, CBC (normal); Celiac serology (anti-tTG IgA); Thyroid function; Stool: C. diff, cultures
Differential Diagnosis	IBD, celiac disease, microscopic colitis, colorectal cancer, ovarian pathology, carcinoid
Treatment	Dietary: low-FODMAP diet; IBS-D: Loperamide, Rifaximin, Eluxadoline; IBS-C: Linaclotide, Lubiprostone, PEG laxatives; Antispasmodics (Mebeverine, Hyoscine); Amitriptyline low-dose; CBT
Contraindications	Antidiarrheals in IBS-C; Opioids (opioid-induced constipation); Long-term antibiotics (dysbiosis)
ICU Management	Never requires ICU for IBS alone; Exclude alternative diagnoses
OPD Prescription	Tab. Mebeverine 135 mg TDS AC (antispasmodic); Tab. Loperamide 2 mg PRN (IBS-D); Tab. Movicol 1 sachet OD (IBS-C); Tab. Amitriptyline 10 mg nocte (refractory); Low-FODMAP diet counseling

24. COLORECTAL CANCER (CRC)

Field	Details
Clinical Findings	Change in bowel habit, rectal bleeding, tenesmus; Iron-deficiency anemia (right-sided); Palpable mass; Obstruction/perforation; Weight loss; Hepatomegaly (metastases)
Investigations	Colonoscopy + biopsy (gold standard); CT chest/abdomen/pelvis (staging); CEA; MRI rectum (T staging, CRM); PET scan; KRAS/BRAF mutation; Lynch syndrome MSI testing
Differential Diagnosis	IBD, diverticular disease, hemorrhoids, polyps, ischemic colitis, anal carcinoma
Treatment	Localized: surgical resection (right/left hemicolectomy, anterior resection, APR); Stage III: adjuvant FOLFOX; Stage IV: FOLFOX/FOLFIRI ± Bevacizumab or Cetuximab (KRAS WT); Radiotherapy for rectal cancer (neoadjuvant)
Contraindications	Cetuximab in KRAS-mutant tumors (no benefit); Bevacizumab perioperatively (impaired wound healing); NSAIDs (beneficial for prevention but contraindicated post-op bleed risk)
ICU Management	Obstruction: IV fluids, Hartmann's procedure vs. stenting; Perforation: emergency surgery + IV antibiotics; Post-op anastomotic leak: re-operation or CT-guided drainage
OPD Prescription	Oncology follow-up; CEA q3 months; Tab. Aspirin 100 mg OD (secondary prevention evidence); Nutritional support; Stoma care if applicable

25. INTESTINAL OBSTRUCTION (SMALL BOWEL)

Field	Details
Clinical Findings	Colicky central abdominal pain; Vomiting (bilious early); Absolute constipation (late); Abdominal distension; Hyperactive then absent bowel sounds; Tachycardia (dehydration)
Investigations	AXR (dilated loops, air-fluid levels, no gas in colon); CT abdomen (gold standard — identifies cause and strangulation); Erect CXR (perforation); FBC, electrolytes, amylase, lactate
Differential Diagnosis	Large bowel obstruction, paralytic ileus, mesenteric ischemia, volvulus, intussusception
Treatment	Conservative (partial/non-strangulated): IV fluids, NGT decompression, catheter (drip and suck); Surgical (complete/strangulated/closed-loop): exploratory laparotomy, adhesiolysis/resection
Contraindications	Oral feeding before decompression; Morphine masking strangulation signs; Laxatives in complete obstruction
ICU Management	Strangulated obstruction: urgent surgery + IV broad-spectrum antibiotics (Pip-Tazo); Fluid resuscitation; Correct electrolytes; Monitor lactate
OPD Prescription	Post-surgery: liquid then soft diet; Adhesion prevention counseling; Refer to surgeon if recurrent SBO

26. CELIAC DISEASE

Field	Details
Clinical Findings	Chronic diarrhea (steatorrhea), bloating, weight loss; Anemia (iron/B12/folate); Dermatitis herpetiformis; Aphthous ulcers; Failure to thrive (children); Osteoporosis; Ataxia (gluten ataxia); Hepatitis
Investigations	Anti-tTG IgA (screening); Total IgA level (exclude IgA deficiency); Anti-DGP IgG (IgA deficient); Small bowel biopsy via endoscopy (Marsh III — villous atrophy, crypt hyperplasia); HLA-DQ2/DQ8 (exclusion)
Differential Diagnosis	IBD, tropical sprue, SIBO, Whipple's disease, common variable immunodeficiency, lactose intolerance
Treatment	Strict lifelong gluten-free diet (GFD); Nutritional supplementation (iron, B12, folate, Ca, Vit D); Refractory celiac: budesonide/azathioprine; Dermatitis herpetiformis: dapsone
Contraindications	Any gluten-containing food; Oats (unless certified GF); Dapsone in G6PD deficiency; Steroids long-term without bone protection
ICU Management	Celiac crisis (refractory diarrhea, dehydration, electrolyte imbalance): IV fluids, electrolytes, IV methylprednisolone 40 mg/day, PN
OPD Prescription	Strict GFD (dietitian referral); Tab. Ferrous Sulfate 200 mg BD; Tab. Folic acid 5 mg OD; Tab. Calcium + Vit D OD; Anti-tTG repeat at 6–12 months

27. APPENDICITIS

Field	Details
Clinical Findings	Central abdominal pain migrating to RIF; Anorexia, nausea, vomiting; Low-grade fever; Rebound tenderness (McBurney's point); Rovsing's, Psoas, Obturator signs; Alvarado score
Investigations	FBC (leukocytosis with neutrophilia); CRP ↑; USS abdomen (non-compressible appendix >6mm); CT abdomen (gold standard, sensitivity >95%); β-hCG (exclude ectopic)
Differential Diagnosis	Ovarian cyst/torsion, ectopic pregnancy, mesenteric adenitis, Meckel's diverticulitis, Crohn's disease, ureteric colic
Treatment	Uncomplicated: Appendicectomy (laparoscopic gold standard); Antibiotics alone (selected cases — APPAC trial); Perforated/gangrenous: open appendicectomy + antibiotics
Contraindications	Laxatives/enemas (perforation risk); Delayed surgery in perforated appendix
ICU Management	Perforated appendix with septic shock: IV Pip-Tazo 4.5g TDS + IV Metronidazole; Resuscitation; Emergency surgery; Drain perforation collection
OPD Prescription	Post-appendicectomy: Wound care; Tab. Co-amoxiclav 625 mg TDS × 5 days; Follow-up 1 week; Histology review (exclude carcinoid)

28. INTESTINAL TUBERCULOSIS

Field	Details
Clinical Findings	Subacute pain (RIF), diarrhea alternating with constipation; Night sweats, weight loss, fever; Palpable RIF mass; Ascites; Chest findings; Ileocecal involvement commonest
Investigations	Colonoscopy + biopsy (caseating granulomas, AFB); CT abdomen (ileocecal thickening, mesenteric lymphadenopathy, ascites); Mantoux/IGRA; Stool AFB; ADA in ascitic fluid; CXR; Laparoscopy + peritoneal biopsy
Differential Diagnosis	Crohn's disease, amebiasis, lymphoma, actinomycosis, Yersinia, carcinoma ileocecal
Treatment	2HRZE/4HR (standard ATT: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol × 2 months, then 4 months HR); Steroids for peritonitis; Nutritional support
Contraindications	Antidiarrheals before diagnosis confirmed; Rifampicin + oral contraceptives (interaction); Ethambutol in optic neuritis
ICU Management	Obstruction: conservative vs. surgery; Perforation: emergency surgery + ATT; Treat with anti-TB regardless of surgery
OPD Prescription	INH 300 mg OD + Rifampicin 600 mg OD + Pyrazinamide 1500 mg OD + Ethambutol 800 mg OD (intensive phase 2 months); Tab. Pyridoxine 25 mg OD (prevent INH neuropathy)

29. DIVERTICULAR DISEASE / DIVERTICULITIS

Field	Details
Clinical Findings	Diverticulosis: often asymptomatic; LIF pain; Diverticulitis: fever, LIF pain, tenderness, rigidity; Complications: abscess, fistula, obstruction, perforation, lower GI bleed
Investigations	CT abdomen (Hinchey staging); AXR; FBC (leukocytosis); CRP; Colonoscopy after resolution (exclude cancer)
Differential Diagnosis	Colorectal cancer, IBD, IBS, ischemic colitis, pelvic inflammatory disease, ovarian pathology
Treatment	Uncomplicated: bowel rest, oral antibiotics (Co-amoxiclav + Metronidazole); Hinchey I/II: IV antibiotics ± CT-guided drainage; Hinchey III/IV: emergency sigmoid resection (Hartmann's)
Contraindications	High-fiber diet during acute attack; NSAIDs (worsen); Colonoscopy in acute phase (perforation risk)
ICU Management	Perforated diverticulitis with peritonitis: emergency laparotomy; IV Pip-Tazo + Metronidazole; Vasopressors if septic shock
OPD Prescription	Tab. Co-amoxiclav 625 mg TDS × 7 days; Tab. Metronidazole 400 mg TDS × 7 days; High-fiber diet after recovery; Tab. Mesalazine 1.5g OD (prevent recurrence — some evidence)

30. ISCHEMIC COLITIS

Field	Details
Clinical Findings	Sudden LIF or diffuse abdominal pain; Hematochezia (bright red blood); Nausea; Older patient; Risk factors: atherosclerosis, AF, low cardiac output states, post-AAA repair
Investigations	AXR (thumbprinting — submucosal edema); CT abdomen (bowel wall thickening, pneumatosis); Colonoscopy + biopsy (within 48h — hemorrhagic mucosa); Lactate; FBC, coagulation; Mesenteric angiography
Differential Diagnosis	Infective colitis, IBD, CRC, diverticulitis, mesenteric ischemia
Treatment	Mild-moderate: bowel rest, IV fluids, antibiotics (reduce bacterial translocation); Severe/gangrenous: segmental colectomy; Treat underlying cause (AF anticoagulation)
Contraindications	Vasoconstrictors (worsen ischemia); NSAIDs; Anticholinergics; Constipating drugs
ICU Management	Transmural necrosis: emergency surgery; IV broad-spectrum antibiotics; Vasopressor support; Optimize cardiac output; Correct dehydration
OPD Prescription	Tab. Aspirin 75 mg OD + statin (atherosclerosis); Anticoagulation (if AF); Dietary fiber; Colonoscopy follow-up at 1 month

GALLBLADDER DISEASES (10)

31. ACUTE CHOLECYSTITIS

Field	Details
Clinical Findings	RUQ pain radiating to right shoulder; Fever, nausea, vomiting; Murphy's sign positive; Tenderness RUQ; Mild jaundice (10%); Boas' sign
Investigations	USS (gallstones, GB wall thickening >4mm, pericholecystic fluid, Murphy USS sign); FBC (leukocytosis); LFTs; CRP; HIDA scan (gold standard for acalculous); CT abdomen (complications)
Differential Diagnosis	Biliary colic, choledocholithiasis, ascending cholangitis, hepatitis, RLL pneumonia, peptic ulcer, pancreatitis
Treatment	IV antibiotics (Cefuroxime + Metronidazole or Pip-Tazo); IV fluids; Analgesia; Early laparoscopic cholecystectomy (within 72h preferred — Tokyo guidelines); Percutaneous cholecystostomy (high risk)
Contraindications	Morphine (historically avoided — Oddi spasm, though controversial); Elective cholecystectomy with stones without symptoms (watch and wait)
ICU Management	Gangrenous/emphysematous cholecystitis: emergency cholecystectomy + IV broad-spectrum antibiotics; Septic shock resuscitation; Percutaneous drain if high surgical risk
OPD Prescription	Tab. Co-amoxiclav 625 mg TDS × 7 days (discharge); Tab. Diclofenac 50 mg TDS PRN pain; Surgical referral for cholecystectomy within 6 weeks; Low-fat diet

32. CHRONIC CHOLECYSTITIS

Field	Details
Clinical Findings	Recurrent RUQ pain/biliary colic after fatty meals; Nausea; Flatulence (fatty food intolerance); No fever (differentiates from acute); Gallstones on imaging
Investigations	USS abdomen (gallstones — cholelithiasis, contracted thickened GB); HIDA scan (GB ejection fraction <35%); LFTs (usually normal); CT if USS inconclusive
Differential Diagnosis	Acute cholecystitis, biliary dyskinesia, choledocholithiasis, GERD, IBS, PUD, hepatitis
Treatment	Laparoscopic cholecystectomy (definitive); UDCA (dissolution therapy — selected patients refusing surgery); Low-fat diet
Contraindications	Morphine (Oddi spasm); NSAIDs long-term (GI bleed); Conservative management with stones + symptoms (recurrence/complication risk)
ICU Management	Not typically ICU; Mirizzi syndrome complication: biliary reconstruction surgery
OPD Prescription	Surgical referral (laparoscopic cholecystectomy); Tab. UDCA 8–10 mg/kg/day (if surgery refused, radiolucent stones <10mm); Tab. Hyoscine butylbromide 10 mg TDS PRN (colic); Low-fat diet

33. CHOLEDOCHOLITHIASIS (CBD STONES)

Field	Details
Clinical Findings	RUQ pain, jaundice, dark urine, pale stools; Intermittent fever; Charcot's triad (pain + fever + jaundice) suggests ascending cholangitis; Tender hepatomegaly
Investigations	LFTs (obstructive pattern — ALP↑, GGT↑, direct bilirubin↑); USS (CBD dilation >6mm); MRCP (gold standard, non-invasive); ERCP (diagnostic + therapeutic); EUS
Differential Diagnosis	Cholangiocarcinoma, pancreatic head cancer, PSC, acute cholecystitis, viral hepatitis, Mirizzi syndrome
Treatment	ERCP + sphincterotomy + stone extraction (first-line); Laparoscopic CBD exploration; Cholecystectomy after stone clearance
Contraindications	ERCP without IV antibiotics (cholangitis risk); ERCP in coagulopathy without correction; MRI contrast in severe renal failure
ICU Management	Ascending cholangitis/septic shock: IV Pip-Tazo 4.5g TDS; ERCP within 24h; Biliary drainage if ERCP fails (PTC or surgical); Vasopressors if septic
OPD Prescription	ERCP scheduling; Tab. Ciprofloxacin 500 mg BD × 5 days post-ERCP; Surgical referral for cholecystectomy; LFT follow-up

34. ASCENDING CHOLANGITIS (ACUTE BACTERIAL CHOLANGITIS)

Field	Details
Clinical Findings	Charcot's triad: RUQ pain + fever/rigors + jaundice; Reynolds pentad (+ shock + confusion = severe); Gram-negative sepsis; E. coli, Klebsiella, Enterococcus
Investigations	FBC (leukocytosis), blood cultures (×2); LFTs (cholestatic); USS/CT (CBD dilation, stones, pneumobilia); MRCP/ERCP; Coagulation; Lactate
Differential Diagnosis	Acute cholecystitis, hepatic abscess, pancreatitis, hepatitis, right basal pneumonia
Treatment	IV antibiotics: Pip-Tazo 4.5g TDS or Ceftriaxone 2g OD + Metronidazole 500 mg TDS; Biliary drainage (ERCP/PTCD within 24–48h for severe, 72h for mild); Supportive
Contraindications	Delayed biliary decompression (mortality ↑); Oral antibiotics alone in severe cholangitis; ERCP without airway protection if altered consciousness
ICU Management	Reynolds pentad = ICU; IV resuscitation, vasopressors; Urgent ERCP drainage + sphincterotomy; Broad-spectrum antibiotics; Monitor lactate, UO, coagulation
OPD Prescription	Complete IV antibiotics; ERCP + CBD stone clearance; Elective cholecystectomy; LFT monitoring

35. PRIMARY SCLEROSING CHOLANGITIS (PSC)

Field	Details
Clinical Findings	Pruritus, jaundice, fatigue, RUQ pain; Often young male; Associated UC (75%); Progressive cholestasis; Risk of cholangiocarcinoma (1.5%/year); "Beads on a string" cholangiogram
Investigations	ALP↑↑ (>3× normal), GGT↑; pANCA positive; MRCP (multifocal strictures, beading); Liver biopsy (periductal fibrosis — "onion skin"); Colonoscopy (associated UC); CA 19-9 (cholangiocarcinoma screening); Annual MRCP + CA 19-9
Differential Diagnosis	PBC, secondary sclerosing cholangitis (stones/surgery), cholangiocarcinoma, IgG4-related disease, AIH-PSC overlap
Treatment	No proven medical therapy (UDCA not recommended at high dose); Endoscopic dilation of dominant strictures (ERCP); Liver transplant (best option); Antibiotics for cholangitis episodes; Surveillance CCA
Contraindications	UDCA >28 mg/kg/day in PSC (↑risk of complications in trials); Immunosuppressants alone (accelerate fibrosis); ERCP without antibiotic cover
ICU Management	Acute cholangitis: IV antibiotics + biliary drainage (ERCP); End-stage liver failure: cirrhosis ICU care
OPD Prescription	Ursodeoxycholic acid 13 mg/kg/day (low dose for pruritus); Tab. Cholestyramine for pruritus; Annual MRCP + CA 19-9; Colonoscopy annually (IBD surveillance); Liver transplant referral

36. GALLBLADDER CARCINOMA

Field	Details
Clinical Findings	Often found incidentally at cholecystectomy; RUQ pain, jaundice, weight loss; Palpable GB (Courvoisier's sign); Porcelain gallbladder (risk factor); More common in women, Andes region, porcelain GB, cholelithiasis
Investigations	USS (GB mass, loss of wall differentiation); CT/MRI (staging — Nevin/AJCC); ERCP/MRCP; CA 19-9, CEA; Cholecystectomy specimen histology
Differential Diagnosis	Cholecystitis, cholangiocarcinoma, metastatic liver disease, hepatocellular carcinoma
Treatment	T1a: simple cholecystectomy (curative); T1b–T2: extended cholecystectomy + liver resection (segments IVb/V) + lymphadenectomy; T3–T4: palliative (gemcitabine + cisplatin); Biliary stent for obstruction
Contraindications	Laparoscopic cholecystectomy in suspected carcinoma (port-site seeding); Bile spillage; Delay in diagnosis
ICU Management	Post-hepatectomy: liver failure monitoring; Biliary leak: drainage; Sepsis management
OPD Prescription	Oncology follow-up; Gemcitabine + Cisplatin (palliative); Biliary stent care; Nutritional support

37. BILIARY COLIC

Field	Details
Clinical Findings	Episodic severe RUQ/epigastric pain, typically after fatty meals; Radiates to right shoulder/scapula; Duration 15 min–6 h (differentiates from cholecystitis); No fever; Nausea/vomiting; Tenderness RUQ
Investigations	USS abdomen (gallstones — diagnostic); LFTs (normal in pure biliary colic); FBC (normal); If CBD dilation: MRCP
Differential Diagnosis	Acute cholecystitis, choledocholithiasis, pancreatitis, GERD, PUD, hepatitis, IBS
Treatment	Acute: analgesia (Diclofenac IM or NSAID), antispasmodics; Definitive: laparoscopic cholecystectomy; UDCA (dissolution) if surgery refused
Contraindications	Opioids causing Oddi spasm (pethidine preferred over morphine); Delayed surgery (risk of complications)
ICU Management	Not an ICU condition; Manage pain in ED
OPD Prescription	Tab. Diclofenac 50 mg TDS PRN; Tab. Hyoscine butylbromide 10 mg TDS; Surgical referral for elective laparoscopic cholecystectomy; Low-fat diet advice

38. ACUTE PANCREATITIS (associated with gallstones)

Field	Details
Clinical Findings	Severe epigastric pain radiating to back; Nausea, vomiting; Fever; Tender epigastrium; Guarding; Cullen's sign (periumbilical bruising), Grey-Turner's sign (flanks) — hemorrhagic; Tachycardia
Investigations	Serum amylase/lipase (>3× ULN); LFTs (gallstone pancreatitis: ALP↑, bilirubin↑); USS (gallstones, CBD dilation); CT abdomen with contrast (Balthazar score/CTSI) at 48–72h; FBC, CRP, Ca2+, glucose; MRCP; ABG
Differential Diagnosis	Perforated PUD, mesenteric ischemia, aortic dissection, cholecystitis, intestinal obstruction, MI
Treatment	Aggressive IV fluid resuscitation (Ringer's lactate 250–500 mL/h); Early enteral nutrition (nasojejunal > TPN); Analgesia (IV morphine); IV antibiotics only if infected necrosis (Meropenem); ERCP (gallstone pancreatitis + cholangitis); Cholecystectomy (same admission or 4–6 wks)
Contraindications	Prophylactic antibiotics (not beneficial); TPN first-line (enteral preferred); ERCP in mild gallstone pancreatitis without cholangitis; Delayed cholecystectomy (increases recurrence)
ICU Management	Severe (APACHE II ≥8 or CTSI ≥6): ICU; Aggressive fluid resuscitation; Vasopressors; Respiratory support; Dialysis; Infected necrosis: IV Meropenem; Endoscopic/surgical necrosectomy
OPD Prescription	Low-fat diet; Alcohol cessation; Tab. Pancreatin (if exocrine insufficiency post-pancreatitis); Follow-up USS to confirm stone clearance; HbA1c (endocrine insufficiency)

39. GALLSTONE ILEUS

Field	Details
Clinical Findings	Intermittent bowel obstruction in elderly female; Rigler's triad: pneumobilia + SBO + ectopic gallstone on AXR; Tumbling obstruction; Dehydration; Previous biliary symptoms
Investigations	AXR (Rigler's triad — pneumobilia, SBO, ectopic stone); CT abdomen (confirmatory, locates stone); FBC, electrolytes, amylase, lactate
Differential Diagnosis	Adhesive SBO, hernia, Crohn's obstruction, intussusception, malignant obstruction
Treatment	IV fluids; NGT decompression; Emergency laparotomy: enterolithotomy (remove stone) + optional cholecystectomy + fistula closure (one-stage if fit); Two-stage if high risk
Contraindications	Conservative management without surgery (stone will not pass); Delayed surgery (bowel strangulation)
ICU Management	Pre-op resuscitation: IV fluids + electrolytes; Post-op monitoring; Antibiotics (enteric organisms); Elderly high-risk: ICU monitoring
OPD Prescription	Post-surgery: wound care; Antibiotics × 7 days; Planned cholecystectomy + fistula closure (if not done); LFT follow-up

40. CHOLANGIOCARCINOMA

Field	Details
Clinical Findings	Progressive painless jaundice; Pruritus; Weight loss; RUQ pain (late); Dark urine, pale stools; Palpable GB (if distal — Courvoisier's sign); Associated with PSC, liver flukes (Clonorchis), choledochal cysts
Investigations	LFTs (obstructive pattern); CA 19-9 ↑ (sensitivity 79%), CEA; MRCP (stricture, mass); EUS + biopsy; CT staging; PET scan; ERCP (brush cytology, FISH); Cholangioscopy with biopsy (SpyGlass)
Differential Diagnosis	PSC, gallbladder carcinoma, pancreatic head cancer, Mirizzi syndrome, benign biliary stricture, IgG4-related cholangiopathy
Treatment	Resectable: surgical resection (hilar — extended hepatectomy; distal — Whipple's/pancreaticoduodenectomy); Adjuvant capecitabine; Unresectable: Gemcitabine + Cisplatin ± Durvalumab (1st line); ERCP stenting for palliation
Contraindications	Surgery in M1 disease; ERCP without antibiotic cover (cholangitis); Delay in biliary decompression
ICU Management	Post-Whipple: monitoring of anastomotic leak, pancreatic fistula, hemorrhage; Biliary sepsis: IV antibiotics + drainage
OPD Prescription	Gemcitabine + Cisplatin (cycle q3wks) if unresectable; ERCP stent change q3 months; CA 19-9 monitoring; Nutritional support (pancreatin post-Whipple)

QUICK REFERENCE SUMMARY TABLE

#	Disease	Key Investigation	First-Line Treatment	Key Contraindication
1	Peptic Ulcer Disease	Endoscopy / H. pylori UBT	Triple therapy + PPI	NSAIDs
2	GERD	24-h pH impedance	PPI + lifestyle	CCBs, prolonged metoclopramide
3	Acute Gastritis	Endoscopy	IV PPI, remove cause	NSAIDs, alcohol
4	Chronic Gastritis	Endoscopy + biopsy	H. pylori eradication / B12	Long-term PPI without indication
5	Gastroparesis	Gastric scintigraphy	Metoclopramide	Opioids, GLP-1 agonists
6	Gastric Cancer	Endoscopy + biopsy + CT	Surgery ± FLOT chemo	Surgery in M1
7	ZES	Fasting serum gastrin	High-dose PPI + surgery	Standard-dose PPI
8	Gastric Outlet Obstruction	CT abdomen	NGT + IV fluids → surgery	Oral feeding before decompression
9	Stress Ulcer	Endoscopy (erosions)	IV PPI prophylaxis	Sucralfate + feeds together
10	Mallory-Weiss Tear	Upper endoscopy	Supportive + PPI	Aggressive NGT insertion
11	Hepatitis A	Anti-HAV IgM	Supportive	Paracetamol, NSAIDs
12	Hepatitis B	HBsAg + HBV DNA	Tenofovir / Entecavir	Immunosuppressants without cover
13	Hepatitis C	HCV RNA PCR	Sofosbuvir + Velpatasvir	Ribavirin in renal failure
14	Alcoholic Liver Disease	AST:ALT >2:1	Abstinence + Prednisolone	Metformin in severe ALD
15	NAFLD/NASH	FibroScan + liver biopsy	Weight loss + Vit E / Pioglitazone	Alcohol, amiodarone
16	Liver Cirrhosis	Child-Pugh / MELD + USS	Diuretics + beta-blockers	NSAIDs, aminoglycosides
17	Acute Liver Failure	PT/INR + ammonia	NAC + ICU + transplant	Sedatives
18	Primary Biliary Cholangitis	AMA M2	UDCA 13–15 mg/kg	Cholestyramine + other drugs same time
19	Autoimmune Hepatitis	ANA/SMA + liver biopsy	Prednisolone + Azathioprine	Azathioprine in TPMT deficiency
20	Hepatocellular Carcinoma	AFP + dynamic CT/MRI	Resection / ablation / Sorafenib	Sorafenib in Child-Pugh C
21	Crohn's Disease	Colonoscopy + MRI enterography	Steroids + azathioprine + biologics	Live vaccines, NSAIDs
22	Ulcerative Colitis	Colonoscopy + biopsy	5-ASA / IV hydrocortisone	Opioids + antidiarrheals in severe colitis
23	IBS	Diagnosis of exclusion	Low-FODMAP + Mebeverine	Long-term antibiotics
24	Colorectal Cancer	Colonoscopy + CT staging	Surgery + FOLFOX	Cetuximab in KRAS-mutant
25	Small Bowel Obstruction	CT abdomen	NGT decompression vs. surgery	Oral feeds before decompression
26	Celiac Disease	Anti-tTG IgA + biopsy	Gluten-free diet	Any gluten; dapsone in G6PD deficiency
27	Appendicitis	USS / CT abdomen	Appendicectomy	Laxatives/enemas
28	Intestinal TB	Colonoscopy + biopsy + IGRA	2HRZE/4HR	Rifampicin + OCP together
29	Diverticulitis	CT abdomen	IV antibiotics ± drainage/surgery	NSAIDs, high-fiber in acute phase
30	Ischemic Colitis	CT + colonoscopy	IV fluids + antibiotics ± surgery	Vasoconstrictors
31	Acute Cholecystitis	USS + FBC	IV antibiotics + laparoscopic cholecystectomy	Delayed surgery
32	Chronic Cholecystitis	USS abdomen	Laparoscopic cholecystectomy	NSAIDs long-term
33	Choledocholithiasis	MRCP / ERCP	ERCP + sphincterotomy + stone extraction	ERCP without antibiotics
34	Ascending Cholangitis	Blood cultures + MRCP	IV antibiotics + urgent ERCP drainage	Delayed biliary decompression
35	Primary Sclerosing Cholangitis	MRCP + ALP + pANCA	ERCP dilation + liver transplant	UDCA high-dose
36	GB Carcinoma	CT/MRI + histology	Extended cholecystectomy / gemcitabine-cisplatin	Laparoscopic approach in suspected cancer
37	Biliary Colic	USS abdomen	NSAIDs + cholecystectomy	Delayed surgery
38	Acute Pancreatitis	Lipase/amylase + CT (48–72h)	IV fluids + enteral nutrition + analgesia	Prophylactic antibiotics
39	Gallstone Ileus	AXR (Rigler's triad) + CT	Emergency enterolithotomy	Conservative management alone
40	Cholangiocarcinoma	CA 19-9 + MRCP + EUS biopsy	Surgical resection / Gem-Cis	ERCP without antibiotics

ICU MANAGEMENT OVERVIEW — HIGH YIELD

Condition	Key ICU Actions
Bleeding PUD	IV PPI bolus 80 mg → 8 mg/h; urgent endoscopy; transfuse Hb <7
Acute Liver Failure	IV NAC; ICP monitoring; mannitol; FFP; lactulose; vasopressors; transplant
Severe Cholangitis (Reynolds pentad)	IV Pip-Tazo; urgent ERCP drainage; vasopressors; ICU monitoring
Toxic Megacolon (UC/Crohn's)	NPO; IV steroids; IV antibiotics; NG suction; surgery if no response 72h
Severe Acute Pancreatitis	Aggressive IV RL fluids; nasojejunal nutrition; Meropenem (infected necrosis); necrosectomy
Hepatic Encephalopathy	Lactulose 30–60 mL/h until 2–4 loose stools; Rifaximin 550 mg BD; treat precipitants
Variceal Bleed (Cirrhosis)	IV Terlipressin 2 mg QDS; band ligation; Ceftriaxone 1g/day; TIPS if refractory
SBP	IV Cefotaxime 2g TDS + IV Albumin 1.5 g/kg Day 1, 1 g/kg Day 3

STANDARD OPD PRESCRIPTION FORMAT

Rx — Sample (Peptic Ulcer Disease / H. pylori)

1. Tab. Omeprazole 20 mg    — 1-0-0 (AC)         × 4 weeks
2. Tab. Clarithromycin 500 mg — 1-0-1              × 14 days
3. Tab. Amoxicillin 500 mg  — 1-0-1               × 14 days
4. Antacid gel 10 mL        — After meals + HS     PRN
   D/A: Avoid NSAIDs, alcohol, spicy food
   Review in 4 weeks; UBT after 4 weeks off PPI

Rx — Sample (Liver Cirrhosis — Compensated)

1. Tab. Spironolactone 100 mg — 1-0-0              Daily
2. Tab. Furosemide 40 mg     — 1-0-0 (morning)    Daily
3. Tab. Propranolol 20 mg    — 1-0-1               Daily (varices)
4. Syrup Lactulose 30 mL     — 0-0-1               Daily (HE prevention)
5. Tab. Multivitamin         — 1-0-0               Daily
   D/A: Restrict Na <2g/day; Fluid restriction if Na <130; Avoid NSAIDs/alcohol
   Monitor: Weight daily; LFTs, electrolytes monthly

Rx — Sample (Acute Cholecystitis — Discharge)

1. Tab. Co-amoxiclav 625 mg  — 1-1-1 (PC)         × 7 days
2. Tab. Paracetamol 500 mg   — 1-1-1               PRN pain
3. Tab. Domperidone 10 mg    — 1-1-1 (AC)          × 5 days
   D/A: Low-fat diet; surgical referral; USS follow-up in 4 weeks

Sources: Sleisenger & Fordtran's Gastrointestinal and Liver Disease; Yamada's Textbook of Gastroenterology (7e); Harrison's Principles of Internal Medicine (22e); Goldman-Cecil Medicine; Robbins & Cotran Pathologic Basis of Disease; Sabiston Textbook of Surgery; Tintinalli's Emergency Medicine; Washington Manual of Medical TherapeuticsHere is the complete clinical reference covering all 40 GI diseases across 4 organs, with all 7 requested fields for each. Here's a structural summary:

What's Covered

STOMACH (10 diseases) 1–10: PUD, GERD, Acute Gastritis, Chronic Gastritis, Gastroparesis, Gastric Cancer, ZES, Gastric Outlet Obstruction, Stress Ulcer, Mallory-Weiss Tear

LIVER (10 diseases) 11–20: Hepatitis A, Hepatitis B, Hepatitis C, Alcoholic Liver Disease, NAFLD/NASH, Cirrhosis, Acute Liver Failure, PBC, Autoimmune Hepatitis, HCC

INTESTINE (10 diseases) 21–30: Crohn's Disease, Ulcerative Colitis, IBS, Colorectal Cancer, Small Bowel Obstruction, Celiac Disease, Appendicitis, Intestinal TB, Diverticulitis, Ischemic Colitis

GALLBLADDER (10 diseases) 31–40: Acute Cholecystitis, Chronic Cholecystitis, Choledocholithiasis, Ascending Cholangitis, PSC, GB Carcinoma, Biliary Colic, Acute Pancreatitis, Gallstone Ileus, Cholangiocarcinoma

Each Disease Includes

Clinical findings (history + examination)
Investigations (in order of priority)
Differential diagnosis
Treatment (medical + surgical)
Contraindications (drug + procedural)
ICU management (specific protocols with doses)
OPD prescription (drug name, dose, frequency, duration)

Plus: Quick reference summary table, ICU protocol overview, and 3 sample OPD prescription templates in standard Rx format.

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