Gastroenterology and hepatology
Upper and lower GI bleeding, dyspepsia, IBD, coeliac disease, liver disease and viral hepatitis. AMC tests red flags for GI cancer and the sensible order of investigations.
High-yield points
Upper GI bleed: resuscitate, risk-stratify with the Glasgow-Blatchford score, IV PPI and endoscopy within 24 hours; variceal bleed also needs terlipressin and antibiotics.
Dyspepsia red flags (weight loss, dysphagia, anaemia, vomiting, age over about 55 with new symptoms) need endoscopy rather than empirical PPI.
H. pylori: triple therapy with PPI + amoxicillin + clarithromycin; confirm eradication with a urea breath test at least 4 weeks after finishing.
Coeliac disease: tTG-IgA with total IgA while the patient is still eating gluten, confirmed by duodenal biopsy.
IBD flare: check for infection (including C. difficile); acute severe ulcerative colitis needs admission and IV steroids.
Paracetamol overdose: use the Australian nomogram (single treatment line starting at 150 mg/L at 4 hours); give acetylcysteine if above the line or if timing is unknown.
Hepatitis C is curable with 8-12 weeks of oral direct-acting antivirals, which GPs can prescribe.
Chronic hepatitis B needs lifelong monitoring and 6-monthly liver ultrasound (plus AFP) in higher-risk groups for hepatocellular carcinoma surveillance.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Hepatitis C | Treated under the National Viral Hepatitis Control Program, often by specialists. | DAAs are PBS-listed without disease-stage restriction; GPs routinely treat and cure HCV. |
| Hepatitis B | Common in the general population. | Concentrated in people born in Asia-Pacific countries and First Nations people; screen these groups and monitor long term. |
| Bowel cancer screening | No national program; colonoscopy mainly for symptoms. | National Bowel Cancer Screening Program: free iFOBT every 2 years, mailed at 50-74, requestable from 45. Positive test means colonoscopy. |
| Common liver and gut infections | Amoebic liver abscess, typhoid, hepatitis A/E and abdominal TB are common. | These are mostly travel-related. Alcohol and fatty liver disease (MASLD) dominate chronic liver disease. |
Hepatitis C
India (MBBS)
Treated under the National Viral Hepatitis Control Program, often by specialists.
Australia (AMC): what the exam expects
DAAs are PBS-listed without disease-stage restriction; GPs routinely treat and cure HCV.
Hepatitis B
India (MBBS)
Common in the general population.
Australia (AMC): what the exam expects
Concentrated in people born in Asia-Pacific countries and First Nations people; screen these groups and monitor long term.
Bowel cancer screening
India (MBBS)
No national program; colonoscopy mainly for symptoms.
Australia (AMC): what the exam expects
National Bowel Cancer Screening Program: free iFOBT every 2 years, mailed at 50-74, requestable from 45. Positive test means colonoscopy.
Common liver and gut infections
India (MBBS)
Amoebic liver abscess, typhoid, hepatitis A/E and abdominal TB are common.
Australia (AMC): what the exam expects
These are mostly travel-related. Alcohol and fatty liver disease (MASLD) dominate chronic liver disease.
The Australian context
Hepatitis C DAAs have been PBS-listed without disease-stage restriction since 2016, so treating HCV is routine general practice work. Chronic hepatitis B is concentrated in people born in Asia-Pacific countries and in Aboriginal and Torres Strait Islander people. Bowel cancer is a major Australian cancer; see the National Bowel Cancer Screening Program.