By Dr. Sunir Kumar
Gastroenterology and Hepatology comprises about 9% of the ABIM Internal Medicine exam,
making it one of the more critical subjects on the boards. Below, we review 5 High Yield
Gastroenterology / Hepatology Pearls that may help you score a few extra points on your
ABIM or Internal Medicine shelf examination.
Pearl # 1: Remembering Hepatitis B markers can be difficult, but is worth it
Start with these key points:
o Hepatitis B surface Antigen (HBsAg) → active infection
o Hepatitis B surface Antibody (HBsAb) → past infection or vaccination against
hepatitis B
o Hepatitis Be Antigen (HBeAg) → active replication of the virus
o Anti Hepatitis B core IgM Antibody (Anti-HBc IgM) → acute infection
o Anti Hepatitis B core IgG Antibody (Anti-HBc IgG) → chronic infection
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As you see above: Along with the Cleared state, both Chronic and Carrier Hepatitis B patients
will have positive HBsAg and Anti-HBcIgG. How can these two conditions be differentiated?
Easily. Just look at the Liver function tests (LFTs)
o Chronic → Increased LFTs
o Carrier → Normal LFTs
What about that Hepatitis D virus?
o Hepatitis D can’t exist on its own. It requires Hepatitis B infection to be present
o Anti-HBc IgM + Hepatitis D virus → acute co-infection and will not worsen
hepatitis
o Anti-HBc IgG + Hepatitis D virus → acute super-infection and can cause
fulminant hepatitis
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Pearl # 2: Main causes of dysphagia can be broken down into Mechanical & Motility