May reflect intrahepatic cccDNA levels, particularly in HBeAg-positive patients, and help define disease phase and predict treatment response. Total anti-HBc levels correlate with disease activity and decline with successful antiviral therapy.
HBV RNA: Marker of cccDNA transcriptional activity. Correlates with HBeAg loss during treatment and may predict viral rebound after nucleos(t)ide analog discontinuation.

✳️ Clinical Assessment
Initial evaluation of HBsAg-positive patients should include a comprehensive history focusing on risk factors, family history of HBV and hepatocellular carcinoma, and alcohol use.
Laboratory assessment should include complete blood count with platelets, liver function tests (AST, ALT, bilirubin, alkaline phosphatase, albumin), coagulation studies (PT/INR), HBeAg/anti-HBe, quantitative HBV DNA, and testing for coinfections (anti-HAV, anti-HCV, anti-HDV, anti-HIV in at-risk individuals).
Imaging with abdominal ultrasound and assessment of fibrosis stage using transient elastography or serum fibrosis panels (APRI, FIB-4) should be performed. Liver biopsy may be indicated when treatment decisions are unclear or to assess for other causes of liver disease.
HBV genotype determination can inform prognosis and treatment response, particularly for interferon-based therapy. Genotype A shows higher rates of HBeAg and HBsAg loss with interferon compared to genotypes B-D.

Best practice advice in management of ascites, volume overload, and hyponatremia in cirrhosis.

AGA 2025

Zenker diverticulum (ZD) is a false diverticulum (herniation of mucosa and submucosa only) that typically herniates through the Killian triangle at the dorsal hypopharynx. The best confirmatory test in patients with ZD is barium esophagram with dynamic continuous fluoroscopy. The characteristic outpouching in the posterior pharyngoesophageal wall confirms the diagnosis.

Patients presenting with symptomatic ZD should undergo open surgical or endoscopic treatment.

Causes of Acute abdominal pain ( acute abdomen)

Hyponatremia in cirrhosis

Management of Chronic Hepatitis B

Treatment of Hepatitis C

Uti in Men and women

State of the art review : Medical management of inflammatory bowel diseases.

BMJ 19,December 2025

Simplified treatment for HBV treatment

MASLD

Pancreas divisum is the most common pancreatic congenital abnormality, seen in approximately 6% of persons. It occurs when the ducts of the dorsal and ventral parts of the pancreas fail to fuse during embryonic development. As a result, the two parts of the pancreas maintain distinct drainage into the duodenum. The majority of secretions enter the duodenum by way of the dorsal duct, which enters the duodenum at the smaller minor papilla; the ventral duct drains a smaller part of the pancreas and enters the duodenum at the major papilla.

Most patients with pancreas divisum are asymptomatic. It seems likely, although unproven, that a small subgroup of patients present with recurrent episodes of pancreatitis, thought to be due to the small caliber of the minor papilla, leading to obstruction and subsequent pancreatitis.

The treatment of incidental pancreas divisum is observation.

✳️ The most appropriate management step for a patient who is found to have a gastric residual of 100 mL after starting on enteral feeding through a percutaneous gastrostomy tube is to elevate the head of the bed and continue the tube feeding.