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Gastrointestinal and Hepatology Mnemonics

A ValueMD community study resource, originally shared on our forums and preserved here for students reviewing GI anatomy, IBD, pancreatitis, and liver disease.

Educational note: these are student-built memory aids for exam review, not a substitute for your course material or a clinical reference. A few entries below have been corrected or reorganized from the original forum thread for accuracy.

GI Anatomy

Bowel Segments in Order: “Dow Jones Industrial Averages Closing Stock Report”

  • Duodenum
  • Jejunum
  • Ileum
  • Appendix
  • Colon
  • Sigmoid
  • Rectum

This mnemonic captures the general order of the GI tract but skips the cecum, which sits between the ileum and the appendix/ascending colon. Keep that gap in mind rather than treating this list as fully complete.

Liver Lobes

The liver has four lobes: caudate, quadrate, left, and right. One way to keep them straight is to remember that the caudate and quadrate lobes are the two smaller lobes visible on the visceral (posterior/inferior) surface of the liver, sandwiched between the much larger left and right lobes seen from the front.

Peritoneal Relationships

  • stOMach and OMentum: the omentum drapes over the stomach.
  • The lesser omentum connects the liver and stomach.
  • The mesentery suspends the small intestine.
  • The mesocolon attaches the colon to the posterior abdominal wall.
  • The peritoneum lines the abdominal cavity and helps keep the intestines from kinking as they move.

Sphincters of the Alimentary Canal: APE OIL

  • Anal
  • Pyloric
  • (Lower) Esophageal
  • Oddi
  • Ileocecal
  • (the second L simply completes the acronym; this covers five true sphincters)

Stomach Parts: “The CAR is FUN ’til the BODY PILES”

  • Cardia
  • Fundus
  • BODY
  • Pylorus (where food collects, “piles,” waiting for the pyloric sphincter to open)

Inflammatory Bowel Disease

Ulcerative Colitis: Severe Attack Criteria (“A STATE”)

  • Anemia: hemoglobin below 10 g/dL
  • Stool frequency greater than 6 stools/day with blood
  • Temperature greater than 37.5°C
  • Albumin below 30 g/L
  • Tachycardia greater than 90 bpm
  • ESR greater than 30 mm/hr

Note: this expands on the classic Truelove and Witts severity criteria, which core version does not include albumin; some modified versions add it as an additional marker of severity.

IBD: Indications for Surgery (“I CHOP”)

  • Infection
  • Carcinoma
  • Haemorrhage
  • Obstruction
  • Perforation

IBD: Extraintestinal Manifestations (“A PIE SAC”)

  • Aphthous ulcers
  • Pyoderma gangrenosum
  • Iritis
  • Erythema nodosum
  • Sclerosing cholangitis
  • Arthritis
  • Clubbing of fingertips

Ulcerative Colitis: Complications (“PAST Colitis”)

  • Pyoderma gangrenosum
  • Ankylosing spondylitis
  • Sclerosing (peri)cholangitis
  • Toxic megacolon
  • Colitis leading to colon carcinoma with long-standing disease

Crohn’s Disease: Morphology and Symptoms (“CHRISTMAS”)

  • Cobblestone mucosa
  • High temperature
  • Reduced lumen (strictures)
  • Intestinal fistulae
  • Skip lesions
  • Transmural inflammation (all layers, may ulcerate)
  • Malabsorption
  • Abdominal pain
  • Submucosal fibrosis

Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome)

Caused by a defect in DNA mismatch repair. One way to visualize it: a mismatch creates a small “bubble” in the DNA strand where the two nucleotides don’t pair correctly, similar in shape to the polyps that later develop in the colon.

Pancreatitis

Causes: “GET SMASHED”

  • Gallstones
  • Ethanol
  • Trauma
  • Steroids
  • Mumps
  • Autoimmune disease
  • Scorpion stings
  • Hyperlipidemia/hypercalcemia
  • ERCP
  • Drugs (including azathioprine and certain diuretics)

Severity Scoring: Glasgow-Imrie Criteria (“PANCREAS”)

  • PaO2 below 8 kPa
  • Age over 55
  • Neutrophils: WBC over 15
  • Calcium below 2 mmol/L
  • Renal: urea over 16 mmol/L
  • Enzymes: LDH over 600, AST over 200
  • Albumin below 32 g/L
  • Sugar: glucose over 10 mmol/L (unless the patient is diabetic)

Ranson Criteria at Admission: “GA LAW”

  • Glucose over 200 mg/dL
  • AST over 250
  • LDH over 350
  • Age over 55
  • WBC over 16,000

Ranson Criteria at 48 Hours: “C & HOBBS”

  • Calcium below 8 mg/dL
  • Hct drop greater than 10%
  • Oxygen (PaO2) below 60 mmHg
  • BUN rise greater than 5 mg/dL
  • Base deficit greater than 4
  • Sequestration of fluid greater than 6 L

Biliary and Liver Disease

Cholangitis: Charcot’s Triad (“Charge a FEE”)

  • Fever
  • Epigastric/RUQ pain
  • E (visualize “jaundice” here, the third true component of Charcot’s triad, alongside fever and RUQ pain)

When a patient with Charcot’s triad also develops hypotension and altered mental status, the full picture is called Reynolds’ pentad, a marker of more severe, often suppurative cholangitis requiring urgent biliary decompression.

Separately, primary sclerosing cholangitis (a distinct, usually chronic condition rather than an acute infection) is associated with ulcerative colitis and with HLA-B8/DR3, features that are easy to confuse with acute cholangitis if lumped into the same mnemonic.

Bilirubin: Common Causes of Elevated Levels (“HOT Liver”)

  • Hemolysis
  • Obstruction
  • Tumor
  • Liver disease

Haemochromatosis: Complications

  • Hypogonadism
  • Cancer (hepatocellular)
  • Cirrhosis
  • Cardiomyopathy
  • Diabetes mellitus
  • Arthropathy

Cirrhosis: Causes (“HEPATIC”)

  • Hemochromatosis (primary)
  • Enzyme deficiency (alpha-1-antitrypsin)
  • Post-hepatic (infection, drug-induced)
  • Alcoholic
  • Tyrosinosis
  • Indian childhood cirrhosis / galactosemia
  • Cardiac, cholestatic, cancer, or copper (Wilson’s disease)

Hepatic Encephalopathy: Precipitating Factors (“HEPATICS”)

  • Hemorrhage (GI bleed)
  • Excess protein in the diet
  • Paracentesis
  • Acidosis, anemia
  • Trauma
  • Infection
  • Constipation
  • Sedatives, surgery

Chronic Liver Failure: Signs on the Arms (“CLAPS”)

  • Clubbing
  • Leukonychia
  • Asterixis
  • Palmar erythema
  • Scratch marks

Other GI and Related Conditions

Vomiting: Non-GI Differential (“VOMITING”)

  • Vestibular disturbance, vagal reflex pain
  • Opiates
  • Migraine, metabolic (DKA, gastroparesis, hypercalcemia)
  • Infections
  • Toxicity (cytotoxic drugs, digitalis toxicity)
  • Increased ICP, ingested alcohol
  • Neurogenic, psychogenic
  • Gestation

GI Symptom Review

A quick review of core GI symptoms to screen for: bleeding, abdominal pain, dysphagia, bloating, nausea and vomiting, appetite changes, lethargy, diarrhea, heartburn, and jaundice or fever suggesting hepatobiliary involvement.

H. Pylori Treatment: “Please Make Tummy Better”

  • Proton pump inhibitor
  • Metronidazole
  • Tetracycline
  • Bismuth

This reflects one classic quadruple-therapy regimen. Current first-line treatment varies by region based on local clarithromycin resistance patterns, so confirm against current guidelines rather than treating this as a fixed regimen.

Dysphagia: Differential

Causes span mechanical, neuromuscular, and systemic categories: intrinsic esophageal lesions, oropharyngeal disease and tonsil problems, diffuse esophageal spasm, scleroderma, achalasia, bulbar palsy or other neuromuscular disease, an enlarged left atrium compressing the esophagus, goiter or mediastinal masses, and infections such as Chagas disease (American trypanosomiasis), which can cause achalasia-like esophageal dysfunction.

Dry Mouth: Differential (“DRI”)

  • Drugs, dehydration
  • Renal failure, radiotherapy
  • Immunological causes (such as Sjogren’s syndrome), intense emotional states

Diabetic Ketoacidosis: Precipitating Factors (“5 I’s”)

  • Infection
  • Ischemia (cardiac, mesenteric)
  • Infarction
  • Ignorance (poor glycemic control or missed insulin doses)
  • Intoxication (alcohol)

Whipple’s Disease: Clinical Manifestations (“SHELDA”)

  • Serositis
  • Hyperpigmentation of skin
  • Eating less (weight loss)
  • Lymphadenopathy
  • Diarrhea
  • Arthritis

Celiac Disease: Gluten-Containing Grains to Avoid (“BROW”)

  • Barley
  • Rye
  • Oats
  • Wheat

Note: pure, uncontaminated oats are generally considered gluten-free and tolerated by most people with celiac disease, though commercial oats are frequently cross-contaminated during processing, and a small subset of patients react to oat avenin specifically. Many clinical sources still list oats cautiously for this reason, but it’s a more nuanced point than the other three grains.

Splenomegaly: Causes (“CHIMP”)

  • Cysts
  • Haematological disease (such as CML or myelofibrosis)
  • Infective causes (viral, including infectious mononucleosis, or bacterial)
  • Metabolic/miscellaneous (amyloidosis, Gaucher disease)
  • Portal hypertension

Frequently Asked Questions

What’s the difference between Charcot’s triad and Reynolds’ pentad? Charcot’s triad (fever, RUQ pain, and jaundice) suggests acute cholangitis. Reynolds’ pentad adds hypotension and altered mental status to those three findings, signaling a more severe, often suppurative form of cholangitis that typically needs urgent biliary decompression.

What’s the difference between the Ranson criteria and the Glasgow-Imrie criteria for pancreatitis? Both are severity-scoring systems for acute pancreatitis. Ranson’s criteria are split into signs assessed at admission and additional signs assessed at 48 hours, while the Glasgow-Imrie criteria (the “PANCREAS” mnemonic) combine multiple lab and clinical values into a single assessment, typically also evaluated within the first 48 hours.

Is oat consumption safe for someone with celiac disease? Pure, uncontaminated oats are gluten-free and tolerated by most people with celiac disease, but most commercially available oats are cross-contaminated with wheat, barley, or rye during growing or processing, and a small subset of patients react to a protein in oats called avenin. Look for oats specifically labeled gluten-free, and check with a physician or dietitian before adding them back to a gluten-free diet.

What causes hepatic encephalopathy to worsen in a patient with cirrhosis? Common precipitants include GI bleeding, excess dietary protein, constipation, infection, dehydration from procedures like paracentesis, electrolyte disturbances, and sedative medications, all of which increase ammonia production or reduce its clearance in a liver that already has limited reserve.

Want to Know More?

Working through a tricky GI or hepatology topic, or want to compare mnemonics with other students? Visit our forum to connect with students and residents reviewing the same material and share what’s helped it stick.