Liver disorders

This chapter covers core curriculum topics relating to liver disorders including the anatomy, physiology, and biochemistry of the liver as it relates to disease processes. There is a focus on the investigation and management of acute hepatitis including viral, drug- and toxin-induced, and the risk stratification of patients with acute liver failure. All major chronic liver diseases are discussed including non-alcoholic fatty liver disease, autoimmune liver disease, alcohol related liver disease and chronic viral hepatitis. There is also education on managing the complications of cirrhosis including renal dysfunction, hepatic encephalopathy, variceal haemorrhage, and spontaneous bacterial peritonitis. Additional important topics covered include nutrition in liver disease, hepatocellular carcinoma, liver transplantation indications and assessment, and complications following liver transplantation. Additional curriculum material regarding liver disorders will also be covered in the mock examination chapter.

Oesophageal disorders

This chapter covers core curriculum topics relating to disorders of the oesophagus. A diagnostic and therapeutic approach to symptoms of gastro-oesophageal reflux disease is covered including physiology testing and the role of anti-reflux surgery. Other benign conditions causing dysphagia and chest pain are presented incorporating disorders of motility, infections, and the management of eosinophilic oesophagitis and oesophageal stricturing. Coverage is given to the investigation and management of patients with foreign body or caustic substance ingestions. There is particular focus on the investigation and management of oesophageal malignancy including in palliative stages, along with the various stages of Barret’s oesophagus. This includes diagnostic features, surveillance intervals and management of dysplasia associated with Barrett’s. Additional curriculum material regarding disorders of the oesophagus will also be covered in the mock examination chapter.

Gastrointestinal haemorrhage

This chapter covers core curriculum topics relating to gastrointestinal haemorrhage. This includes risk assessment for upper gastrointestinal haemorrhage incorporating natural history and prediction of rebleed following peptic ulcer bleeding. Comprehensive coverage of assessment and management of variceal bleeding (gastric and oesophageal) is included including the role of stenting. Causes of presentations with lower gastrointestinal bleeding, including following radiotherapy, are presented along with guidance on assessing shock index, investigation and management strategies. The role of acute imaging versus endoscopic intervention is discussed. Furthermore, investigation and management of obscure and occult gastrointestinal bleeding is covered including small bowel endoscopy and specialist imaging. Additional curriculum material regarding gastrointestinal haemorrhage will also be covered in the mock examination chapter.

Nutrition

This chapter covers core curriculum topics relating to nutrition including assessment of nutritional risk. Specific micronutrient deficiencies are largely covered in the ‘Small Intestine’ chapter but, where appropriate, additional information is provided in this chapter. Decision making about enteral feeding routes and complications of longer-term feeding tubes such as percutaneous endoscopic gastrostomies, and their management, is discussed. Key aspects of intestinal failure requiring parenteral nutrition, including short bowel syndrome, are presented including management of types 2 and 3 intestinal failure. Education is provided on electrolyte content of key intravenous fluids. Coverage of bariatric surgical techniques and their complications round off this chapter. Additional curriculum material regarding nutrition will also be covered in the mock examination chapter.

Inflammatory bowel disease and colonic disorders

This chapter covers core curriculum topics relating to inflammatory bowel disease (IBD) and colonic disorders. A diagnostic approach to IBD is covered including the role of imaging, endoscopy, histopathology and clinical features. Pathophysiology and epidemiology of IBD is detailed. Management of Ulcerative colitis and Crohn’s disease includes assessment of disease severity, imaging modalities and therapeutic management. Particular focus is given to therapeutic drug monitoring and indications for biologic therapies. Surgical management of IBD is broadly covered including indications, timing and approach. Coverage is also given to the diagnosis and management of extra-intestinal manifestations of IBD, IBD in special situations (pregnancy, elderly, transition) and the prevention of cancer in IBD. Colorectal cancer and benign conditions including constipation, functional gut disorders and other colitides are also featured.

Stomach and duodenal disorders

This chapter covers core curriculum topics relating to benign and malignant conditions of the stomach and duodenum. Particular focus is given to the diagnostic approach to and therapeutic management of Helicobacter pylori infection and peptic ulcer disease. Other benign conditions covered include gastroparesis and duodenal adenomas, namely the investigation and management thereof. Attention is given to the identification of and management of GISTs, pre-malignant gastric lesions, gastric dysplasia and gastric polyps. Also importantly covered are the epidemiology, presentation, investigation and treatment of gastric adenocarcinoma. Finally, a selection of questions covers the rare presentations of neuroendocrine tumours, Ménétrier’s disease and Zollinger-Ellison syndrome.

Pancreatic disorders

This chapter covers core curriculum topics relating to pancreatic disorders. This includes the investigation and management of acute pancreatitis incorporating knowledge on aetiology, staging of acute pancreatitis, complications including pseudocyst and walled off necrosis, nutritional support, and role of imaging and endoscopy. The chapter also covers genetic pancreatic disorders, anatomical variants of the pancreas, and describes the different cell types of the pancreas. These is also an emphasis on the aetiology and complications of chronic pancreatitis including pancreatic exocrine insufficiency and chronic pain. Finally the chapter also covers the presentation, diagnosis and management of benign and malignant pancreatic tumours. Additional curriculum material regarding pancreatic disorders will also be covered in the mock examination chapter.

Miscellaneous

This chapter includes a range of miscellaneous curriculum topics including endoscopy, anorectal disorders and gastrointestinal (GI) investigations. Questions discussing the role and indications for antibiotic prophylaxis in endoscopy, sedation, performance measures and consent will provide education on best practice in endoscopy. Coverage is also given to the management of anticoagulation pre- and post-endoscopy together with commonly encountered procedural complications: post-polypectomy syndrome, post-endoscopic retrograde cholangiopancreatography pancreatitis and caustic injury. The presentation and management of key anorectal disorders (haemorrhoids, anal fissures, anal intraepithelial neoplasia, infectious proctitis) are also presented here. Finally, principles of salient GI investigations including anorectal manometry and breath tests are well described. Additional curriculum material regarding miscellaneous gastrointestinal conditions and investigations will be covered in the mock examination chapter.

Biliary disorders

This chapter covers core curriculum topics relating to disorders of the biliary tract including physiology and biochemistry of bile formation and the pathogenesis of gallstones; complications of gallstones disease including biliary colic, acute cholecystitis, biliary obstruction, and cholangitis, and options for operative and non-operative management. Material is also provided on conditions of the gallbladder including adenomyomatosis, gallbladder polyps, and porcelain gallbladder; primary sclerosing cholangitis and other causes of cholangitistumours of the bile duct, gall bladder, and ampulla; indications and complications of endoscopic and radiological treatment of biliary disease including endoscopic retrograde choalngiopancreatography, cholangioscopy, and Percutaneous transhepatic cholangiography. There is also discussion on the diagnosis and management of biliary complications after liver transplantation. Additional curriculum material regarding disorders of the biliary tract will also be covered in the mock examination chapter.

Mock examination

This chapter contains 50 questions, which exactly match the proportions of topic areas found in the European Specialty Examination in Gastroenterology and Hepatology (ESEGH), and is designed to act as a mock-examination for use in the final stages of preparation. The questions are unique to this chapter and therefore add to the coverage of the curriculum over and above that in preceding sections.