Gastroenterology

Medical specialty of the GI tract. 

Shares body system and diseases with General Surgery. 

Training (7 years post foundation)

• Internal Medical Training: 3 years

• Specialty Training: 4 years

Physiology

• GI and Liver Anatomy

• Bilirubin metabolism

• Nutrition

• Drug metabolism

GI Diseases

Alimentary Canal Diseases

• Oesphagus: Oesphageal Cancer , Achalasia , pharyngeal pouch, GORD/ reflux, Oesophageal candida, Oesophageal varices

• Stomach: Gastric Cancer , alcoholic gastritis, peptic ulcer disease, gastric outlet obstruction

• Small intestine: Gastro-enteritis, Crohn's Disease, coeliac disease, Irritable Bowel Syndrome,

• Large intestine: Colitis- Ulcerative Colitis & Ischaemic Colitis, Diverticulitis, appendicitis, Colorectal cancer- HNPCC , FAP

• Anal & rectum: anal fissure, haemorrhoids, anal cancer

Liver Diseases

• Acute: Acute Hepatitis, Acute Liver Failure; Chronic: hepatitis, Liver Cirrhosis & portal hypertension

• Alcoholic Liver Disease (ALD)

• MASLD (Metabolic Dysfunction Associated Steatotic Liver Diseases)  (NAFLD / MAFLD)

• Acute: Paracetamol Overdose , Viral Hepatitis

• Inherited: Haemachromatosis , Wilson's Disease ,  Alpha Trypsin 1 Deficiency , 

• Autoimmune: Autoimmune Hepatitis , Primary Biliary Cirrhosis (PBC) , Primary Sclerosing Cholangitis (PSC) 

• Hepatorenal Syndrome (HRS), Hepatopulmonary Syndrome (HPS) 

• Hepatocellular carcinoma (HCC), cholangiocarcinoma

Gallbladder pathology

• Gallstones : cholecystitis, ascending cholangitis, gallstone pancreatitis, cholelithiasis, choledocholithiasis

• Gallbladder cancer (cholangiocarcinoma)

• Primary Sclerosing Cholangitis (PSC)

Pancreatic Diseases

• Pancreatitis : acute, chronic

• Pancreatic Cancer

• Pancreatic insufficiency

• Bile Acid Diarrhoea 

  • Related diseases: diabetes mellitus, cystic fibrosis

Nutrition

• Obesity 

• Anorexia Nervosa , Bulimia nervosa

Presentations

• Abdominal pain, weight loss

• Dysphagia, reflux, vomiting

• Diarrhoea, constipation, melaena, 

Clinical 

History: Gastroenterology 

Exam: GI + hernia, testicles, PR

Investigations

• FBC, EUC, LFT, CRP, CMP, TFT, B12, Folate, HbA1c

• Ethanol, hepatitis serology, caeroplasmin, ferritin, alpha-1 typsin,  pANCA, cANCA, anti-smooth,

• Faecal- calprotectin, elastase, culture & sensitivity

• 24hr urinary copper

• USS: liver scan, gallbladder; CT Abdo Pelvis, MRI small bowel ?strictures, MRCP

• Barium swallow

• Ascitic tap

• Endoscopy, colonoscopy, sigmoidoscopy

Management

1. Lifestyle: 

   1. • Alcohol, smoking, diet, exercise, 

      • Safe injecting/ sex, mental health hygiene

2. Medications

   1. • Laxatives, bowel stimulants, anti reflux

      • Antibiotics, antivirals

      • DMARDs, chemotherapy

3. Interventions

   1. • Ascitic tap & drain

      • Endoscopy- OGD, colon/sigmoidoscopy, ERCP

      • TIPSS

Written in 2025

Resources & References