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Curriculum standards

Knowledge guides

LG12: Gastrointestinal nuclear medicine

Key presentations and conditions

Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Less common or more complex presentations and conditions

Trainees will understand these presentations and conditions.

Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Presentations
  • Gallbladder dyskinesia
  • Gastrointestinal (GI) bleeding
  • GI motility disorders
  • Hepatic disease and hepatic lesions for evaluation
  • Inflammatory bowel disease
Conditions
  • Gallbladder and biliary function conditions:
    • acute cholecystitis
    • bile leaks
    • biliary dyskinesia / sphincter of Oddi dysfunction
    • chronic cholecystitis
    • common bile duct obstruction
    • obstruction of major hepatic ducts
    • post-cholecystectomy pain
  • GI dysmotility and associated systemic conditions:
    • diabetes
    • dysphagia and gastro-oesophageal reflux
    • Hirschsprung disease
    • spinal cord injury
    • systemic sclerosis
  • Hepatic disease:
    • Budd–Chiari syndrome
    • cavernous haemangioma
    • chronic liver disease
    • focal nodular hyperplasia
    • hepatic adenoma
    • hepatosplenomegaly
    • portal hypertension
    • portal vein thrombosis

PCH

  • Child and adolescent conditions:
    • constipation
    • gastric dysmotility
    • gastro-oesophageal reflux
    • Meckel diverticulum
    • pulmonary aspiration
    • swallowing issues
  • Neonatal conditions:
    • Conjugated hyperbilirubinaemia

For each presentation and condition, Advanced Trainees will know how to:

Synthesise
  • recognise the clinical presentation
  • identify relevant epidemiology, prevalence, pathophysiology, and clinical science
  • take a comprehensive clinical history
  • conduct an appropriate examination
  • establish a differential diagnosis
  • plan and arrange appropriate investigations
  • consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
  • provide evidence-based management
  • prescribe therapies tailored to patients’ needs and conditions
  • recognise potential complications of disease and its management, and initiate preventative strategies
  • involve multidisciplinary teams
Consider other factors
  • identify individual and social factors and the impact of these on diagnosis and management
Presentations
  • Evaluate for H. pylori infection with urea breath test
  • Evaluate for small bowel bacterial overgrowth and fat malabsorption
  • Inflammatory bowel disease (IBD) and intra-abdominal sepsis
  • Salivary and lacrimal gland imaging
  • Splenic lesions or suspected splenuculus
  • Suspected GI blood loss
  • Suspected malfunction or to confirm patency of hepatic catheter or peritoneal-venous shunts
Conditions
  • Abnormal splenic function and ectopic spleen
  • GI haemorrhage
  • H. pylori infection
  • Intestinal malabsorption
  • Known hepatic catheter and peritoneal-venous shunts
  • Salivary gland dysfunction
  • Tear duct blockage

PCH

  • GI bleeding
  • IBD
  • Liver and spleen disorders

For each presentation and condition, Advanced Trainees will know how to:

Synthesise
  • recognise the clinical presentation
  • identify relevant epidemiology, prevalence, pathophysiology, and clinical science
  • take a comprehensive clinical history
  • conduct an appropriate examination
  • establish a differential diagnosis
  • plan and arrange appropriate investigations
  • consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
  • provide evidence-based management
  • prescribe therapies tailored to patients’ needs and conditions
  • recognise potential complications of disease and its management, and initiate preventative strategies
  • involve multidisciplinary teams
Consider other factors
  • identify individual and social factors and the impact of these on diagnosis and management
  • Epidemiology of GI conditions:
    • gallbladder pathology
    • H. pylori infection
    • hepatic disease
    • primary and secondary GI motility disorders
    • small bowel bacterial overgrowth
  • GI anatomy:
    • colon and anus
    • gallbladder and biliary tree
    • liver anatomy
    • oesophagus
    • small bowel
    • splenic anatomy
    • stomach
    • vascular supply of the GI tract
  • Key radioisotopes and imaging protocols:
    • technetium and Gallium based radioisotopes
    • dual isotope imaging
    • patient preparation required for motility studies, gallbladder and abdominal imaging studies, in vivo testing
    • use and limitations of quantitative measures in GI nuclear studies Guideline recommendations for assessing GI motility
    • alterations to standard GI motility imaging protocols
    • protocols for use in assessing gallbladder contraction
  • Pathophysiology of gastrointestinal conditions:
    • describe the clinical conditions in which Tc99m labelled heat-damaged red blood cell studies may be of use
    • determinants of GI blood flow
    • discuss the underlying pathology of small bowel bacterial overgrowth and fat malabsorption
    • normal GI motility and its influences:
      • biochemistry of urea / urease in the stomach
      • mechanisms of transport and food mixing along the gastrointestinal tract
      • normal patterns of stooling and mechanism of defaecation
      • secretory functions of the GI tract
    • pathophysiology of common inflammation and infection in the gastrointestinal tract
    • physiology of the hepatobiliary system:
      • biliary kinetics and its disorders
      • metabolic functions of the liver, including bile production

PCH

  • Embryology and development of the gastrointestinal tract
Investigations
  • Catheter and shunt patency studies
  • Colonic transit
  • Functional proctography
  • Gastric emptying
  • GI blood loss studies
  • Heat-damaged red cell study to evaluate for functional splenic tissue
  • Hepatobiliary studies, including pre-procedural quantification
  • In vitro nuclear medicine studies of the GI system, including:
    • C-13 / 14 breath tests
    • C-14 urea breath tests
    • Cr-51 labelled red blood cell blood loss study
  • Oesophageal motility and reflux
  • Salivary and lacrimal gland imaging
  • Small bowel transit
Procedures
  • Accessing hepatic artery catheters and peritoneal-venous shunts to inject Tc-99m labelled tracers
  • Administration of Tc-99m labelled tracer into eye

PCH

  • GI motility – colonic, gastric, and small bowel
  • Hepatobiliary scintigraphy for biliary atresia
  • Meckel scan
  • Milk scan / reflux
  • Salivary aspiration
  • Individual patient clinical indications to determine patients’ needs, and the most appropriate approach to investigations and care
  • Patient demographics, including geographic location, socioeconomic status, ethnicity, and cultural background, and the considerations when managing and following up these patients, such as travel from rural to metropolitan areas
  • Patient preparation requirements for GI disorders, including fasting, medication cessation, opiate use, and modification of protocols as required
  • Radiation protection, patient safety and consent
  • Radioisotope decay and patient proximity to therapy / examination
  • Strengths and limitations of nuclear medicine scans and other imaging modalities for the assessment of GI conditions, including the impact of incomplete preparation on obtained scan results

PCH

  • Premedication for HIDA study in neonates
  • Role of medications in GI studies, including hepatobiliary, Meckel, and transit studies