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
