Key presentations and conditions
Basic Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Presentations
- Abdominal pain
- Altered bowel habit
- Diarrhoea, acute and chronic
- Gastrointestinal (GI) bleeding
- Indigestion
- Jaundice
- Pallor and fatigue
Conditions
- Biliary obstruction
- Bowel cancer
- Coeliac disease
- Gallstones
- Gastro-oesophageal reflux disease
- Hepatitis:
- alcohol induced
- autoimmune
- drug induced
- viral
- Inflammatory bowel disease
- Iron deficiency
- Irritable bowel syndrome
- Liver disease:
- acute
- alcoholic
- chronic
- Non-alcoholic steatohepatitis (NASH)
- Pancreatitis
- Peptic ulcer disease
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - 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
Less common or more complex presentations and conditions
Basic Trainees will understand these presentations and conditions. Basic Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Conditions
- Barrett’s oesophagus
- GI malignancy
- GI manifestations of systemic and chronic disease, such as amyloidosis, cystic fibrosis, diabetes, and neuroendocrine tumours
- Liver disease of less common aetiology, such as:
- haemochromatosis
- primary biliary cirrhosis (PBC)
- primary sclerosing cholangitis (PSC)
- Wilson disease
- Malabsorption
- Malnutrition
- Oesophageal motility disorders
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - 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, pathophysiology and clinical sciences
Basic Trainees will describe the principles of the foundational sciences.
- Alcohol metabolism
- Anatomy and physiology of the GI and hepatobiliary system
- Bilirubin metabolism
- Hormonal or enzymatic control of the alimentary tract, including control of acid and pancreatic secretion
- Laboratory markers of hepatic and pancreatic function and malabsorption
- Microbiota in health and disease
- Pharmacology of major drug classes used to manage gastroenterological conditions
- Principles of macro- and micronutrient absorption
- Principles of nutrition and fluid balance
Investigations, procedures and clinical assessment tools
Basic Trainees will know the indications for, and how to interpret the results of these investigations, procedures, and clinical assessments tools. Basic Trainees will know how to explain the investigation, procedure, or clinical assessment tool to patients, families, and carers.
Investigations
- Abdominal imaging:
- CT scan
- MRI, including MRA and MRCP
- Ultrasound
- X-ray
- Bowel cancer screening
- Haemochromatosis diagnostic tests
- Investigation of oesophageal disorders, including 24 hour pH monitoring, oesophageal manometry, nuclear medicine transit study, and barium swallow
- Laboratory tests, such as:
- coeliac serology
- culture and toxin testing
- faecal microscopy
- genetic testing (appropriate use of)
- Helicobacter pylori testing
- liver function test (LFT)
- liver screen
- malabsorption tests
- viral serology
- Liver biopsy
- Non-invasive methods of assessing liver fibrosis, such as transient elastography
Procedures
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Upper and lower endoscopy
Clinical assessment tools
- Rectal examination
Important specific issues
Basic Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
- Excessive alcohol consumption
- Hepatitis B and C management in context of newer therapies
- Indications and pre-treatment screening for immunosuppressant and biological agents in management of inflammatory bowel disease
- Indications for and complications of bariatric surgery
- Indications for liver transplantation
- Management of chronic liver disease complications, such as ascites, coagulopathy, and encephalopathy
- Overuse of long term proton pump inhibitor medications
- References to patients in the remainder of this document may include their families or carers.