Master CPS - Gastroenterology/Nutrition
for MSRA
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Gastroenterology covers conditions of the GI tract, liver, and pancreas. Key areas include inflammatory, functional, infectious, and neoplastic diseases. Common conditions like Gastro-Oesophageal Reflux Disease (GERD) and Peptic Ulcer Disease (PUD) often involve acid secretion and H. pylori. Inflammatory Bowel Disease (IBD) encompasses Crohn's disease (transmural inflammation, skip lesions) and Ulcerative Colitis (mucosal inflammation, continuous lesions). Irritable Bowel Syndrome (IBS) is a functional disorder. Celiac disease is an autoimmune response to gluten. Pancreatitis involves inflammation of the pancreas, commonly from gallstones or alcohol. Liver disease progresses from hepatitis to fibrosis and cirrhosis, leading to portal hypertension and hepatic decompensation. Malabsorption can result from various conditions affecting digestion or absorption. Nutritional assessment and support are crucial in many GI pathologies.
Clinical Presentation
- Abdominal Pain: Location (epigastric, RUQ, LLQ), character (burning, colicky, dull, constant), radiation. Suggests PUD, pancreatitis, biliary colic, appendicitis, diverticulitis, IBS, IBD.
- Dysphagia/Odynophagia: Difficulty/painful swallowing. Oesophageal causes (stricture, cancer, achalasia, oesophagitis).
- Nausea/Vomiting: Timing, content. Gastritis, obstruction, pancreatitis, infections.
- GI Bleeding: Haematemesis (UGIB), Melaena (UGIB/small bowel), Haematochezia (LGIB).
- Altered Bowel Habit: Diarrhoea (acute/chronic, fatty/bloody), Constipation. IBD, IBS, infection, malabsorption, cancer.
- Jaundice: Yellow skin/sclera. Pre-hepatic, hepatic, post-hepatic causes of hyperbilirubinemia.
- Weight Loss: Unexplained. Malignancy, malabsorption, IBD, hyperthyroidism.
- Systemic: Fever, fatigue, malaise, signs of malnutrition (cachexia, oedema), signs of liver failure (ascites, encephalopathy, spider naevi, palmar erythema).
Diagnosis (Gold Standard)
- GERD: Clinical diagnosis; Endoscopy if alarm symptoms, refractory, or pre-surgical assessment.
- Peptic Ulcer Disease (PUD): Oesophago-Gastro-Duodenoscopy (OGD) with biopsy for H. pylori.
- H. pylori: Urea breath test, stool antigen test, or biopsy urease test (CLO test) during OGD.
- Inflammatory Bowel Disease (IBD): Colonoscopy with biopsies (for characteristic histological features).
- Celiac Disease: Serology (Tissue Transglutaminase IgA, Total IgA) followed by Duodenal biopsy.
- Acute Pancreatitis: Clinical presentation + Lipase/Amylase >3x upper limit of normal. CT for severity/complications.
- Gallstones: Ultrasound abdomen. MRCP for suspected Common Bile Duct (CBD) stones.
- Hepatitis: Serology (viral hepatitis), LFTs. Liver biopsy for definitive staging/diagnosis of some chronic liver diseases.
- Cirrhosis: Clinical, LFTs, imaging (USS, Fibroscan), liver biopsy (definitive).
- Malabsorption: Faecal elastase (pancreatic insufficiency), stool fat, specific serologies/biopsies (e.g., Celiac).
- Acute GI Bleed: OGD for UGIB, Colonoscopy for LGIB.
Management (First Line)
- GERD: Lifestyle modifications (diet, weight loss, avoid triggers), Proton Pump Inhibitors (PPIs).
- PUD: PPIs. If H. pylori positive, eradication therapy (PPI + two antibiotics).
- IBD (Acute Flare): Oral/IV Corticosteroids.
- IBD (Maintenance): 5-Aminosalicylates (UC), Immunomodulators (Azathioprine, Methotrexate), Biologics (anti-TNF, etc.).
- Irritable Bowel Syndrome (IBS): Dietary modifications (FODMAPs), lifestyle advice, antispasmodics, laxatives/loperamide, tricyclic antidepressants.
- Celiac Disease: Strict lifelong gluten-free diet.
- Acute Pancreatitis: Aggressive IV fluid resuscitation, analgesia, nil per os (NPO), nutritional support (NG/NJ if prolonged), treat underlying cause (e.g., ERCP for gallstones).
- Symptomatic Gallstones: Laparoscopic cholecystectomy.
- Acute GI Bleed: ABCs, resuscitation (fluids, blood products), IV PPI (UGIB), endoscopic intervention (clipping, adrenaline, banding).
- Cirrhosis Complications: Diuretics (ascites), Lactulose/Rifaximin (encephalopathy), Non-selective Beta-blockers/Endoscopic variceal ligation (variceal bleeding prophylaxis).
Exam Red Flags
- Malignancy: Dysphagia/Odynophagia (especially new onset), unexplained weight loss, iron deficiency anaemia, persistent vomiting, palpable abdominal mass, persistent change in bowel habit (>6 weeks, particularly >40-60 years), new-onset PR bleeding (>40-50 years).
- Acute Abdomen: Severe, sudden onset abdominal pain; peritonism (guarding, rigidity, rebound tenderness); absent bowel sounds; hemodynamic instability; fever; raised inflammatory markers. Suggests perforation, peritonitis, ischaemic bowel, severe appendicitis/diverticulitis.
- Severe GI Bleeding: Hemodynamic instability (tachycardia, hypotension, pallor), large volume haematemesis or melaena, syncope/dizziness.
- Acute Liver Failure: Jaundice, coagulopathy (prolonged INR), and hepatic encephalopathy.
- Severe Pancreatitis: Systemic Inflammatory Response Syndrome (SIRS) criteria, organ failure (respiratory, renal, circulatory), persistent pain despite analgesia.
- Bowel Obstruction: Colicky abdominal pain, vomiting, abdominal distension, absolute constipation, tinkling bowel sounds (early) then absent (late).
Sample Practice Questions
A 28-year-old female presents with chronic watery diarrhoea, abdominal pain, and significant weight loss over the past 6 months. She reports occasional oral aphthous ulcers and perianal skin tags. Endoscopy reveals patchy inflammation with deep ulcerations in the terminal ileum and colon, with 'skip lesions'. Biopsies show non-caseating granulomas. Which of the following is the most likely diagnosis?
A 35-year-old female presents to the emergency department with sudden onset, severe epigastric pain radiating to her back, associated with nausea and vomiting. She admits to heavy alcohol consumption over the weekend. On examination, she is tachycardic, hypotensive, and has tenderness in the epigastrium. Lab tests show significantly elevated serum amylase and lipase. What is the most important initial management priority?
A 28-year-old male presents with a two-month history of intermittent abdominal pain, bloody diarrhea, and weight loss. He also reports painful red nodules on his shins and occasional joint pain. On examination, he is pale and has a tender right lower quadrant. His CRP is elevated. Which of the following is the most likely diagnosis?
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