Browse topics
Gastroenterology and hepatology
49 notes, 150 questions and 436 flashcards.
Tier 1 is core knowledge expected of every trainee. Tier 2 is deeper or less common.
Presentations
- Abdominal painFree sampleCauses by site and by system, the history and examination that separate surgical from medical pain, red flags, which imaging to order, and the traps of mesenteric ischaemia, older patients and pregnancy.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Altered bowel habit and constipationWhen a change in bowel habit needs colonoscopy, Rome criteria for chronic constipation, secondary causes, the stepwise laxative ladder, defecatory disorders, opioid-induced constipation, faecal impaction and pseudo-obstruction.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Diarrhoea, acute and chronicInfective causes and when to test or treat acute diarrhoea, Clostridioides difficile under the 2025 ASID guideline, and a structured work-up of chronic diarrhoea including bile acid diarrhoea, microscopic colitis, coeliac disease and pancreatic insufficiency.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Gastrointestinal bleedingResuscitation, Glasgow-Blatchford and Oakland triage, endoscopy timing, variceal versus non-variceal care, and restarting antithrombotics after upper and lower GI bleeding.Tier 1, approach to a presentation, 3 questions, 10 flashcards
- Indigestion (dyspepsia)Who needs gastroscopy, testing for and eradicating H. pylori, functional dyspepsia under Rome IV and Rome V, the stepwise PPI, tricyclic and prokinetic ladder, and deprescribing PPIs.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- JaundicePre-hepatic, hepatocellular and cholestatic jaundice, reading the liver test pattern (R ratio, very high aminotransferases, Hy's law), ultrasound first, the liver screen, and the emergencies of cholangitis and acute liver failure.Tier 1, approach to a presentation, 3 questions, 9 flashcards
Key conditions
- Acute pancreatitisDiagnosis, revised Atlanta severity, moderate goal-directed fluids, early feeding, when to use ERCP and antibiotics, necrosis management and preventing recurrence.Tier 1, condition, 3 questions, 9 flashcards
- Biliary obstruction and cholangitisBenign and malignant bile duct obstruction, risk-stratifying suspected duct stones (ASGE 2019), Tokyo 2018 diagnosis and grading of cholangitis, antibiotics and drainage timing, stent choice, and the complications of ERCP.Tier 1, condition, 3 questions, 9 flashcards
- Chronic pancreatitis and exocrine insufficiencyCauses by TIGAR-O, CT then EUS or secretin MRCP for diagnosis, faecal elastase and pancreatic enzyme dosing, pain management and the ESCAPE trial, type 3c diabetes, and the complications that need surveillance.Tier 1, condition, 3 questions, 9 flashcards
- Coeliac diseaseImmune enteropathy triggered by gluten in HLA-DQ2 or DQ8 carriers. Who to test, serology on a gluten-containing diet, why adults still need duodenal biopsy in Australia, gluten challenge, the gluten-free diet, follow-up, and non-responsive and refractory disease.Tier 1, condition, 3 questions, 10 flashcards
- Colorectal cancerRisk factors and hereditary syndromes, immunochemical FOBT and the National Bowel Cancer Screening Program, family history categories, presentation and staging, stage-based treatment of colon and rectal cancer, MMR status, biomarker-driven treatment of metastatic disease, and surveillance.Tier 1, condition, 4 questions, 10 flashcards
- GallstonesStone types and risk factors, who needs cholecystectomy, biliary colic versus acute cholecystitis (Tokyo 2018 criteria and grading), early surgery versus cholecystostomy, and the complications from duct stones to gallstone ileus and gallbladder cancer.Tier 1, condition, 3 questions, 9 flashcards
- Gastro-oesophageal reflux diseaseTypical and atypical reflux, the PPI trial, who needs gastroscopy, Lyon 2.0 criteria for proving reflux, PPI-refractory symptoms, surgery, and the complications to look for.Tier 1, condition, 3 questions, 9 flashcards
- Inflammatory bowel diseaseUlcerative colitis and Crohn's disease compared, severity scores, induction and maintenance therapy, acute severe colitis, extraintestinal disease, pregnancy and cancer surveillance.Tier 1, condition, 3 questions, 10 flashcards
- Iron deficiency, pallor and fatigueConfirming iron deficiency with ferritin (and when inflammation hides it), who needs gastroscopy and colonoscopy, coeliac and H. pylori testing, alternate-day oral iron, choosing IV iron and its hypophosphataemia risk, and the pale, tired patient.Tier 1, condition, 3 questions, 8 flashcards
- Irritable bowel syndromeA positive diagnosis with Rome V criteria and minimal tests, the alarm features that need colonoscopy, the low FODMAP diet, subtype-directed drugs, low-dose amitriptyline (ATLANTIS) and gut-directed psychological therapy.Tier 1, condition, 3 questions, 8 flashcards
- MASLD and MASH (formerly NAFLD and NASH)The 2023 steatotic liver disease nomenclature, who to test, FIB-4 then elastography, why fibrosis and the heart decide prognosis, weight-loss targets, and where semaglutide, resmetirom, pioglitazone, vitamin E and bariatric surgery fit.Tier 1, condition, 3 questions, 9 flashcards
- Peptic ulcer disease and Helicobacter pyloriH. pylori and NSAIDs as the two main causes, gastric versus duodenal ulcers, testing at endoscopy, eradication and confirming cure, NSAID and aspirin strategy after an ulcer (CONCERN), perforation and outlet obstruction, refractory ulcers and Zollinger-Ellison syndrome.Tier 1, condition, 3 questions, 10 flashcards
Hepatitis
- Alcohol-induced hepatitisNIAAA criteria, severity by Maddrey and MELD, the infection screen before prednisolone, the Lille stopping rule, what doesn't work, and treating the alcohol use disorder that decides survival.Tier 1, condition, 3 questions, 9 flashcards
- Autoimmune hepatitisAntibodies, IgG and interface hepatitis, the simplified diagnostic score, prednisolone with azathioprine or mycophenolate (EASL 2025), response definitions, who can try withdrawal, overlap syndromes and pregnancy.Tier 1, condition, 3 questions, 9 flashcards
- Drug-induced hepatitisIntrinsic, idiosyncratic and indirect liver injury, the R ratio and Hy's law, the usual culprits including flucloxacillin, amoxicillin-clavulanate, TB drugs, supplements and checkpoint inhibitors, excluding hepatitis E, when to stop a drug, and paracetamol in brief.Tier 1, condition, 3 questions, 9 flashcards
- Viral hepatitisHepatitis A to E, reading hepatitis B serology and phases, who to treat with entecavir or tenofovir, prophylaxis before immunosuppression and in pregnancy, curing hepatitis C with pan-genotypic DAAs, and hepatitis E in the immunosuppressed.Tier 1, condition, 3 questions, 10 flashcards
Liver disease
- Acute liver disease and acute liver failureFree sampleAcute hepatitis versus acute liver injury versus acute liver failure, the hyperacute to subacute spectrum, causes from paracetamol to death cap mushrooms, ICU care of encephalopathy and cerebral oedema, King's College criteria and super-urgent transplant.Tier 1, condition, 3 questions, 9 flashcards
- Alcohol-related liver diseaseThe spectrum from steatosis to cirrhosis, standard drinks and the NHMRC limits, AUDIT-C and biomarkers including PEth, staging fibrosis when alcohol inflates liver stiffness, withdrawal and Wernicke, relapse-prevention drugs in liver disease, and transplant.Tier 1, condition, 3 questions, 9 flashcards
- Chronic liver disease and cirrhosisCauses and work-up of chronic liver disease, non-invasive staging, Child-Pugh and MELD, Baveno VIII portal hypertension care, decompensation and HCC surveillance.Tier 1, condition, 3 questions, 9 flashcards
Less common or complex conditions
- Malnutrition and refeeding syndromeScreening and GLIM diagnosis of malnutrition, choosing oral, enteral or parenteral support, and preventing and treating refeeding syndrome under the 2025 AuSPEN consensus and NICE CG32.Tier 1, condition, 3 questions, 9 flashcards
- Barrett's oesophagusWhat counts as Barrett oesophagus, cancer risk by grade, surveillance intervals by segment length, confirming dysplasia, endoscopic eradication for dysplasia and early cancer, and PPI chemoprevention.Tier 2, condition, 3 questions, 9 flashcards
- GI manifestations of systemic and chronic diseaseDiabetic gastroparesis and diarrhoea, GLP-1 receptor agonists before endoscopy, GI amyloidosis and how to prove it, cystic fibrosis in the gut (pancreatic insufficiency, DIOS, liver, bowel cancer), carcinoid syndrome, and quick links for scleroderma, endocrine, renal and vascular disease.Tier 2, topic overview, 3 questions, 8 flashcards
- MalabsorptionSorting malabsorption by site (luminal, mucosal, post-mucosal), the first-line tests (coeliac serology, faecal elastase, duodenal biopsy), SIBO breath testing and antibiotics, bile acid diarrhoea, Whipple disease, and replacing what has been lost.Tier 2, condition, 3 questions, 8 flashcards
- Oesophageal and gastric cancerSquamous versus adenocarcinoma of the oesophagus, gastric cancer risk (H. pylori, CDH1), alarm features and urgent gastroscopy, staging, perioperative FLOT and immunotherapy, biomarker testing in advanced disease, palliation and life after gastrectomy.Tier 2, condition, 3 questions, 9 flashcards
- Oesophageal motility disordersDysphagia to solids and liquids, gastroscopy first to exclude cancer, high-resolution manometry and the Chicago Classification 4.0, achalasia subtypes and the choice between dilatation, Heller myotomy and POEM, spastic disorders, and scleroderma oesophagus.Tier 2, condition, 3 questions, 8 flashcards
Liver disease of less common aetiology
- HaemochromatosisFree sampleHFE C282Y homozygosity, reading iron studies, who needs HFE testing and fibrosis assessment, venesection targets, and family screening.Tier 1, condition, 3 questions, 9 flashcards
- Primary biliary cholangitisCholestatic LFTs plus antimitochondrial antibody, ursodeoxycholic acid at 13 to 15 mg/kg, judging response at 12 months, second-line elafibranor (PBS 2025) and the fall of obeticholic acid, pruritus, bone health and transplant referral.Tier 2, condition, 3 questions, 9 flashcards
- Primary sclerosing cholangitisCholestatic LFTs in a young man with colitis, MRCP for diagnosis, why UDCA isn't routine, surveillance for cholangiocarcinoma, gallbladder and colorectal cancer, dominant strictures and when to refer for transplant.Tier 2, condition, 3 questions, 8 flashcards
- Wilson diseaseATP7B copper overload in a young person with liver disease, a movement disorder or psychiatric change; caeruloplasmin, 24-hour urine copper and the Leipzig score; chelation versus zinc (EASL-ERN 2025); acute liver failure, pregnancy and family screening.Tier 2, condition, 3 questions, 9 flashcards
Investigations and procedures
- Abdominal imagingChoosing between plain X-ray, ultrasound, CT and MRI (including MRCP and MRA) for the common abdominal questions, reading the key findings step by step with worked reports, accuracy figures that change management, contrast and radiation safety under RANZCR guidance, and imaging in pregnancy.Tier 1, medical sciences concept, 3 questions, 10 flashcards
- Bowel cancer screeningHow the NBCSP immunochemical FOBT works and what a positive or negative result means in numbers, who should have colonoscopy instead, colonoscopy quality and surveillance after polyps, screening beyond 74, and the gaps for Aboriginal and Torres Strait Islander and Māori people, including New Zealand's 2026 age change.Tier 1, medical sciences concept, 3 questions, 8 flashcards
- GI laboratory testsHow to order and read the GI laboratory work-up, with worked results; the liver screen, hepatitis B and C serology patterns, coeliac serology traps, H. pylori tests and washout rules, stool culture, PCR, C. difficile and microscopy, faecal calprotectin and elastase, breath tests and the genetic tests used in gastroenterology.Tier 1, medical sciences concept, 3 questions, 10 flashcards
- Upper and lower endoscopyWho needs gastroscopy, colonoscopy or both, preparing the patient (antithrombotics, GLP-1 receptor agonists, bowel preparation), reading an endoscopy report and its quality markers, biopsies that change management, complications, and alternatives when colonoscopy fails.Tier 1, medical sciences concept, 3 questions, 8 flashcards
- Endoscopic retrograde cholangiopancreatographyERCP as a treatment, not a diagnostic test. Indications, preparation (antithrombotics, antibiotics), reading the cholangiogram and the report, preventing post-ERCP pancreatitis with rectal NSAIDs and pancreatic stents, and working up pain afterwards.Tier 2, medical sciences concept, 3 questions, 8 flashcards
- Investigation of oesophageal disordersWhich oesophageal test answers which question after gastroscopy, how to read high-resolution manometry (IRP, DCI, distal latency) under Chicago 4.0, ambulatory pH and pH-impedance under Lyon 2.0, barium swallow and timed barium oesophagram, nuclear transit studies and FLIP, with worked results.Tier 2, medical sciences concept, 3 questions, 8 flashcards
- Liver biopsy and non-invasive assessment of fibrosisStaging liver fibrosis step by step with FIB-4, ELF and transient elastography (reliability, confounders, disease-specific cut-offs), when a biopsy still earns its risk, choosing the route, and reading a histology report.Tier 2, medical sciences concept, 3 questions, 9 flashcards
- Rectal examinationWhen a digital rectal examination helps and when it doesn't (prostate screening, neutropenia, cauda equina), consent and chaperones, a systematic technique, interpreting the findings, and what to do next.Tier 2, medical sciences concept, 3 questions, 7 flashcards
Specific issues
- Hepatitis B and C management with newer therapiesChoosing and monitoring entecavir, tenofovir disoproxil and tenofovir alafenamide, when nucleos(t)ides can stop, functional cure and bepirovirsen, bulevirtide for hepatitis D, DAA choice in decompensation, renal failure and retreatment, and Australia's hepatitis B and C cascade of care.Tier 1, condition, 3 questions, 9 flashcards
- Immunosuppressants and biologics in IBD: indications and pre-treatment screeningWhat each IBD immunosuppressant and advanced therapy is for, the screen before starting (hepatitis B, TB, varicella, HIV, strongyloides, TPMT and NUDT15), reading the results with worked examples, vaccination, drug-specific checks for JAK inhibitors, S1P modulators and ciclosporin, and anti-TNF drug level interpretation.Tier 1, medical sciences concept, 4 questions, 10 flashcards
- Management of chronic liver disease complicationsWorking through ascites, refractory ascites, hyponatraemia, HRS-AKI, hepatic encephalopathy and the coagulopathy of cirrhosis, with worked results and the 2025 to 2026 AGA, ACG and Baveno VIII updates.Tier 1, medical sciences concept, 4 questions, 9 flashcards
- Overuse of long-term proton pump inhibitorsWho needs a PPI for life, how strong the evidence for long-term harms is, interactions and test interference, a worked deprescribing plan, rebound acid hypersecretion and the PBS authority rules.Tier 1, medical sciences concept, 3 questions, 8 flashcards
- Bariatric surgery: indications and complicationsWho qualifies for metabolic and bariatric surgery, how sleeve gastrectomy, Roux-en-Y and one-anastomosis bypass differ, complications sorted by timing from leak to internal hernia, post-bariatric hypoglycaemia, lifelong micronutrient monitoring, and drugs and pregnancy after surgery.Tier 2, medical sciences concept, 3 questions, 8 flashcards
- Indications for liver transplantationWhen to refer for liver transplant (MELD 15, first decompensation, HCC, acute liver failure), calculating and reading MELD-Na, disease-specific indications from PSC to hepatopulmonary syndrome, UCSF and Metroticket 2.0 for HCC in Australia and New Zealand, contraindications, alcohol and the 6-month rule, and the ANZ transplant system.Tier 2, medical sciences concept, 3 questions, 9 flashcards