Modules
- Year 1
- Year 2
- Introduction to Year 2 and Year Outcomes
- Cardiorespiratory 2
- Metabolism 2
- Brain and Behaviour 2
- Human Development 2
- Human Sciences and Public Health 2
- Locomotor 2
- Cancer Week
- Moving and Handling Training
- Year 2 Lifesaver Programme
- Clinical Communication Skills
- Medicine in Society 2
- Extended Patient Contact
- Student Selected Component (SSC)
- Year 3
- Introduction to Year 3 and Year Outcomes
- Clinical Science and Professionalism (Weeks 1-3)
- Cardiovascular, Respiratory and Haematology (CR3)
- Gastroenterology and Cancer (MET3A)
- Public Health
- Endocrinology and Renal Medicine (MET3B)
- General Practice and Community Care
- Student Selected Component (SSC)
- Clinical and Communication Skills
- Year 4
- Introduction and Year 4 Outcomes
- Obstetrics and Gynaecology
- Child Health
- HIV & Sexual Health
- Musculoskeletal
- Health Care of the Elderly
- Neuroscience
- Dermatology
- General Practice and Community Care
- Psychiatry
- Ear, Nose and Throat
- Global Health and Ethics
- Ophthalmology
- Clinical & Communication Skills
- Student Selected Component (SSC)
- Year 5
- Introduction to Year 5 and Year Outcomes
- Teaching Week 1
- Teaching Week 2
- Anaesthesia & ITU (AN & ITU)
- Breaking Bad News
- Clinical Pharmacology & Therapeutics
- Community Care
- Doctors as Teachers and Educators (DATE)
- Emergency Medicine (EMERG MED)
- General (Internal) Medicine (G(I)M)
- Immediate Life Support (ILS)
- Student Assistantship
- Simulation
- Surgery
- Student Selected Component (SSC)
- Year GEP 1
Year 3 MET3A: Gastroenterology and Cancer (MET3A)
- Mr Shafi Ahmed
- shafi.ahmed@bartsandthelondon.nhs.uk
Teaching Material for this Module
Introduction
In addition to the broad learning objectives given in the main Year 3 Handbook, students are expected to achieve the following objectives whilst attending the MET3A module;
1. The development of core clinical and communication skills as per the Clinical and Communication Skills hand book
2. Core knowledge/skills in the examinations specific to MET3A ie Abdominal and Vascular
3. Competency in relevant practical skills
4. Satisfactory completion of MET3A PBL/CBL sessions
5. Attendance to MET3A lectures and teaching sessions during the introductory week
6. Attendance at all GP sessions
7. Satisfactory completion of the Year 3 SSC
8. Attendance at the half day hospice visit is compulsory.
You should be aware that the majority of your knowledge should be gained from spending time on the wards; the set teaching is there to supplement this. Be aware that patients and their diseases do not behave as the textbooks imply - in neatly defined categories. Instead they may have many features and presentations that cross systems.
SDL = Self Directed Learning
CE = Clinical Experience
KEY TO THE PRIORITY OF CONDITIONS
By the time you reach Foundation Year, you will be expected to know about the conditions in this module. The Priority codes give you an idea of their importance:
Priority * = Emergency, life threatening or serious condition. Essential to bbe able to recognise and know how to treat.
Priority 1 = Have a good knowledge of these conditions; be able to recognise them and be familiar with their treatment
Priority 2 = Have some knowledge of these conditions and their treatment
Priority 3 = Be aware of the existence of these conditions and know where to seek more information about them
Index
- General Outcomes for the Cardiovascular System
- General Outcomes for the Whole Person
- General Outcomes for Surgical & Emergency Medicine & Anaesthesia
- General Outcomes for Gastrointestinal System
- General Outcomes for Renal and Urinary System
- Acute and Chronic Limb Ischaemia / Peripheral Vascular Disease (Priority 2*) (See also Met 3A outcomes)
- Arterial Aneurysms (Priority 2*) (See also Met 3A outcomes)
- Acute Abdomen
- Diverticular Disease
- Disorders of the Hepato-biliary System
- GI Ulcer Disease and Bleeding
- Obstructive Disorders of the GI System
- Gastrointestinal Cancer
- Diarrhoeal and Inflammatory Disorders
- GI Surgery and Anaesthetics (General)
- Malabsorption Disorders
- General Outcomes for the Cardiovascular System
- Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
- General Outcomes for Cardiovascular Diagnosis
- Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
- General Outcomes for the Whole Person
- Clinical skills: HISTORY (TD 13 a-b)
- Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
- Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
- General Surgical Outcomes
- General Outcomes for Surgical & Emergency Medicine & Anaesthesia
- Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
- General
- Clinical skills: SURGERY and ANAESTHETICS (TD 14 g)
- General Surgical Outcomes
- Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
- General Outcomes for Gastrointestinal System
- Medical knowledge: ANATOMY (TD 8.1)
- Medical knowledge: PHYSIOLOGY (TD 8.2)
- Gastrointestinal Motility
- Medical knowledge: NUTRITION (TD 8.11)
- Under nutrition and Malnutrition
- General Outcomes for Nutrition
-
Artificial Feeding (inc. Enteral Nutrition & Total Parenteral Nutrition)
- Describe how feeds can be administered: sip feeds; nasogastric and gastrostomy
- Explain how artificial feeding techniques minimise the principal complications of aspiration, dehydration, hyperglycaemia, sodium overload and diarrhoea
- Describe the techniques of peripheral and central venous parenteral nutrition and how the technique employed may reduce the risk of thrombophlebitis, sepsis, hyperglycaemia and sodium overload
- Protein Energy Malnutrition (PEM)
- Eating Disorders
- Clinical skills: HISTORY (TD 13 a-b)
- Abdominal Examination
- Patient History for GI Disorders
- Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
- General Outcomes for Gastrointestinal Diagnosis
- Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
- Pharmacological Therapy - Gastrointestinal Disorders (General)
- Professional issues: WORKING IN TEAMS (TD 22 a-c)
- Multi-disciplinary Team Work (MDT)
- General Outcomes for Renal and Urinary System
- Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
- General Procedures
- Clinical skills: DIAGNOSTIC PROCEDURES (TD 18 a)
- Acute and Chronic Limb Ischaemia / Peripheral Vascular Disease (Priority 2*) (See also Met 3A outcomes)
- General Outcomes for Limb Ischaemia / PVD
- Arterial Aneurysms (Priority 2*) (See also Met 3A outcomes)
- Acute Abdomen
- General Outcomes for Acute Abdomen
- Recognise the presentation of a patient with an acute abdomen
- Be able to take a history of a patient with an acute abdomen
- Be able to perform an examination of a patient with an acute abdomen
- Be able to elicit guarding (voluntary and involuntary), and rebound tenderness
- Able to offer a suitable differential diagnosis
- Be able to classify the causes of an acute abdomen
- Be able to institute a management plan for a patient with an acute abdomen
- Know the indications for referral from primary care
- Appendicitis
- Know the different positions of the appendix (retrocaecal, post-ileal, pre-ileal, pelvic)
- Describe the surgical anatomy of appendicectomy
- Know the classical and alternative presentations of appendicitis
- Know the different clinical picture of acute and perforated appendicitis
- Know the role of imaging in the diagnosis of appendicitis
- Know the differential diagnosis of appendicitis
- Be able to discriminate appendicitis from the other differential diagnoses on the patient's history
- Describe the blood and urine results in appendicitis
- Know the management of an appendix mass
- Know the role laparoscopy in the diagnosis and treatment of appendicitis
- Know the different surgical approaches to appendicectomy
- Know the complications of appendicectomy
- Know the aetiology of appendicitis
- Pancreatitis
- Understand the difference between mild and severe pancreatitis
- Be able to describe the early and late complications of acute pancreatitis
- Understand the difference between acute and chronic pancreatitis
- Know the classical clinical presentation of acute pancreatitis
- Know the causes of acute pancreatitis
- Know the pathophysiology of acute pancreatitis
- Know the differential diagnosis of acute pancreatitis
- Know the diagnostic investigations useful for the diagnosis of acute pancreatitis
- Know the role of Ultrasound, CT and ERCP in the management of acute pancreatitis
- Know Atlanta criteria for severity scoring
- Know the importance and prognostic value of the scoring systems (Ranson & Glasgow) in patient management
- Know the current indication for antibiotics in acute pancreatitis
- Be aware that acute severe pancreatitis can lead to multi-organ failure
- Describe the principles of management of acute pancreatitis
- Be aware of the role of surgery in the management of acute pancreatitis
- Be able to describe the epidemiology of pancreatitis
- General Outcomes for Acute Abdomen
- Diverticular Disease
- General Outcomes for Diverticular Disease
- Understand the causes of diverticular disease
- Understand the complications of diverticular disease
- Know the common presentation of a patient with acute diverticulitis
- Know the medical management of a patient with acute diverticulitis
- Understand the role of surgery in the management of a patient with acute diverticulitis
- General Outcomes for Diverticular Disease
- Disorders of the Hepato-biliary System
- Hepato-biliary Disorders - General
- Apply BRAINS&AIMS when choosing, giving and monitoring the following medications: Lactulose; Furosemide; Vasopressin; Phosphate Enema; Vitamin K; Spironolactone; Propranolol; Antibiotics eg Ciprofloxacin; Human Albumin Solution
- Be able to identify patients who are prone to drug-induced liver disease
- Be able to identify patients with active drug-induced hepatoxicity
- Be aware of the specialist drugs Interferon-a and Ribavirin. Be aware of their important adverse effects and drug-drug interactions
- Be aware that there are treatment options in hepatitis C infection
- Know how to monitor drug effects in patients with liver disease
- Know how to monitor patients for hepatotoxic drug effects
- Know which drugs may damage the liver and how this occurs
- Know the main indications / contraindications and mechanisms of action of and describe the main adverse effects of vasopressin
- Understand how liver disease alters how drugs work; adjust prescriptions in patients with liver disease
- Cirrhosis (General)
- Cholecystitis
- Know the pathology of gallstones
- Know the causes of cholecystitis
- Be able to differentiate between acute and chronic cholecystitis
- Be able to differentiate biliary colic from cholecystitis
- Be able to construct a differential diagnosis
- Be able to elicit Murphys sign
- Know the surgical options for the treatment of gallstones
- Know the epidemiology and risk factors for Gallstones
- Know the complications of cholecystitis
- Know the clinical signs and symptoms of acute cholecystitis
- Be able to take an accurate and comprehensive history from an acute patient with cholecystitis
- Competently be able to perform an abdominal examination for an acute patient with cholecystitis
- Be able to present clinical findings in a clear and logical manner
- Be able to describe radiological tests and findings to confirm diagnosis
- Be able to institute a management plan for a patient with acute cholecystitis
- Hepato-biliary Disorders - General
- GI Ulcer Disease and Bleeding
- General
- Define peptic ulceration; list the sites where peptic ulcers can occur
- Describe the different types of peptic ulcer and the underlying aetiological factors
- Describe the pathology of peptic ulcers; outline the features that distinguish between peptic ulcers and ulcerating carinomas
- Describe the treatment options for the management of peptic ulceration and non-ulcer dyspepsia
- Know how to detect and eradicate H.pylori
- Describe the treatment options for uncomplicated duodenal ulceration
- Discuss the management of recurrent peptic ulceration
- Know how to manage a patient with complicated peptic ulceration
- Discuss the value of endoscopy and barium examinations in the evaluation of patients with peptic ulcer disease
- Know how to manage a patient with dyspepsia in line with current NICE guidelines
- List the complications of peptic ulceration
- List the diagnostic features in a history which are suggestive of peptic ulceration
- Outline the causes of peptic ulceration; describe the role of H.pylori and non-steroidal anti-inflammatory drugs in the pathogenesis of peptic ulcers
- Be able to recognise the presence of free intra-peritoneal air on plain radiograph and CT Scan
- Be able to describe the epidemiology of duodenal and gastric ulceration
- Know the common anatomical sites of duodenal ulcer perforation
- Know the classical presentation of a patient with a perforated peptic ulcer
- Know the common causes of peptic ulcer perforation
- Know the initial resuscitative measures in a patient with a perforated peptic ulcer
- Understand the variable clinical presentations of a patient with a perforated peptic ulcer
- Know the available diagnostic investigations in a patient with perforated peptic ulcer
- Know the surgical management of a perforated peptic ulcer
- Know the conservative management of a perforated peptic ulcer and its indications
- Gastrointestinal Bleeding
- Be able to assess whether the patient requires immediate resuscitation (ABC)
- Be able to distinguish between upper and lower gastrointestinal bleeding
- Be able to list the causes of upper and lower gastrointestinal bleeding
- Be able to list the methods of fluid resuscitation
- Be able to outline the risk stratification of patients with a high risk of re-bleeding
- Know and understand the complications of massive blood transfusion
- Know how to manage a patient with an acute GI bleed
- Know the aetiopathology of the common causes of lower GI bleeding including: haemorrhoids; diverticular disease; ischaemic colitis; colonic polyps and carcinoma; angiodysplasia; ulcerative colitis
- Know the aetiology of common causes of upper GI bleeding including: duodenal ulcer; gastric ulcer; gastric erosions; oesophageal varices; Mallory Weiss tear
- Know the anatomy of the coeliac, superior and inferior mesenteric artery territories
- Know the endoscopic management of bleeding from the gastrointestinal tract
- Know the initial management of gastrointestinal haemorrhage
- Know the radiological investigations available for assessment of a gastrointestinal bleed
- Know the risk factors for upper gastrointestinal bleeding and the role of the GP in its prevention
- Know the role and indication of surgery in the management of gastrointestinal bleeding
- Know the role of red cell scanning and interventional radiology in the management of gastrointestinal bleeding
- Understand the role of oesophago-gastro-duodenoscopy (OGD) and colonoscopy in the management of gastrointestinal bleeding
- Gastro-oesophageal Reflux Disease (GORD)
- Apply BRAINS&AIMS when choosing, giving and monitoring: Antacids; H2 receptor blockers eg Ranitidine; Proton Pump Inhibitors eg Omeprazole; Misoprostol; Bismuth Chelate; Metoclopramide; Vasopressin: IV Fluids/Blood
- Describe the causes, pathology and complications of gastro-oesophageal reflux disease (GORD)
- Apply BRAINS&AIMS when choosing, giving and monitoring Antibiotics for H.Pylori eradication eg amoxycillin, clarithromycin, metronidazole;
- Define Barrett's Oesophagus; outline the aetiology, pathogenesis. pathology and complications
- Be able to look up the main indications, contraindications, cautions, mechanisms of action, main adverse effects, interactions and dosage regimen of Bismuth Chelate and Vasopressin
- Be able to distinguish between the following terms and conditions: Upper / Lower GI Bleeding; Dyspepsia; Gastro-oesophageal Reflux Disease; Peptic / Gastric / Duodenal Ulceration
- Be able to discuss non-pharmacological therapy with a patient with GORD or Peptic Ulcer Disease
- General
- Obstructive Disorders of the GI System
- Obstructive Jaundice
- Understand the physiology of the anatomy of the liver and gallbladder
- To be able to describe the physiology of bilirubin metabolism
- Understand the differences between conjugated and un-conjugated bilirubinaemia
- Be able to list the causes of jaundice
- Know the presentation of a patient with obstructive jaundice
- To be able to take a focussed history form a patient with obstructive jaundice
- Be able to present clinical findings with a patient with obstructive jaundice
- Know the relevant blood tests to determine cause of jaundice
- Understand the role of ultrasound in a patient with obstructive jaundice
- Understand the role of ERCP in a patient with obstructive jaundice
- Understand the role of Surgery in a patient with obstructive jaundice
- Bowel Obstruction (General)
- Small Bowel Obstruction
- Competently be able to examine a patient with small bowel obstruction
- Be able to obtain an accurate history from a patient with an small bowel obstruction
- Know the clinical features of small bowel obstruction
- Know the cardinal signs of small bowel obstruction
- List a differential diagnosis for small bowel obstruction
- Know the most common causes of mechanical small bowel obstruction
- Understand the biochemical derangements resulting from small bowel obstruction
- Know the complications that can result from small bowel obstruction including: ischaemia, perforation and biochemical derangement
- Know the appropriate imaging in the investigation of acute abdominal pain including: plain radiography (erect chest X-Ray and abdominal X-Ray), abdominal ultrasound scan, CT scan, contrast studies
- Be able to interpret plain abdominal X-Rays showing small bowel obstruction
- Know the conservative treatment of small bowel obstruction
- Understand the importance of small bowel obstruction as an acute surgical presentation.
- Know the indications for surgical intervention and the consequences of resection of small bowel
- Know the operative procedures available for small bowel obstruction
- Know the possible post-op complications of surgical treatment for small bowel obstruction
- Large Bowel Obstruction
- Know the most common causes and classification of mechanical large bowel obstruction
- Understand the biochemical derangements resulting from large bowel obstruction
- Know the clinical features and cardinal signs associated with large bowel obstruction
- Competently be able to obtain an accurate history from a patient with large bowel obstruction
- Know the imaging modalities available to interpret cause of large bowel obstruction
- Be able to interpret plain abdominal X-Rays showing large bowel obstruction
- Know the complications that can result from large bowel obstruction: (ischaemia, perforation and biochemical derangement)
- Understand the importance of large bowel obstruction as an acute surgical presentation
- Know the indications for surgical intervention and the consequences of resection of the large bowel
- Understand the operative procedures available for large bowel obstruction
- Know the possible post-operative complications of surgical treatment
- Obstructive Jaundice
- Gastrointestinal Cancer
- General Outcomes for Gastrointestinal Cancer
- Oesophageal Cancer
- Gastric Cancer
- Colorectal Cancer
- Understand the incidence and prevalence of colorectal cancer
- Know the risk factors for colorectal cancer
- Know the genetic groups at risk of colorectal cancer
- Be able to take a history for a patient with colorectal disease
- Be able to perform a examination for a patient with colorectal cancer
- Be able to present clinical findings in a clear and logical manner
- Know the symptoms and signs of colorectal cancer
- To understand the investigations for colorectal cancer
- Be able to define the triple assessment for colorectal cancer
- Be aware of the importance of multi disciplinary teams in the management of colorectal cancer
- Know the surgical treatment of colorectal cancer
- Understand the role of the colorectal nurse specialist / colorectal stoma nurse
- Be able to recognise a stoma and its problems
- Understand the role of palliative care in the management of colorectal cancer
- Diarrhoeal and Inflammatory Disorders
- General Outcomes for Diarrhoeal and Inflammatory Disorders
- Be able to take a history of a patient with diarrhoea
- Understand the assessment of a patient with diarrhoea
- Be able to request the investigations to establish a diagnosis
- Be able to offer a differential diagnosis for a patient presenting with diarrhoea
- Be able to understand the different methods of presentation of infectious diarrhoea and inflammatory bowel disease
- Know the treatment options for diarrhoea
- Compare and contrast the clinical and pathological features of the idiopathic types of Ulcerative Colitis and Crohn's Disease
- Understand the public health implications and management of infectious diarrhoea
- Describe the clinical features of Crohn's Disease and Ulcerative Colitis; know the main features of other common types of IBD
- Be able to distinguish between the following terms and conditions: increased bowel frequency; diarrhoea; inflammatory / secretory / osmotic diarrhoea; irritable bowel syndrome; diverticular disease; vomiting centre; chemoreceptor trigger zone
- Describe the management of acute infective diarrhoea
- Describe the pathophysiological mechanisms that may produce diarrhoea
- Outline the management of a patient with Crohn's Disease affecting the small bowel
- List the causes of diarrhoea and outline the diagnostic features in the history
- Be able to distinguish between the following terms and conditions: Crohn's Disease; Ulcerative Colitis; Irritable Bowel Syndrome; Acute Flare; Toxic Megacolon; Infective Diarrhoea
- Be able to recognise when surgical referral is appropriate
- Know how manifestations of Crohn's depends on site and severity of disease
- Know how to manage a patient with active Crohn's Disease in line with current BSG guidelines
- Know how to manage a patient with severe ulcerative colitis in line with current BSG guidelines
- Understand the role of monitoring patients with inflammatory bowel disease
- Inflammatory Bowel Disease
- Understand from a patient perspective of living with inflammatory disease
- Be aware of the specialist drugs: Thiopurines eg Azathipprine; Ciclosporin; Methotrexate; Anti-TNFa eg infliximab
- Understand the difference between Crohns Disease and Ulcerative Colitis
- Recognise when a patient should be referred for specialist treatment
- Appreciate the mutidisciplinary team approach to the treatment of IBD
- Use specialist drugs under close specialist supervision only and monitor patients taking these drugs
- Understand the medical options of treatment of IBD
- Recognise that patients presenting to you unwell, may be so as a result of an adverse reaction these medications; be aware of important adverse effects and interactions to avoid in inadvertent serious drug-drug interactions
- Understand the surgical options of treatment of IBD
- Understand the following issues with a patient who has an inflammatory bowel disease: importance of nutrition; drugs used to maintain remission; surveillance for colonic cancer; risk of osteoporosis and measures to reduce this; sources of support and info
- List the complications of IBD, in particular the extra-intestinal manifestations
- Outline the investigation of a patient suspected of having inflammatory bowel disease
- Outline the management of a patient with acute ulcerative colitis
- Outline the risk of colonic malignancy in IBD; describe the methods used in screening for malignancy in IBD
- Be able to take a history from, and examine a patient with inflammatory bowel disease
- Be able to implement a strategy for pain control in a patient with inflammatory bowel disease
- Be able to recognise potentially life-threatening complications of inflammatory bowel disease
- General Outcomes for Diarrhoeal and Inflammatory Disorders
- GI Surgery and Anaesthetics (General)
- Surgery - General
- Be able to describe the complications from major abdominal surgery
- Be able to describe the indications, operations and complications associated with oesophagectomy and gastrectomy
- Know the indications, operations and complications associated with laparoscopic cholecystecomy
- Know the indications, operations and complications associated with right hemicolectomy, anterior resection and the formation of stoma
- Be able to describe the indications, operations and complications associated with Hartman's Operation and abdominoperineal excision of the rectum
- Be able to describe the indications, operations and complications associated with splenectomy
- Be able to describe the indications, operations and complications associated with treatment for haemorrhoids, fissures and fistula
- Surgery - General
- Malabsorption Disorders
- Malabsorption Disorders - General