Year 3 MET3A: Gastroenterology and Cancer (MET3A)

Lecture: Intro and History of Surgery & GI Surgical Operations

Lecture: History and Examination of the Abdomen

1. Take history and define the presenting complaint
2. Know the four quadrants and nine regions of the abdomen
3. Be aware of some common findings on inspection, auscultation and palpation of the abdomen, and what they may mean
4. Know the reason for the sequence of abdominal examination
5. Understand how some common abdominal conditions are diagnosed using physical examination

Lecture: The Acute Abdomen (Priority 1)

1. Recognise the presentation of a patient with an acute abdomen
2. Be able to take a history of a patient with an acute abdomen
3. Be able to perform an examination of a patient with an acute abdomen
4. Be able to elicit guarding (voluntary and involuntary), and rebound tenderness
5. Able to offer a suitable differential diagnosis
6. Be able to classify the causes of an acute abdomen
7. Be able to institute a management plan for a patient with an acute abdomen
8. Know the indications for referral from primary care

Clinical Scenario 2: Sepsis

Diarrhoea: Case Base Discussion

1. Be able to take a history of a patient with diarrhoea
2. Understand the assessment of a patient with diarrhoea
3. Be able to request the investigations to establish a diagnosis
4. Be able to offer a differential diagnosis for a patient presenting with diarrhoea
5. Be able to understand the different methods of presentation of infectious diarrhoea and inflammatory bowel disease
6. Know the treatment options for diarrhoea
7. Understand the public health implications and management of infectious diarrhoea
8. 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
9. Describe the management of acute infective diarrhoea
10. Describe the pathophysiological mechanisms that may produce diarrhoea
11. Know when and how to investigate a patient with diarrhoea, constipation or altered bowel habit
12. List the causes of diarrhoea and outline the diagnostic features in the history
13. Understand the significance of complaints of diarrhoea, constipation and altered bowel habit

Lecture: Trauma

1. Describe the key concepts in trauma care
2. Know of trauma as a leading cause of death
3. Understand the different mechanisms of injury and how these produce different patterns and types of injuries
4. Know that outcomes for trauma care can be significantly improved by timeliness of action, prehospital care, centralised care management (MTCs), secondary transfers, effective handovers and communication
5. Recognise the burden of trauma: mortality, long term morbidity/disability, psychological sequelae, economic
6. Know how trauma calls are handled, depending on severity of case
7. Know the ATMIST and AMPLE approaches to history taking and ATLS approach to patient assessment
8. Know the different approaches to management and resuscitation of trauma patients: ABCDE, radiology, resuscitation (including DCR), ROTEM (rotational thromboelastometry), damage control surgery

Post Operative Complications: Clincial Scenarios

1. To recognise those at risk of complications
2. To recognise complications early
3. To categorise complications accordingly
4. To appreciate appropriate investigations and management

Lecture: Vascular 1: Examination of the Perpheral Vascular System Live Demo

1. Describe the vascular system components
2. Know a structured correct procedures for carrying out peripheral arterial vascular examination of the arm, the abdomen and legs; including pulses, Buerger’s test; ABPI
3. Carry out a venous examination of the lower limbs
4. Understand the pathophysiology of the visible skin changes of venous disease; relate the pathophysiology to the spectrum of complications of venous insufficiency

Lecture: Vascular 2: Aneuysms, PVD and Varicose Veins

1. Describe the pathogenesis of atherosclerosis
2. Describe the signs and symptoms of intermittent claudication
3. Know the epidemiology of peripheral arterial disease (PAD)
4. Describe the symptoms of critical limb ischaemia, approach to diagnosis of this condition, risk factors, prognosis and options for treatment
5. Describe the principles of angioplasty and the risks and benefits associated
6. Understand the principles of bypass surgery and appreciate the higher medical risk associated with comorbidity
7. Understand the importance of Best medical therapy and the non-surgical treatment approaches to PAD
8. Define aneurysms, explain the epidemiology and pathology of aneurysms (AAA and popliteal) and the risk factors predisposing to this condition
9. Explain the indications for surgery and associated risk factors in AAA
10. Know the epidemiology of varicose veins, its clinical assessment, methods of treatment and potential complications and benefits of endovenous technology
11. Explain aortic dissection, the risk factors predisposing to it and the examination and diagnosis of this condition

SDL and CE: Glomerulonephritis (GN)

1. Be aware of the proposed pathophysiology mechanisms behind the development of oedema in nephrotic syndrome.
2. Be aware of the proposed pathophysiology mechanisms behind the development of oedema in nephrotic syndrome.
3. Understand the principles behind the management of nephrotic syndrome.
4. Understand the principles behind the management of nephrotic syndrome.

Lecture: Drugs of the Gastrointestinal Tract

1. When treating GI disease diagnose cause of the problem
2. Use drugs selectively
3. Be aware of side-effects
4. Encourage compliance/adherence
5. Know treatments for IBD, reflux and peptic diseases, use of anti-emetics and laxatives

Lecture: A Lump in the Groin

1. Be able to differentiate different lump protrusions: groin lumps (inguinal hernia, femoral hernia, hydrocele, aneurysm of the femoral artery, saphena varix, psoas abcess); anywhere lumps (soft tissue tumours)
2. Know of the different types of hernias and their prevalence: inguinal, femoral, umbilical, paraumbilical, epigastric, incisional, Spigelian, lumbar, obturator
3. Describe the presentation and progression of different types of hernias
4. Know the surface anatomy of the abodomen and the anatomy of the inguinal canal in relation to other structures in the inguinal region
5. Know the etiology of hernias: direct and indirect
6. Know the epidemiology of hernias: frequency and age-related prevalence
7. Describe the management of hernias
8. Know of other types of hernias: femoral hernia, Richeter's hernia

Lecture: Surgical and GI Radiology

Learning Outcomes TBA

1. Interpret abdominal radiographs (AXR)
2. Know key imaging signs to recognise post surgical complications
3. Know key imaging signs to recognise acute surgical emergencies
4. Recognise important case presentations.

Lecture: Preadmission Clinic and Preoperative Care

1. Know how and why pre-operative assessment is undertaken, including ABCDE, ASA grading, surgical grading and investigations
2. Know of cardiovascular and respiratory assessments to reduce per-operative risk
3. Consider other risk factors to qualify patient's per-operative risk (e.g. disability, drugs, exposure)

Lecture: Hepatitis

1. Understand investigation of liver disease
2. Identify causes of hepatitis
3. Know the epidemiology, diagnosis and treatment of viral hepatitis
4. Appreciate spectrum of alcohol related liver disease and fatty liver disease
5. Understand management of alcoholic hepatitis

Lecture: GI and Peripheral Vascular anatomy

1. Revise basic gross GI anatomy
2. Review the blood supply to the gut
3. Understand somatic vs visceral pain and its clinical relevance
4. Apply anatomical knowledge to common clinical presentations

Lecture: Lower Gastrointestinal Pathology

1. Discuss the pathology of colorectal polyps, colorectal carcinoma, inflammatory bowel disease

Lecture: Colorectal Disorders

Learning Outcomes TBA

Lecture: Upper GI Pathology

Learning Outcomes TBA

1. Discuss the pathology of Barrett's oesophagus, oesophageal carcinoma, chronic gastritis, peptic ulceration, gastric carcinoma

Lecture: Chronic Liver Disease

1. To identify causes of chronic liver disease
2. To understand the diagnosis and management of chronic liver disease
3. To appreciate the complications of chronic liver disease
4. To learn about treatment options for chronic liver disease

Lecture: Patient Safety

1. Understand the importance of team-work and safe team-working
2. Know of safety-checking procedures: anaesthetic checks, patient checks pre-theatre, in-theatre checks ('Time Out', WHO Safer Surgery Initiative), blood transfusion checks
3. Minimise risk of contamination through infection control within theatre: hand-washing, sterile and clean technique

PBL Scenario 1

PBL Scenario 2

PBL Scenario 3

PBL Scenario 4

PBL Scenario 5

PBL Scenario 6

PBL Scenario 7

PBL Scenario 8

The Acute Abdomen Live Demostration

Clinical Skills for Met 3A

Gallstones/Pancreatitis: Case Case Discussion

MDT 1: Colorectal Cancer [Priority 1]

1. Understand the incidence and prevalence of colorectal cancer
2. Know the risk factors for colorectal cancer
3. Know the genetic groups at risk of colorectal cancer
4. Be able to take a history for a patient with colorectal disease
5. Be able to perform a examination for a patient with colorectal cancer
6. Be able to present clinical findings in a clear and logical manner
7. Know the symptoms and signs of colorectal cancer
8. To understand the investigations for colorectal cancer
9. Be able to define the triple assessment for colorectal cancer
10. Be aware of the importance of multi disciplinary teams in the management of colorectal cancer
11. Know the surgical treatment of colorectal cancer
12. Understand the role of the colorectal nurse specialist / colorectal stoma nurse
13. Be able to recognise a stoma and its problems
14. Understand the role of palliative care in the management of colorectal cancer

Clinical Scenario 1: Gastrointestinal Bleeding (Priority 2)

NOTE: A virtual patient is available for this condition. Please log in to Blackboard

1. Be able to assess whether the patient requires immediate resuscitation (ABC)
2. Be able to distinguish between upper and lower gastrointestinal bleeding
3. Be able to list the causes of upper and lower gastrointestinal bleeding
4. Be able to list the methods of fluid resuscitation
5. Be able to outline the risk stratification of patients with a high risk of re-bleeding
6. Know how to manage a patient with an acute GI bleed
7. Know and understand the complications of massive blood transfusion
8. Know the aetiopathology of the common causes of lower GI bleeding including: haemorrhoids; diverticular disease; ischaemic colitis; colonic polyps and carcinoma; angiodysplasia; ulcerative colitis
9. Know the aetiology of common causes of upper GI bleeding including: duodenal ulcer; gastric ulcer; gastric erosions; oesophageal varices; Mallory Weiss tear
10. Know the anatomy of the coeliac, superior and inferior mesenteric artery territories
11. Know the endoscopic management of bleeding from the gastrointestinal tract
12. Know the initial management of gastrointestinal haemorrhage
13. Know the radiological investigations available for assessment of a gastrointestinal bleed
14. Know the risk factors for upper gastrointestinal bleeding and the role of the GP in its prevention
15. Know the role and indication of surgery in the management of gastrointestinal bleeding
16. Know the role of red cell scanning and interventional radiology in the management of gastrointestinal bleeding
17. Understand the role of oesophago-gastro-duodenoscopy (OGD) and colonoscopy in the management of gastrointestinal bleeding

CBD 1: Vascular Surgery

CBD 2: Inflammatory Bowel Disease [Priority 2]

NOTE: A virtual patient is available for this condition. Please log in to Blackboard

1. Understand from a patient perspective of living with inflammatory disease
2. Understand the difference between Crohns Disease and Ulcerative Colitis
3. Appreciate the mutidisciplinary team approach to the treatment of IBD
4. Understand the medical options of treatment of IBD
5. Understand the surgical options of treatment of IBD
6. Compare and contrast the clinical and pathological features of the idiopathic types of Ulcerative Colitis and Crohn's Disease
7. 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
8. Describe the clinical features of Crohn's Disease and Ulcerative Colitis; know the main features of other common types of IBD
9. List the complications of IBD, in particular the extra-intestinal manifestations
10. Outline the investigation of a patient suspected of having inflammatory bowel disease
11. Outline the management of a patient with acute ulcerative colitis
12. Outline the management of a patient with Crohn's Disease affecting the small bowel
13. Outline the risk of colonic malignancy in IBD; describe the methods used in screening for malignancy in IBD
14. Be able to take a history from, and examine a patient with inflammatory bowel disease
15. Be able to distinguish between the following terms and conditions: Crohn's Disease; Ulcerative Colitis; Irritable Bowel Syndrome; Acute Flare; Toxic Megacolon; Infective Diarrhoea
16. Be able to implement a strategy for pain control in a patient with inflammatory bowel disease
17. Be able to recognise potentially life-threatening complications of inflammatory bowel disease
18. Be able to recognise when surgical referral is appropriate
19. Know how manifestations of Crohn's depends on site and severity of disease
20. Know how to manage a patient with active Crohn's Disease in line with current BSG guidelines
21. Know how to manage a patient with severe ulcerative colitis in line with current BSG guidelines
22. Understand the role of monitoring patients with inflammatory bowel disease

SDL & CE: History Taking

1. Initiate consultation and establish rapport
2. Take history and define the presenting complaint
3. Ascertain relevant past medical history, including drug history, allergies, family history and social history
4. Undertake systems review

SDL & CE: Oesophageal Cancer

1. Know the aetiology of oesophageal cancer
2. Know the common presentation of a patient with oesophageal cancer
3. To understand the medical, surgical and endoscopic treatment of oesophageal cancer including palliation
4. Understand the role of the primary care team in the palliative care of terminal gastrointestinal disease.

SDL & CE: Specific Investigations: Interpretation of an Abdominal X-Ray (AXR)

1. Attend radiology meetings to improve skills on AXR
2. Orientate AXR
3. Distinguish between Supine and Erect
4. Describe the adequacy of films, including rotation and penetration
5. Describe the appearance of a normal AXR; Bones (vertebrae, pelvis) Bowel gas patterns, Psoas shadow, Urinary tract
6. Identify abnormalities from X-Ray

SDL & CE: Gastric Cancer (Priority 3)

1. To understand the aetiology of gastric cancer
2. Know the common presentation of a patient with gastric cancer
3. To understand the medical, surgical and endoscopic treatment of gastric cancer

SDL & CE: Specific Investigations: Interpretation of an erect Chest X-Ray (CXR)

1. Orientate CXR
2. Distinguish between Supine and Erect
3. Describe the adequacy of films, including rotation and penetration
4. Describe the appearance of a normal CXR
5. Identify abnormalities: abdominal perforation, pneumothorax, haemothorax

SDL & CE: Nutrition [Priority 2]

1. Define adult groups who are at particular risk of under nutrition in the UK eg, Vitamin D deficiency in Asians; iron and vitamin deficiencies in Vegans and the elderly
2. Describe how a patient's energy requirements can be calculated
3. Describe how feeds can be administered: sip feeds; nasogastric and gastrostomy
4. Explain how artificial feeding techniques minimise the principal complications of aspiration, dehydration, hyperglycaemia, sodium overload and diarrhoea
5. Describe the effects of protein-calorie malnutrition on muscle function; delayed hypersensitivity; wound healing and gonadal function
6. 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
7. Outline the management of a patient with anorexia nervosa
8. Describe the role of primary care in the support and monitoring of patients requiring supplementary nutrition
9. Outline the management of a patient with short bowel syndrome

SDL & CE: Specific Investigations: Interpretation of Urinalysis

1. Carry out a basic urinanalysis
2. Understand the importance of a positive test

SDL & CE: Specific clinical practical skills

1. Carry out scrubbing up, gowning and gloving using correct technique
2. Understand and follow basic theatre principles
3. Be able to carry out basic suturing
4. Measure ankle brachial pressure index
5. Insert a urinary catheter
6. Insert an NG tube

SDL & CE: Specific Practical Skills

1. know basic theatre principles
2. perform basic suturing skills
3. carry out ankle brachial pressure index measurement
4. perform insertion of urinary catheter
5. perform insertion of naso-gastric tube

SDL & CE: Acute Appendicitis [Priority 1]

1. Know the different positions of the appendix (retrocaecal, post-ileal, pre-ileal, pelvic)
2. Describe the surgical anatomy of appendicectomy
3. Know the classical and alternative presentations of appendicitis
4. Know the different clinical picture of acute and perforated appendicitis
5. Understand the significance of McBurney's point
6. Know the role of imaging in the diagnosis of appendicitis
7. Know the differential diagnosis of appendicitis
8. Be able to discriminate appendicitis from the other differential diagnoses on the patient's history
9. Describe the blood and urine results in appendicitis
10. Know the management of an appendix mass
11. Know the role laparoscopy in the diagnosis and treatment of appendicitis
12. Know the different surgical approaches to appendicectomy
13. Know the complications of appendicectomy
14. Know the aetiology of appendicitis

SDL & CE: Acute Cholecystitis [Priority 1]

NOTE: A virtual patient is available for this condition. Please log in to Blackboard

1. Know the pathology of gallstones
2. Know the causes of cholecystitis
3. Be able to differentiate between acute and chronic cholecystitis
4. Be able to differentiate biliary colic from cholecystitis
5. Be able to construct a differential diagnosis
6. Be able to elicit Murphys sign
7. Know the surgical options for the treatment of gallstones
8. Know the epidemiology and risk factors for Gallstones
9. Know the complications of cholecystitis
10. Know the clinical signs and symptoms of acute cholecystitis
11. Be able to take an accurate and comprehensive history from an acute patient with cholecystitis
12. Competently be able to perform an abdominal examination for an acute patient with cholecystitis
13. Be able to present clinical findings in a clear and logical manner
14. Be able to describe radiological tests and findings to confirm diagnosis
15. Be able to institute a management plan for a patient with acute cholecystitis

SDL & CE: Acute Pancreatitis [Priority 1]

1. Understand the difference between mild and severe pancreatitis
2. Be able to describe the early and late complications of acute pancreatitis
3. Understand the difference between acute and chronic pancreatitis
4. Know the classical clinical presentation of acute pancreatitis
5. Know the causes of acute pancreatitis
6. Know the pathophysiology of acute pancreatitis
7. Know the differential diagnosis of acute pancreatitis
8. Know the diagnostic investigations useful for the diagnosis of acute pancreatitis
9. Know the role of Ultrasound, CT and ERCP in the management of acute pancreatitis
10. Know Atlanta criteria for severity scoring
11. Know the importance and prognostic value of the scoring systems (Ranson & Glasgow) in patient management
12. Know the current indication for antibiotics in acute pancreatitis
13. Be aware that acute severe pancreatitis can lead to multi-organ failure
14. Describe the principles of management of acute pancreatitis
15. Be aware of the role of surgery in the management of acute pancreatitis
16. Be able to describe the epidemiology of pancreatitis

SDL & CE: Obstructive Jaundice [Priority 1]

1. Understand the physiology of the anatomy of the liver and gallbladder
2. To be able to describe the physiology of bilirubin metabolism
3. Understand the differences between conjugated and un-conjugated bilirubinaemia
4. Be able to list the causes of jaundice
5. Know the presentation of a patient with obstructive jaundice
6. To be able to take a focussed history form a patient with obstructive jaundice
7. Be able to present clinical findings with a patient with obstructive jaundice
8. Know the relevant blood tests to determine cause of jaundice
9. Understand the role of ultrasound in a patient with obstructive jaundice
10. Understand the role of ERCP in a patient with obstructive jaundice
11. Understand the role of Surgery in a patient with obstructive jaundice

SDL & CE: Acute Diverticulitis [Priority 1]

1. Understand the causes of diverticular disease
2. Understand the complications of diverticular disease
3. Know the common presentation of a patient with acute diverticulitis
4. Know the medical management of a patient with acute diverticulitis
5. Understand the role of surgery in the management of a patient with acute diverticulitis

SDL & CE: Small Bowel Obstruction [Priority 1]

1. Competently be able to examine a patient with small bowel obstruction
2. Be able to obtain an accurate history from a patient with an small bowel obstruction
3. Know the clinical features of small bowel obstruction
4. Know the cardinal signs of small bowel obstruction
5. List a differential diagnosis for small bowel obstruction
6. Know the most common causes of mechanical small bowel obstruction
7. Understand the biochemical derangements resulting from small bowel obstruction
8. Understand the difference between simple and strangulating intestinal obstruction
9. Know the complications that can result from small bowel obstruction including: ischaemia, perforation and biochemical derangement
10. 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
11. Be able to interpret plain abdominal X-Rays showing small bowel obstruction
12. Know the conservative treatment of small bowel obstruction
13. Understand the importance of small bowel obstruction as an acute surgical presentation.
14. Know the indications for surgical intervention and the consequences of resection of small bowel
15. Know the operative procedures available for small bowel obstruction
16. Know the possible post-op complications of surgical treatment for small bowel obstruction

SDL & CE: Large Bowel Obstruction [Priority 1]

1. Know the normal function of the large bowel
2. Know the most common causes and classification of mechanical large bowel obstruction
3. Understand the biochemical derangements resulting from large bowel obstruction
4. Know the clinical features and cardinal signs associated with large bowel obstruction
5. Competently be able to obtain an accurate history from a patient with large bowel obstruction
6. Know the imaging modalities available to interpret cause of large bowel obstruction
7. Be able to interpret plain abdominal X-Rays showing large bowel obstruction
8. Know the complications that can result from large bowel obstruction: (ischaemia, perforation and biochemical derangement)
9. Understand the importance of large bowel obstruction as an acute surgical presentation
10. Know the indications for surgical intervention and the consequences of resection of the large bowel
11. Understand the operative procedures available for large bowel obstruction
12. Know the possible post-operative complications of surgical treatment

SDL & CE: Gastrointestinal Operations - General

1. Know the surgical anatomy of the abdomen including the peritoneum
2. Be able to describe the complications from major abdominal surgery
3. Be able to describe the indications, operations and complications associated with oesophagectomy and gastrectomy
4. Know the indications, operations and complications associated with laparoscopic cholecystecomy
5. Know the indications, operations and complications associated with right hemicolectomy, anterior resection and the formation of stoma
6. Be able to describe the indications, operations and complications associated with Hartman's Operation and abdominoperineal excision of the rectum
7. Be able to describe the indications, operations and complications associated with splenectomy
8. Be able to describe the indications, operations and complications associated with treatment for haemorrhoids, fissures and fistula

SDL & CE: Limb Ulceration [Priority 3 - see also CR3]

SDL & CE: Gangrene [Priority 3 - See also CR3]

SDL & CE: Varicose Veins [Priority 3 - See also CR3]

SDL & CE: Abdominal Aortic Aneurysm

1. Describe the symptoms and signs of a patient presenting with a leak or rupture of an aneurysm of : a) the abdominal aorta; b) the thoracic aorta
2. Describe the emergency management of a patient presenting with a leaking or ruptured aortic aneurysm

SDL & CE: Pharmacological Management of Liver Disease (Priority 3)

1. 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
2. Give indications for percutaneous transluminal angioplasty and arterial reconstruction surgery
3. Be able to identify patients who are prone to drug-induced liver disease
4. Be able to identify patients with active drug-induced hepatoxicity
5. Be aware of the specialist drugs Interferon-a and Ribavirin. Be aware of their important adverse effects and drug-drug interactions
6. Be aware that there are treatment options in hepatitis C infection
7. Know how to monitor drug effects in patients with liver disease
8. Know how to monitor patients for hepatotoxic drug effects
9. Know which drugs may damage the liver and how this occurs
10. Know the main indications / contraindications and mechanisms of action of and describe the main adverse effects of vasopressin
11. Understand how liver disease alters how drugs work; adjust prescriptions in patients with liver disease

SDL & CE: Cirrhosis

1. Be able to define Cirrhosis and its main causes
2. Describe the morphological features of cirrhosis and discuss the pathogenetic mechanisms that underlie its complication

SDL & CE: Pharmacological Management of Inflammatory Bowel Disease (Priority 2)

1. Apply BRAINS&AIMS when choosing, giving and monitoring: 5-Aminosalicylates eg Sulphasalazine; Mesalazine; IV Fluids and Corticosteroids
2. Be aware of the specialist drugs: Thiopurines eg Azathipprine; Ciclosporin; Methotrexate; Anti-TNFa eg infliximab
3. Recognise when a patient should be referred for specialist treatment
4. Use specialist drugs under close specialist supervision only and monitor patients taking these drugs
5. 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

SDL & CE: Gastro-Oesophageal Reflux Disease (GORD) [Priority 1]

1. Describe the causes, pathology and complications of gastro-oesophageal reflux disease (GORD)
2. Define Barrett's Oesophagus; outline the aetiology, pathogenesis. pathology and complications
3. Be able to distinguish between the following terms and conditions: Upper / Lower GI Bleeding; Dyspepsia; Gastro-oesophageal Reflux Disease; Peptic / Gastric / Duodenal Ulceration
4. Be able to discuss non-pharmacological therapy with a patient with GORD or Peptic Ulcer Disease
5. Know how to detect and eradicate H.pylori

SDL & CE: Pharmacological Management of GORD

1. 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
2. Apply BRAINS&AIMS when choosing, giving and monitoring Antibiotics for H.Pylori eradication eg amoxycillin, clarithromycin, metronidazole;
3. 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
4. Know how to manage a patient with dyspepsia in line with current NICE guidelines

SDL & CE: Peptic Ulcer Disease [Priority 1]

1. Define peptic ulceration; list the sites where peptic ulcers can occur
2. Describe the different types of peptic ulcer and the underlying aetiological factors
3. Describe the pathology of peptic ulcers; outline the features that distinguish between peptic ulcers and ulcerating carinomas
4. Describe the treatment options for the management of peptic ulceration and non-ulcer dyspepsia
5. Know how to detect and eradicate H.pylori
6. Describe the treatment options for uncomplicated duodenal ulceration
7. Discuss the management of recurrent peptic ulceration
8. Know how to manage a patient with complicated peptic ulceration
9. Discuss the value of endoscopy and barium examinations in the evaluation of patients with peptic ulcer disease
10. List the complications of peptic ulceration
11. List the diagnostic features in a history which are suggestive of peptic ulceration
12. Outline the causes of peptic ulceration; describe the role of H.pylori and non-steroidal anti-inflammatory drugs in the pathogenesis of peptic ulcers
13. Know the anatomy and blood supply to the stomach and duodenum and their relation to the pancreas
14. Know what a patient with peritonitis board like rigidity is like to examine
15. Be able to recognise the presence of free intra-peritoneal air on plain radiograph and CT Scan
16. Be able to describe the epidemiology of duodenal and gastric ulceration
17. Know the common anatomical sites of duodenal ulcer perforation
18. Know the classical presentation of a patient with a perforated peptic ulcer
19. Know the common causes of peptic ulcer perforation
20. Know the initial resuscitative measures in a patient with a perforated peptic ulcer
21. Understand the variable clinical presentations of a patient with a perforated peptic ulcer
22. Know the available diagnostic investigations in a patient with perforated peptic ulcer
23. Know the surgical management of a perforated peptic ulcer
24. Know the conservative management of a perforated peptic ulcer and its indications

SDL & CE: The Role of the Anaesthetist [Priority 1]

1. Develop a general understanding of the role of the anaesthetist and the multiple roles they perform
2. Know the role of the anaesthetist includes: pre-operative assessment of patient
3. Know the role of the anaesthetist includes: peri-operative management of patients

SDL & CE: Basic Understanding of Anaesthesia [Priority 1]

1. Attain a basic understanding of the different types of anaesthesia: general; regional; local

SDL & CE: Pre-operative Assessment [Priority 1]

1. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on cardiac and respiratory assessment and disease
2. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on the diabetic patient
3. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on the obese patient
4. Have an understanding of patient physiology and pathology relevant to the peri-operative period with special emphasis on investigations relevant to anaesthesia and surgery

SDL & CE: Post Operative Complications

1. To understand the general and common presentations of post operative complications including DVT/PE, infection, haemorrhage, anastomotic leak, urinary retention, cardiopulmonary complications
2. To understand the stress response to surgery

SDL & CE: Patient Monitoring during Anaesthesia [Priority 1]

1. Be able to use and know the limitations of pulse oximetry and blood pressure management (automated and invasive methods)
2. Be able to use and know the limitations of ECG (continuous monitoring)
3. Be able to use and know the limitations of the use of CO2 monitoring (capnography) to confirm correct placement of endotracheal tubes

SDL & CE: Anaesthetics: The Prescription Chart

1. Have a general understanding of safe prescribing practice
2. Understand simple post-operative prescribing (analgesia, anti-emetics, fluids); and how to complete such prescriptions on mock charts
3. Have a basic understanding of the use of patient controlled analgesia (PCA) and epidurals for post-operative pain
4. Know how to reduce the risk of medication error
5. Understand the importance of allergy checks and documentation

SDL & CE: Anaesthetics: Analgesia and Post-operative Pain

1. Have an understanding of analgesia including post-operative pain; NSAIDs and opioids; the WHO pain ladder
2. A basic understanding of the use of PCAs and epidurals for post operative pain
3. Understand the role of the acute pain team.

SDL & CE: Anaesthetics: Fluid Therapy

1. Know the types of IV fluid and their uses peri-operatively; how to write a simple post-operative fluid regimen and perform a simple assessment of a patient's fluid status
2. Know the procedure for the safe prescription and delivery of blood

SDL & CE: Anaesthetics: Oxygen Therapy

1. Know when to give oxygen and which delivery system to use
2. Know the methods of delivering oxygen (fixed vs. variable delivery systems)
3. Know how to monitor patients receiving oxygen

SDL & CE: Anaesthetics: Anti-Emetics

1. Know the anti-emetic drugs commonly used
2. Know the indications for use of anti-emetics

SDL & CE: Anaesthetics: Local Anaesthetics

1. Know the long and short acting and methods of administration of local anaesthetics
2. Regarding local anaesthetics, know the maximum safe dosages and have an understanding of how the % concentration relates to mg/ml when calculating doses
3. Regarding local anaesthetics, know the toxicity symptoms signs and treatment

SDL & CE: Anaesthetics: Care of the Unconscious Patient

1. Know the assessment and management of the airway and prevention of aspiration
2. Know the assessment of the Glasgow Coma Scale (GCS); attention to pressure points and maintenance of temperature

SDL & CE: Anaesthetics: The Initial Approach to the Sick Patient

1. Be able to recognise the sick patient
2. Know the early warning scores eg, patient at risk scores
3. Understand a simple ABCDE approach to any acutely ill patient

SDL & CE: Anaesthetics: Patient Related Communication Skills

1. Consent - the discussion of risk with patients. This is best accomplished by student observation of the anaesthetic pre-assessment

SDL & CE: Anaesthetics: Team Related Communication Skills

1. Effective communication between professionals; how to refer a patient and ask for advice or help from another professional
2. Effective telephone communication
3. Communication within a team during an emergency
4. Effective handover

SDL & CE: Anaesthetics: Patient Safety

1. Know what patient safety is and why it is important
2. Understand how to maximise patient safety
3. Know of error reduction strategies and other methods to maximise safety
4. Know how to report errors as incidents, serious incidents, near misses, never events