IBD, liver disease, pancreatitis, GI malignancies, coeliac disease, and functional gut disorders with endoscopic and pharmacological management.
Oesophageal motility disorder characterised by failure of LOS relaxation and absent peristalsis, causing progressive dysphagia to solids and liquids. Treated with pneumatic dilatation or Heller myotomy.
Acute inflammation of the gallbladder, usually from gallstone impaction in the cystic duct (90%). Presents with persistent RUQ pain, fever, and positive Murphy's sign. Early laparoscopic cholecystectomy (within 72 hours) is recommended.
Acute inflammation of a colonic diverticulum causing LIF pain, fever, and raised inflammatory markers. CT is the gold standard investigation. Most cases are uncomplicated and managed with antibiotics and bowel rest.
Acute inflammation of the pancreas most commonly caused by gallstones (50%) and alcohol (25%). Diagnosed by ≥2 of: typical pain, lipase >3x ULN, CT findings. Severity ranges from mild (80%) to severe necrotising (20%).
Spectrum of liver damage from excess alcohol: steatosis → steatohepatitis → fibrosis → cirrhosis. Leading cause of liver-related death in the UK. Abstinence is the most important intervention at all stages.
Acute inflammation of the vermiform appendix — commonest surgical emergency worldwide. Lifetime risk ~7%. Presents with periumbilical pain migrating to RIF. Appendicectomy (laparoscopic) is the standard treatment.
Pathological accumulation of fluid in the peritoneal cavity. Most commonly caused by cirrhosis with portal hypertension (75%). SAAG ≥11 g/L indicates portal hypertension. Managed with salt restriction, diuretics, and paracentesis.
Chronic inflammatory liver disease caused by immune-mediated destruction of hepatocytes. Female predominance (4:1). Characterised by raised IgG, autoantibodies (ANA/SMA), and interface hepatitis. Responds to immunosuppression.
Metaplastic change of oesophageal squamous epithelium to intestinal-type columnar epithelium due to chronic GORD. Pre-malignant condition with 0.3-0.5% annual risk of progression to oesophageal adenocarcinoma.
NHS programme offering faecal immunochemical testing (FIT) every 2 years to adults aged 56-74. Screening reduces CRC mortality by ~25%. Positive FIT (≥120 μg Hb/g) triggers diagnostic colonoscopy.
Mechanical or functional blockage of intestinal passage. Small bowel obstruction (SBO) most commonly caused by adhesions; large bowel obstruction (LBO) most commonly by colorectal cancer. Surgical emergency if strangulation suspected.
Bacterial infection of the biliary tree, usually caused by bile duct obstruction (CBD stones most common). Life-threatening septic emergency. Charcot's triad: fever, jaundice, RUQ pain. Requires urgent biliary drainage (ERCP).
Progressive inflammatory disease causing irreversible structural damage to the pancreas with fibrosis, exocrine insufficiency (malabsorption), and endocrine insufficiency (diabetes). Alcohol is the commonest cause in the UK (~70%).
End-stage chronic liver disease characterised by diffuse fibrosis and regenerative nodules. Leading causes in the UK: alcohol, NAFLD, and hepatitis C. Classified as compensated or decompensated. Liver transplantation is the only curative option.
Autoimmune enteropathy triggered by dietary gluten in genetically susceptible individuals (HLA-DQ2/DQ8). Prevalence ~1% in UK. Lifelong gluten-free diet is the only effective treatment.
Third most common cancer in the UK (~42,900 cases/year). Adenoma-carcinoma sequence accounts for most cases. NHS bowel cancer screening (FIT) from age 56-74 has improved early detection. Overall 5-year survival ~55%.
Mucosal protrusions into the bowel lumen, most commonly adenomatous. Adenomatous polyps are precursors of colorectal cancer through the adenoma-carcinoma sequence. Polypectomy at colonoscopy is curative for most.
Chronic transmural inflammatory bowel disease that can affect any part of the GI tract (mouth to anus). Characterised by skip lesions, granulomata, and fistulae. UK prevalence ~145 per 100,000.
Solid crystalline deposits in the gallbladder, affecting 10-15% of the UK adult population. Most are asymptomatic. Symptomatic gallstones present with biliary colic and complications include cholecystitis, choledocholithiasis, cholangitis, and pancreatitis.
Malignancy of the stomach, predominantly adenocarcinoma (>90%). Incidence declining in the UK but prognosis remains poor with overall 5-year survival ~20%. H. pylori and dietary factors are key risk factors.
Common condition caused by reflux of gastric contents into the oesophagus, causing heartburn and regurgitation. Affects ~20% of the UK adult population. First-line treatment is PPI therapy.
Bleeding from the gastrointestinal tract classified as upper (proximal to ligament of Treitz) or lower (distal). Upper GI bleeding is more common and potentially more life-threatening. Requires systematic assessment, resuscitation, and endoscopic evaluation.
Gram-negative spiral bacterium colonising the gastric mucosa, causing chronic gastritis, peptic ulcer disease, and increasing gastric cancer risk. UK prevalence ~30%. Eradication with triple therapy cures most associated ulcers.
Autosomal recessive iron overload disorder caused by HFE gene mutation (C282Y homozygosity). Commonest genetic condition in Northern Europeans (~1 in 200). Treated with venesection to prevent organ damage.
Neuropsychiatric syndrome in liver disease caused by accumulation of neurotoxins (primarily ammonia) due to portosystemic shunting and hepatic dysfunction. Ranges from subtle cognitive impairment to coma. Lactulose and rifaximin are mainstays of treatment.
Acute self-limiting viral hepatitis caused by hepatitis A virus (HAV), transmitted via faecal-oral route. Notifiable disease. No chronic state. Supportive management; prevention through vaccination and hygiene.
DNA virus causing acute and chronic hepatitis. Transmitted via blood/bodily fluids. ~95% of adult infections resolve; ~90% of neonatal infections become chronic. Chronic HBV carries significant risk of cirrhosis and HCC.
RNA virus causing chronic hepatitis in ~75% of infections, leading to cirrhosis and HCC. Now curable in >95% with direct-acting antivirals (DAAs). UK aims for HCV elimination by 2030.
Primary liver cancer arising from hepatocytes, almost always in the context of chronic liver disease/cirrhosis. ~6,200 new cases/year in UK. Diagnosed radiologically (CT/MRI arterial enhancement + washout). Curative options include resection, transplant, and ablation.
Herniation of the stomach through the oesophageal hiatus of the diaphragm. Sliding type (80%) causes GORD; rolling/para-oesophageal type (20%) risks gastric volvulus. Very common — prevalence increases with age. Most are asymptomatic.
Protrusion of abdominal contents through the inguinal canal. Commonest type of hernia (75% of all abdominal wall hernias). Indirect (lateral to inferior epigastric vessels, through deep ring) or direct (medial, through Hesselbach's triangle). M:F 9:1. Surgical repair recommended for symptomatic hernias.
Reduced blood flow to the small and/or large bowel causing ischaemic injury. Acute mesenteric ischaemia is a surgical emergency with >60% mortality. Commonest causes: SMA embolism (50%), SMA thrombosis (25%), non-occlusive mesenteric ischaemia (20%).
Functional gastrointestinal disorder characterised by recurrent abdominal pain associated with altered bowel habit. Prevalence 10-15% in UK. Diagnosis is clinical using Rome IV criteria after excluding organic disease.
Transient or permanent colonic ischaemia due to reduced blood flow, typically affecting watershed areas (splenic flexure, rectosigmoid junction). Commonest form of intestinal ischaemia. Usually self-limiting in non-gangrenous disease. Affects elderly with CVD risk factors.
Severe impairment of hepatic function causing coagulopathy (INR >1.5) and encephalopathy. Acute liver failure occurs without pre-existing liver disease. Paracetamol overdose is the commonest cause in the UK. Emergency transplant may be required.
Bleeding from a source distal to the ligament of Treitz, presenting as haematochezia (fresh PR blood). Commonest causes: diverticular disease, haemorrhoids, colorectal cancer, angiodysplasia, IBD. Most is self-limiting; massive LGIB requires CT angiography.
Aggressive malignancy with two main subtypes: adenocarcinoma (distal, GORD/Barrett-related, rising incidence) and squamous cell carcinoma (mid-oesophagus, smoking/alcohol-related). Overall 5-year survival ~15%.
Dilated submucosal veins in the oesophagus due to portal hypertension, most commonly from cirrhosis. Variceal bleeding is a life-threatening emergency with 15-20% mortality per episode.
Aggressive malignancy with 5-year survival <10%. ~10,500 new cases/year in UK. Typically presents late with painless obstructive jaundice (head tumours) or pain/weight loss (body/tail). Only ~15-20% are resectable at diagnosis.
Mucosal defects in the stomach or duodenum caused by acid-peptic digestion, primarily driven by H. pylori infection and NSAID use. Lifetime prevalence ~10%. Complications include bleeding, perforation, and obstruction.
Elevated portal venous pressure (HVPG >5 mmHg) most commonly caused by cirrhosis. Clinically significant at >10 mmHg. Leads to varices, ascites, splenomegaly, and portosystemic shunting.
Chronic autoimmune cholestatic liver disease causing progressive destruction of intrahepatic bile ducts. Strong female predominance (9:1). Diagnosed by AMA positivity and raised ALP. First-line treatment is ursodeoxycholic acid (UDCA).
Chronic cholestatic liver disease causing progressive inflammation and fibrosis of intra- and extrahepatic bile ducts. Strong association with IBD (~70%, usually UC). Male predominance (2:1). 10-15% lifetime cholangiocarcinoma risk.
Chronic inflammatory bowel disease causing continuous mucosal inflammation extending proximally from the rectum. UK prevalence ~240 per 100,000. Managed with 5-ASAs (mild), steroids, immunomodulators, and biologics.
Bleeding proximal to the ligament of Treitz. Commonest causes: peptic ulcer disease (35-50%), oesophageal varices (10-20%), Mallory-Weiss tear (5-10%). Incidence ~100 per 100,000/year. Overall mortality ~10%.