High-Yield Gastroenterology for MRCP Part 1

TL;DR

This article breaks down high-yield gastroenterology for MRCP Part 1, focusing on the most tested diseases, biochemical patterns, and question traps. We’ll cover ten essential areas — from liver function tests to inflammatory bowel disease — plus one mini-case and practical study tips. Use these insights to refine your QBank sessions and avoid classic errors MRCP examiners love to set.

Why this matters

Gastroenterology contributes a significant share of MRCP Part 1 questions — often blending internal medicine, biochemistry, and pathology. Examiners test your ability to interpret investigations, recognise patterns, and exclude distractors. A solid grasp of GI physiology and key diseases is a major differentiator for high scorers.

Crack Medicine helps candidates focus on exam-relevant topics, reinforced through detailed Free MRCP MCQs and high-yield mock tests.

The 10 High-Yield Gastroenterology Topics for MRCP Part 1

Rank	Topic	Common Question Focus
1	Liver Function Test Interpretation	AST:ALT ratio, cholestatic vs hepatocellular patterns
2	Hepatitis Serology	HBV markers (HBsAg, HBeAg, anti-HBc)
3	Cirrhosis & Portal Hypertension	Varices, ascites, hepatic encephalopathy
4	Inflammatory Bowel Disease	Extra-intestinal features, 5-ASA use
5	Peptic Ulcer Disease	H. pylori diagnosis & eradication regimes
6	Pancreatitis	Severity scoring, amylase vs lipase
7	Malabsorption	Coeliac antibodies, stool fat tests
8	GI Bleeding	Rockall/Blatchford scores, resuscitation order
9	GI Malignancy	Red-flag features, tumour markers
10	Gallstone Disease	Post-cholecystectomy complications, Murphy’s sign

1. Liver Function Tests (LFTs)

Know how to distinguish hepatocellular (↑ALT, ↑AST) from cholestatic (↑ALP, ↑GGT) patterns. Remember:

• AST:ALT >2 → alcoholic hepatitis.

• Isolated raised ALP → consider bone origin (check GGT).Examiners love pairing LFTs with case vignettes of drug-induced liver injury (e.g., paracetamol vs amiodarone).

2. Viral Hepatitis Patterns

Interpret serology confidently:

• HBsAg positive = current infection.

• Anti-HBs positive only = vaccination.

• Anti-HBc IgM = acute infection. Common trap: interpreting isolated anti-HBc positivity — may indicate resolved infection or “window period.”

  
  

3. Cirrhosis and Portal Hypertension

Recognise the complications: ascites, varices, and hepatic encephalopathy.Key investigations: ultrasound (nodular liver), ascitic tap (SAAG >1.1 g/dL = portal hypertension).Know prophylaxis: non-selective β-blockers (propranolol) for variceal prevention.

4. Inflammatory Bowel Disease (IBD)

Distinguish UC vs Crohn’s:

• UC = continuous, colon-only, bloody diarrhoea.

• Crohn’s = skip lesions, any GI segment, transmural.Extra-intestinal: PSC, erythema nodosum, arthritis.MRCP trap: confusing backwash ileitis (UC) with Crohn’s terminal ileitis.

5. Peptic Ulcer Disease

Common question: “Which H. pylori test remains positive after eradication?” → IgG serology. Remember clarithromycin resistance and quadruple therapy (PPI + bismuth + 2 antibiotics) as second-line.

6. Pancreatitis

Diagnostic triad: characteristic pain + raised amylase/lipase + imaging. Severity: Glasgow score ≥3 predicts severe disease. Classic cause recall: “GET SMASHED” mnemonic (Gallstones, Ethanol, Trauma...).Trap: amylase can normalise early; lipase is more specific and stays elevated longer.

7. Malabsorption & Coeliac Disease

Investigations:

• IgA anti-tTG (first-line).

• Duodenal biopsy: villous atrophy confirms diagnosis. Complication clue: iron-deficiency anaemia resistant to therapy. Dietary trap: oats contain avenin (not gluten) but may cause relapse in some.

8. GI Bleeding

Know your scoring:

• Blatchford (pre-endoscopy risk).

• Rockall (post-endoscopy prognosis).MRCP favourite: management order — “Resuscitate first, scope later.” Always recall “ABC, IV access x2, cross-match blood.”

9. GI Malignancy Patterns

• Colorectal cancer: left-sided = obstruction; right-sided = anaemia.

• Hepatocellular carcinoma: raised AFP, chronic HBV/HCV background.

• Pancreatic carcinoma: painless jaundice + palpable gallbladder (Courvoisier sign).

10. Gallstone Disease

Differentiate:

• Biliary colic – transient, no fever.

• Acute cholecystitis – fever, +Murphy’s sign.

• Choledocholithiasis – jaundice + elevated ALP.

• Cholangitis – Charcot’s triad: fever, jaundice, RUQ pain.Trap: post-cholecystectomy syndrome often from retained CBD stones.

  
  

Mini-Case Example

Case: A 48-year-old woman with chronic alcohol use presents with fatigue, spider naevi, and splenomegaly. Labs show ↑bilirubin, ↑ALT, ↑AST (AST:ALT = 2.5), and prolonged INR. Ultrasound reveals a nodular liver.

Question: What’s the most likely diagnosis?→ Answer: Alcoholic cirrhosis. Explanation: The AST:ALT ratio > 2 and stigmata of chronic liver disease confirm alcoholic aetiology.

Common Pitfalls (and Fixes)

1. Confusing hepatitis markers → memorise patterns via flowcharts, not rote.

2. Ignoring red-flag symptoms (dysphagia, weight loss) → suspect malignancy.

3. Overlooking medication causes (methotrexate, amiodarone, isoniazid).

4. Not checking amylase timing → false negatives in delayed pancreatitis.

5. Forgetting overlapping features of UC vs Crohn’s in systemic manifestations.

   
   

Study-Tip Checklist

1. Use spaced repetition with system-wise QBank questions (try the Free MRCP MCQs).

2. Schedule mock test weekends to simulate pressure (Start a mock test).

3. Focus on diagnostic algorithms (LFT, bleeding, and hepatitis flowcharts).

4. Keep one concise summary notebook for lab interpretation tables.

5. Revise tricky serology and scoring systems the night before exam.

   
   

FAQs

1. How much Gastroenterology appears in MRCP Part 1?

Roughly 10–15% of the paper — often integrated with hepatology, pathology, and pharmacology.

2. What’s the best way to revise Gastro for MRCP Part 1?

Use a mixed-mode approach — read concise notes, then apply learning through QBank and timed mocks.

3. Which liver enzymes are most specific for hepatocellular injury?

ALT is more specific than AST for liver injury; AST may rise in muscle or cardiac disease.

4. What score is used to predict severe pancreatitis?

The Glasgow-Imrie score (≥3 = severe). Know the mnemonic “PANCREAS.”

5. Where can I find trusted MRCP Gastro questions?

Try Crack Medicine’s curated Free MRCP MCQs and full-length mocks for authentic exam-level practice.

Ready to start?

Gastroenterology can feel data-heavy — but targeted, pattern-based learning simplifies it.👉 Explore Crack Medicine’s MRCP Part 1 overview, try our Free MRCP MCQs, and challenge yourself with mock tests that replicate real exam pressure.

Sources

• MRCP(UK) Examination Blueprint

• NICE Clinical Knowledge Summaries – Gastroenterology

• Kumar & Clark’s Clinical Medicine, 10th Edition