Most Tested Gastroenterology Topics (MRCP Part 1)

TL;DR

The most frequently tested gastroenterology topics (MRCP Part 1) revolve around liver function tests, inflammatory bowel disease, peptic ulcer disease, and pancreatitis. This article summarises the 10 most exam-relevant areas, includes a realistic MCQ with explanation, and provides a quick checklist to optimise your revision.

Why this matters

Gastroenterology consistently accounts for a large proportion of marks in MRCP Part 1, integrating physiology, pathology, and clinical reasoning. Candidates often struggle with interpreting liver function tests, distinguishing inflammatory bowel diseases, and recognising subtle metabolic clues in hepatobiliary disorders. Understanding how questions are framed — and which topics repeatedly appear — can dramatically improve your score.

The 10 most frequently tested gastroenterology topics

Here are the areas you’re most likely to face, based on recent exam patterns and topic analyses:

Rank	Topic	Typical Exam Focus
1	Liver Function Tests (LFTs)	Patterns in hepatocellular vs cholestatic vs mixed injury; isolated raised ALP.
2	Cirrhosis & Portal Hypertension	Ascites management, variceal bleeding, hepatic encephalopathy.
3	Inflammatory Bowel Disease (IBD)	UC vs Crohn’s features, extra-intestinal signs, treatment algorithms.
4	Pancreatitis (acute & chronic)	Diagnostic criteria, complications, causes (gallstones, alcohol, drugs).
5	Peptic Ulcer Disease (PUD) & H. pylori	Eradication regimens, complications (bleeding, perforation).
6	Malabsorption Syndromes	Coeliac disease, tropical sprue, pancreatic insufficiency.
7	Hepatitis & Autoimmune Liver Disease	Viral serologies, autoimmune hepatitis markers (ANA, SMA, LKM).
8	Gallstone Disease	Acute cholecystitis, choledocholithiasis, gallstone pancreatitis.
9	GI Bleeding	Rockall & Blatchford scores, variceal vs non-variceal bleeding management.
10	Gastrointestinal Malignancy	Colorectal screening, tumour markers (CEA, AFP), hereditary syndromes.

These topics appear across multiple question styles — data interpretation, clinical vignettes, and “best next investigation” type stems.

Quick high-yield notes for each topic

1. LFT interpretation:

   • ALT/AST > ALP → hepatocellular pattern.

   • ALP > ALT/AST → cholestatic pattern.

   • Isolated raised bilirubin → consider Gilbert’s or haemolysis.

2. Portal hypertension:

   • Commonest cause: cirrhosis.

   • Key complications: variceal bleed, ascites, splenomegaly.

   • Tip: Beta-blockers reduce portal pressure; avoid NSAIDs.

3. IBD differentiation:

   • Crohn’s: transmural, skip lesions, perianal disease.

   • UC: mucosal, continuous from rectum proximally.

   • 5-ASA for mild disease; biologics for severe.

4. Acute pancreatitis:

   • Causes: Gallstones, alcohol, post-ERCP.

   • Severity: Glasgow or Ranson criteria.

   • Complications: ARDS, pseudocyst, necrosis.

5. Peptic ulcer disease:

   • Always test for H. pylori.

   • Avoid NSAIDs and steroids where possible.

   • Eradication: PPI + clarithromycin + amoxicillin/metronidazole (7–14 days).

6. Coeliac disease:

   • Antibody tests: anti-TTG, anti-endomysial.

   • Biopsy: villous atrophy.

   • Watch for: iron deficiency anaemia and hyposplenism.

7. Autoimmune liver disease:

   • Autoimmune hepatitis: ANA, SMA, raised IgG.

   • Primary biliary cholangitis: antimitochondrial antibody (AMA).

   • Primary sclerosing cholangitis: associated with UC.

8. Gallstone disease:

   • Murphy’s sign positive in acute cholecystitis.

   • Common bile duct stones → raised ALP, bilirubin, cholangitis risk.

9. GI bleeding:

   • Upper GI bleed: peptic ulcer, varices.

   • Lower GI bleed: diverticulosis, cancer, angiodysplasia.

   • Management: IV fluids, endoscopic intervention, then cause-specific therapy.

10. GI malignancy:

11. Colorectal: left-sided = obstruction; right-sided = anaemia.

12. Pancreatic: painless jaundice, weight loss.

13. AFP raised in hepatocellular carcinoma.

Practical example (MCQ)

Question: A 48-year-old man presents with fatigue and pruritus. LFTs show raised ALP and GGT with mildly elevated bilirubin. Antimitochondrial antibody (AMA) is positive. What is the most likely diagnosis?

A. Primary biliary cholangitisB. Primary sclerosing cholangitisC. Autoimmune hepatitisD. Drug-induced cholestasis

Answer: A. Primary biliary cholangitis. Explanation: A cholestatic pattern (↑ALP, ↑GGT) with positive AMA is diagnostic. PSC is associated with UC and shows “beading” on cholangiography, whereas autoimmune hepatitis shows high IgG with ANA/SMA positivity.

Study-tip checklist for gastroenterology

✅ Focus on data interpretation — graphs, LFT panels, endoscopy images.✅ Use Crack Medicine’s Free MRCP MCQs daily to reinforce retention.✅ Revise IBD and hepatology together — their immunological overlaps are tested.✅ Practise mock tests under timed conditions before the exam week.✅ Review metabolic liver diseases (Wilson’s, haemochromatosis) at least twice — they appear deceptively simple but tricky in stems.

Common pitfalls

• Confusing ulcerative colitis and Crohn’s in extra-intestinal manifestations.

• Assuming all raised bilirubin = hepatic cause — check haemolysis first.

• Ignoring drug-induced liver injury patterns (e.g., valproate, amiodarone).

• Overlooking autoimmune hepatitis in young females with high transaminases.

• Forgetting pancreatic pseudocyst as a late complication.

  
  

FAQs

1. How many gastroenterology questions are in MRCP Part 1?

Usually 10–15% of the paper, integrated with hepatology and metabolic topics.

2. What is the best way to revise gastroenterology for MRCP Part 1?

Use a structured QBank, focus on explanation logic, and review weak topics weekly.

3. Are endoscopy images common in the written exam?

Yes — especially for varices, ulcers, and IBD changes, but image interpretation remains textual.

4. What are the hardest GI topics for candidates?

Autoimmune liver diseases, metabolic syndromes, and distinguishing hepatic vs post-hepatic jaundice.

5. How should I manage last-week revision?

Practise mixed QBank sets, re-do marked questions, and read concise notes like Crack Medicine’s lectures.

Ready to start?

Gastroenterology can feel dense, but mastering its recurring patterns boosts your overall performance in MRCP Part 1. Explore the MRCP Part 1 overview for structured guidance, try Free MRCP MCQs daily, and start a mock test to experience real-exam pacing.

Sources

• MRCP(UK) Examination Blueprint

• NICE Clinical Guidelines – Gastroenterology

• British Society of Gastroenterology (BSG)