Fellowship of the Royal College of Surgeons (FRCS) General and Gastrointestinal Surgery Syllabus

General and Gastrointestinal Surgery syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for General and Gastrointestinal Surgery in Fellowship of the Royal College of Surgeons (FRCS), not a summary of it.

1. 1

   Upper Gastrointestinal Surgery

   4 topics

   • Oesophageal disease
     • Gastro-oesophageal reflux and hiatus hernia
     • Achalasia and motility disorders
     • Oesophageal carcinoma staging and resection
   • Gastric pathology
     • Peptic ulcer disease and complications
     • Gastric cancer and GIST
   • Bariatric and metabolic surgery
     • Sleeve gastrectomy and gastric bypass
     • Complications of bariatric procedures
   • Upper GI bleeding management
2. 2

   Hepatobiliary and Pancreatic Surgery

   6 topics

   • Gallstone disease
     • Biliary colic and acute cholecystitis
     • Choledocholithiasis and cholangitis
     • Cholecystectomy and bile duct injury
   • Pancreatitis
     • Acute pancreatitis severity and management
     • Chronic pancreatitis and complications
   • Pancreatic and periampullary tumours
   • Liver lesions and hepatic resection
     • Hepatocellular carcinoma and colorectal metastases
     • Benign liver tumours and cysts
   • Portal hypertension and its complications
   • Obstructive jaundice work-up
3. 3

   Colorectal Surgery

   6 topics

   • Colorectal cancer
     • Staging, screening and surveillance
     • Surgical resection principles and TME
     • Management of rectal cancer
   • Inflammatory bowel disease
     • Crohn's disease surgical indications
     • Ulcerative colitis and pouch surgery
   • Diverticular disease and complications
   • Benign anorectal conditions
     • Haemorrhoids and fissure
     • Anal fistula and abscess
     • Pilonidal disease
   • Intestinal obstruction and ischaemia
   • Stoma formation and complications
4. 4

   Emergency General Surgery and Trauma

   5 topics

   • The acute abdomen
     • Appendicitis
     • Perforated viscus and peritonitis
   • Abdominal trauma assessment and damage control
     • FAST and CT in trauma
     • Splenic and hepatic injury management
   • Mesenteric ischaemia
   • Gastrointestinal fistula management
   • Abdominal compartment syndrome
5. 5

   Hernia, Skin and Soft Tissue

   4 topics

   • Abdominal wall hernias
     • Inguinal and femoral hernia repair
     • Incisional and ventral hernia
     • Complications and mesh principles
   • Cutaneous and subcutaneous lesions
   • Soft tissue sarcoma principles
   • Management of complex abdominal wall defects

General and Gastrointestinal Surgery flashcards for Fellowship of the Royal College of Surgeons (FRCS)

19 of 63 cards from the General and Gastrointestinal Surgery deck — real questions with worked answers.

1. What is the most common histological type of oesophageal cancer worldwide versus in the West, and the key risk factor for each?

   Worldwide: squamous cell carcinoma (risk factors: smoking, alcohol, hot beverages, achalasia). In the West: adenocarcinoma is now most common (risk factors: GORD, Barrett's oesophagus, obesity), typically arising in the lower third/GOJ.

2. Define Barrett's oesophagus and state the approximate annual risk of progression to adenocarcinoma.

   Metaplastic replacement of the normal squamous epithelium of the distal oesophagus by columnar (intestinal-type, goblet cell-containing) epithelium, due to chronic GORD. Annual risk of progression to adenocarcinoma is roughly 0.3-0.5% per year for non-dysplastic Barrett's.

3. What is achalasia, and what are the classic manometric and barium swallow findings?

   Failure of lower oesophageal sphincter relaxation with absent oesophageal peristalsis (loss of myenteric/Auerbach plexus ganglion cells). Manometry: incomplete LOS relaxation, elevated LOS resting pressure, aperistalsis. Barium swallow: dilated oesophagus with smooth tapering 'bird's beak' at the GOJ.

4. What is the gold-standard staging investigation for assessing T and N stage in oesophageal/gastric cancer, and which scan detects distant metastases?

   Endoscopic ultrasound (EUS) is best for locoregional T (depth of invasion) and N staging. CT (chest/abdomen/pelvis) plus PET-CT is used to detect distant metastases. Staging laparoscopy is added for gastric/lower oesophageal tumours to detect peritoneal disease.

5. In gastric cancer, what is a Krukenberg tumour and what are Virchow's node and Sister Mary Joseph nodule?

   Krukenberg tumour: metastasis to the ovary (classically signet-ring cell). Virchow's node: enlarged left supraclavicular lymph node (Troisier's sign). Sister Mary Joseph nodule: metastatic periumbilical nodule. All indicate advanced/metastatic gastric (or other GI) cancer.

6. What organism causes most peptic ulcers and gastric cancers, and what is its association with gastric lymphoma?

   Helicobacter pylori. It is a major cause of peptic ulcer disease and a class I carcinogen for gastric adenocarcinoma. It is strongly associated with gastric MALT lymphoma, which can regress with H. pylori eradication.

7. What is the Lauren classification of gastric adenocarcinoma?

   Two main types: Intestinal type (well-differentiated, glandular, gland-forming, older patients, better prognosis, environmental factors) and Diffuse type (poorly differentiated, signet-ring cells, infiltrative, linitis plastica, younger patients, worse prognosis, often E-cadherin/CDH1 loss).

8. List the standard eligibility criteria (BMI) for bariatric surgery per NICE guidance.

   BMI $\geq 40\ \text{kg/m}^{2}$, or BMI $35\text{-}40\ \text{kg/m}^{2}$ with a significant obesity-related comorbidity (e.g. type 2 diabetes, obstructive sleep apnoea). Lower thresholds (e.g. $\geq 30$) considered in recent-onset type 2 diabetes, especially in people of South Asian origin.

9. Compare the mechanisms of the three main bariatric procedures: gastric band, sleeve gastrectomy, and Roux-en-Y gastric bypass.

   Adjustable gastric band: purely restrictive. Sleeve gastrectomy: restrictive (removes ~80% greater curve) plus reduced ghrelin. Roux-en-Y gastric bypass: restrictive (small pouch) plus malabsorptive (bypasses duodenum/proximal jejunum) plus favourable incretin/hormonal changes.

10. What is dumping syndrome after gastric surgery, and how do early and late dumping differ?

    Rapid delivery of hyperosmolar chyme into the small bowel. Early dumping (15-30 min): osmotic fluid shift causing abdominal cramps, diarrhoea, tachycardia, hypotension. Late dumping (1-3 h): reactive hypoglycaemia from an exaggerated insulin response to a glucose surge.

11. State the Glasgow-Blatchford and Rockall scores' purposes in upper GI bleeding.

    Glasgow-Blatchford score (GBS): pre-endoscopy risk stratification predicting need for intervention/transfusion; a score of 0 may allow outpatient management. Rockall score: predicts mortality and rebleeding risk (full score is post-endoscopy, incorporating diagnosis and stigmata of recent haemorrhage).

12. What is the Forrest classification and why is it used?

    Endoscopic classification of peptic ulcer bleeding predicting rebleeding risk: Ia spurting; Ib oozing; IIa non-bleeding visible vessel; IIb adherent clot; IIc flat pigmented spot; III clean base. Higher-risk lesions (I and IIa/b) require endoscopic therapy; III/IIc are low risk.

13. Outline the endoscopic management of a bleeding peptic ulcer.

    Dual therapy: adrenaline injection (1:10,000) combined with a second modality — thermal (heater probe/coagulation) or mechanical (clips). High-dose IV proton pump inhibitor after endoscopy. Treat H. pylori. Consider angiographic embolisation or surgery if endoscopy fails.

14. What is the first-line treatment for acutely bleeding oesophageal varices, including drug and endoscopic management?

    Resuscitation, terlipressin (splanchnic vasoconstrictor) plus prophylactic antibiotics (e.g. ceftriaxone). Endoscopic variceal band ligation is first-line. If uncontrolled: balloon tamponade (Sengstaken-Blakemore) as a bridge, then TIPS (transjugular intrahepatic portosystemic shunt).

15. State the components of Charcot's triad and Reynolds' pentad in ascending cholangitis.

    Charcot's triad: right upper quadrant pain, fever (with rigors), and jaundice. Reynolds' pentad adds hypotension (septic shock) and altered mental status/confusion, indicating severe suppurative cholangitis.

16. Differentiate biliary colic, acute cholecystitis, and ascending cholangitis.

    Biliary colic: transient cystic duct obstruction by a stone, RUQ pain without fever/inflammation. Acute cholecystitis: persistent obstruction causing gallbladder inflammation, pain, fever, Murphy's sign positive. Cholangitis: common bile duct obstruction with biliary infection, Charcot's triad, deranged LFTs.

17. What is Mirizzi syndrome?

    Extrinsic compression of the common hepatic duct by a gallstone impacted in the cystic duct or Hartmann's pouch, causing obstructive jaundice. It increases the risk of bile duct injury at cholecystectomy and may form a cholecystocholedochal fistula.

18. State the modified Glasgow (Imrie) criteria for severity of acute pancreatitis.

    PANCREAS mnemonic (each scores 1; $\geq 3$ within 48h = severe): $P\text{aO}_2 < 8\ \text{kPa}$; Age $>55$; Neutrophils (WCC $>15\times10^9/\text{L}$); Calcium $<2\ \text{mmol/L}$; Renal (urea $>16\ \text{mmol/L}$); Enzymes (LDH $>600$, AST $>200$); Albumin $<32\ \text{g/L}$; Sugar (glucose $>10\ \text{mmol/L}$).

19. List the most common causes of acute pancreatitis (mnemonic).

    GET SMASHED: Gallstones, Ethanol, Trauma, Steroids, Mumps (and other infections), Autoimmune, Scorpion sting, Hypercalcaemia/Hypertriglyceridaemia/Hypothermia, ERCP, Drugs. Gallstones and alcohol account for the majority.

See more General and Gastrointestinal Surgery flashcards →

Planning General and Gastrointestinal Surgery for Fellowship of the Royal College of Surgeons (FRCS)

General and Gastrointestinal Surgery (Fellowship of the Royal College of Surgeons (FRCS)) FAQ