MCh Surgical Gastroenterology: Admissions, medical colleges, fees, eligibility criteria details

Written by Dr Nitisha Kalia Published On 2023-02-22T17:00:25+05:30 | Updated On 16 Dec 2023 3:50 PM IST

MCh Surgical Gastroenterology: Admissions, medical colleges, fees, eligibility criteria details

MCh Surgical Gastroenterology or Master of Chirurgiae in Surgical Gastroenterology also known as MCh in Surgical Gastroenterology is a super specialty level course for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of this super specialty course is 3 years, and it focuses on the study of diseases and surgery of the Gastrointestinal system. This includes the esophagus, stomach, small intestine, large intestine, and rectum. It also includes the liver, gallbladder, and pancreas.

The course is a full-time course pursued at various recognized medical colleges across the country. Some of the top medical colleges offering this course include Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, Indira Gandhi Institute of Medical Sciences, Sheikhupura, Patna, Bihar, Postgraduate Institute of Medical Education & Research, Chandigarh many more.

Admission to this course is done through the NEET-SS Entrance exam conducted by the National Board of Examinations, followed by counseling based on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing MCh (Surgical Gastroenterology) varies from college to college and may range from Rs.1,500 to Rs 6,04,000 in a government college and for private colleges from Rs.15,00,000 to Rs.29,00,000 per year.

After completion of their respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programs recognized by NMC and NBE. Candidates can take reputed jobs at positions as Senior residents, Consultants, etc. with an approximate salary range of Rs 35 lakhs to Rs. 50 lakhs per annum.

What is MCh in Surgical Gastroenterology?

Master of Chirurgiae in Surgical Gastroenterology, also known as MCh (Surgical Gastroenterology) or MCh in (Surgical Gastroenterology) is a three-year super specialty program that candidates can pursue after completing a postgraduate degree.

Surgical Gastroenterology is the branch of medical science dealing with the study of diseases and surgery of the Gastrointestinal system. This includes the esophagus, stomach, small intestine, large intestine, and rectum. It also includes the liver, gallbladder, and pancreas.

National Medical Commission (NMC), the apex medical regulator, has released a Guidelines for Competency-Based Postgraduate Training Programme for MCh in Surgical Gastroenterology.

The Competency-Based Postgraduate Training Programme governs the education and training of MChs in Surgical Gastroenterology.

The postgraduate students must gain ample knowledge and experience in the diagnosis, and treatment of patients with acute, serious, and life-threatening medical and surgical diseases.

PG education intends to create specialists who can contribute to high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Surgical Gastroenterology would help the specialist to recognize the health needs of the community. The student should be competent to handle medical problems effectively and should be aware of the recent advances in their specialty.

The candidate is also expected to know the principles of research methodology and modes of the consulting library. The candidate should regularly attend conferences, workshops, and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of MCh in Surgical Gastroenterology

Name of Course	MCh in Surgical Gastroenterology
Level	Doctorate
Duration of Course	Three years
Course Mode	Full Time
Minimum Academic Requirement	Candidates must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.
Admission Process / Entrance Process / Entrance Modalities	Entrance Exam (NEET-SS) INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru Counseling by DGHS/MCC/State Authorities
Course Fees	1,500 to Rs 6,04,000 per year in Government colleges Rs.15,00,000 to Rs.29,00,000 per year in Private colleges
Average Salary	Rs 35 lakhs to Rs.50 lakhs per annum

Eligibility Criteria

The eligibility criteria for MCh in Surgical Gastroenterology are defined as the set of rules or minimum prerequisites that aspirants must meet to be eligible for admission, which include:

Name of Super Specialty course	Course Type	Prior Eligibility Requirement
Surgical Gastroenterology	MCh	MS/DNB (General Surgery)

Note:

· The feeder qualification for MCh Surgical Gastroenterology is defined by the NBE and is subject to changes by the NBE.

· The feeder qualification mentioned here is as of 2022.

· For any changes, please refer to the NBE website.

The prior entry qualifications shall be strictly by Post Graduate Medical Education Regulations, 2000, and its amendments notified by the NMC and any clarification issued from NMC in this regard.
The candidate must have obtained permanent registration with any State Medical Council to be eligible for admission.
The medical college's recognition cut-off dates for the Postgraduate Degree courses shall be as prescribed by the Medical Council of India (now NMC).

Admission Process

The admission process contains a few steps to be followed in order by the candidates for admission to MCh in Surgical Gastroenterology. Candidates can view the complete admission process for MCh in Surgical Gastroenterology mentioned below:

The NEET-SS or National Eligibility Entrance Test for Super specialty courses is a national-level master's level examination conducted by the NBE for admission to DM/MCh/DrNB Courses.
Qualifying Criteria-Candidates placed at the 50th percentile or above shall be declared as qualified in the NEET-SS in their respective specialty.
The following Medical institutions are not covered under centralized admissions for DM/MCh courses through NEET-SS:

1. AIIMS, New Delhi, and other AIIMS.

2. PGIMER, Chandigarh

3. JIPMER, Puducherry

4. NIMHANS, Bengaluru

Candidates from all eligible feeder specialty subjects shall be required to appear in the question paper of the respective group if they are willing to opt for a super specialty course in any of the super specialty courses covered in that group.
A candidate can opt for appearing in the question papers of as many groups for which his/her Postgraduate specialty qualification is an eligible feeder qualification.
By appearing in the question paper of a group and on qualifying for the examination, a candidate shall be eligible to exercise his/her choices in the counseling only for those super specialty subjects covered in the said group for which his/ her broad specialty is an eligible feeder qualification.

Fees Structure

The fee structure for MCh in Surgical Gastroenterology varies from college to college. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for MCh in Surgical Gastroenterology may range from Rs.1,500 to Rs 6,04,000 per year in government colleges and for private colleges from Rs.15,00,000 to Rs.29,00,000 per year.

Colleges offering
MCh in Surgical Gastroenterology

Various medical colleges across India offer courses for pursuing MCh in (Surgical Gastroenterology).

As per National Medical Commission (NMC) website, the following medical colleges are offering MCh in (Surgical Gastroenterology) courses for the academic year 2022-23.

Sl.No.	Course Name	State	Name and Address of Medical College / Medical Institution	Annual Intake (Seats)
1	M.Ch - Surgical Gastroenterology/G.I. Surgery	Andhra Pradesh	Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati	4
2	M.Ch - Surgical Gastroenterology/G.I. Surgery	Andhra Pradesh	Narayana Medical College, Nellore	2
3	M.Ch - Surgical Gastroenterology/G.I. Surgery	Bihar	Indira Gandhi Institute of Medical Sciences, Sheikhupura, Patna	3
4	M.Ch - Surgical Gastroenterology/G.I. Surgery	Chandigarh	Postgraduate Institute of Medical Education & Research, Chandigarh
5	M.Ch - Surgical Gastroenterology/G.I. Surgery	Delhi	G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi	3
6	M.Ch - Surgical Gastroenterology/G.I. Surgery	Delhi	All India Institute of Medical Sciences, New Delhi	15
7	M.Ch - Surgical Gastroenterology/G.I. Surgery	Gujarat	Smt. N.H.L.Municipal Medical College, Ahmedabad	1
8	M.Ch - Surgical Gastroenterology/G.I. Surgery	Jammu & Kashmir	Sher-I-Kashmir Instt. Of Medical Sciences, Srinagar	2
9	M.Ch - Surgical Gastroenterology/G.I. Surgery	Karnataka	Karnataka Institute of Medical Sciences, Hubballi	2
10	M.Ch - Surgical Gastroenterology/G.I. Surgery	Karnataka	Bangalore Medical College and Research Institute, Bangalore	2
11	M.Ch - Surgical Gastroenterology/G.I. Surgery	Kerala	Medical College, Thiruvananthapuram	2
12	M.Ch - Surgical Gastroenterology/G.I. Surgery	Kerala	Amrita School of Medicine, Elamkara, Kochi	4
13	M.Ch - Surgical Gastroenterology/G.I. Surgery	Maharashtra	Seth GS Medical College, and KEM Hospital, Mumbai	2
14	M.Ch - Surgical Gastroenterology/G.I. Surgery	Orissa	Instt. Of Medical Sciences & SUM Hospital, Bhubaneswar	2
15	M.Ch - Surgical Gastroenterology/G.I. Surgery	Pondicherry	Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry	3
16	M.Ch - Surgical Gastroenterology/G.I. Surgery	Rajasthan	All India Institute of Medical Sciences, Jodhpur	2
17	M.Ch - Surgical Gastroenterology/G.I. Surgery	Rajasthan	National Institute of Medical Science & Research, Jaipur	3
18	M.Ch - Surgical Gastroenterology/G.I. Surgery	Rajasthan	Mahatma Gandhi Medical College and Hospital, Sitapur, Jaipur	2
19	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Stanley Medical College, Chennai	7
20	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Madras Medical College, Chennai	6
21	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Dhanalakshmi Srinivasan Medical College and Hospital,Perambalur	2
22	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Tirunelveli Medical College,Tirunelveli	2
23	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Madurai Medical College, Madurai	3
24	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Kilpauk Medical College, Chennai	2
25	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Thanjavur Medical College,Thanjavur	2
26	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Govt. Mohan Kumaramangalam Medical College, Salem- 30	2
27	M.Ch - Surgical Gastroenterology/G.I. Surgery	Tamil Nadu	Sri Ramachandra Medical College & Research Institute, Chennai	2
28	M.Ch - Surgical Gastroenterology/G.I. Surgery	Telangana	Osmania Medical College, Hyderabad	1
29	M.Ch - Surgical Gastroenterology/G.I. Surgery	Uttarakhand	All India Institute of Medical Sciences, Rishikesh	20
30	M.Ch - Surgical Gastroenterology/G.I. Surgery	Uttar Pradesh	Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow	10
31	M.Ch - Surgical Gastroenterology/G.I. Surgery	Uttar Pradesh	Dr. Ram Manohar Lohia Institute of Medical Sciences,Lucknow	2
32	M.Ch - Surgical Gastroenterology/G.I. Surgery	Uttar Pradesh	Command Hospital, Lucknow	2
33	M.Ch - Surgical Gastroenterology/G.I. Surgery	Uttar Pradesh	King George Medical University, Lucknow	3
34	M.Ch - Surgical Gastroenterology/G.I. Surgery	West Bengal	Institute of Postgraduate Medical Education & Research, Kolkata	1

Syllabus

An MCh in Surgical Gastroenterology is a three years specialization course that provides training in the stream of Surgical Gastroenterology.

The course content for MCh in Surgical Gastroenterology is given in the Competency-Based Postgraduate Training Programme released by National Medical Commission, which can be assessed through the link mentioned below:

NMC Guidelines For Competency-Based Training Programme For MCh Surgical Gastroenterology

Syllabus

BASIC SCIENCES AND PRINCIPLES OF SURGICAL GASTROENTEROLOGY and GI ONCOLOGY

• Anatomy: Gross and histological anatomy of the abdomen and its contents including the entire GI tract, Liver (including segmental anatomy), Biliary tract, Pancreas, spleen, portal, and Hepatic venous system.

• Physiology: Normal function of the GI tract and related organs including endocrine functions of the gut and pancreas. Physiological basis of various tests to study these functions

• Pharmacology of drugs used in GI surgical disorders e.g. to control acid secretion, in the management of ulcerative colitis, and immunosuppressive drugs.

• Fluid-electrolyte and acid-base disturbance: general aspects, imbalance in GI surgical patient's physiological responses to volume and osmolality abnormalities, interpretation of blood gas analysis, maintenance and replacement therapy.

• Nutritional considerations in GI surgical patients: nutrient stores and body compositions, nutrient requirements, malnutrition, evaluation of nutritional status, nutritional therapy, enteral and parenteral therapy, and complications of these.

• Wound healing: Principles, phases, types of healing, factors influencing wound healing, wound dehiscence, and management.

• Principles and disorders of hemostasis.

• Immunology in GI surgery. Especially about organ transplantation and GI Oncology.

Oesophagus

• Anatomical detail, physiology of swallowing, oesophageal manometry, pH monitoring, endoscopic ultrasound, and other diagnostic techniques, brush cytology, vital staining, contrast imaging, and CT scan,

• Congenital lesions (trachea-oesophageal fistula), Zenker's diverticulum, epiphanic diverticulum, oesophageal trauma, spontaneous or iatrogenic perforations, esophageal motility disorders

• Corrosive burns: detection, evaluation, and management,

• Gastroesophageal reflux disease, achalasia cardia. Barrett's esophagus, oesophageal cancer: adeno & squamous, various oesophageal operations: diverticulectomy, excision of leiomyoma, oesophagostomy, myotomy, fundoplication, oesophageal resection (Ivor lewis, McKeown, Trans-hiatal)

• Cervical exploration, oesophagogastrostomy, gastric pull-up, gastric and colonic bypass, complications of oesophagectomy, management of chylothorax.

Stomach and Duodenum

• Anatomical details, physiology of gastric secretions, gastroduodenal motility, diaphragmatic hernia (congenital and acquired), volvulus, pyloric stenosis in children and adults, foreign bodies (bezoars), stomach trauma,

• H. pylori in gastric diseases, peptic ulcer, Zollinger-Ellison syndrome, non-ulcer dyspepsia

• Gastric tumors: benign and mlignant, gastric surgery: vagotomy, pyloric drainage, gastrojejunostomy

• Bariatric procedures, Creation of gastric tube, Roux-en-Y oesophagojejunal anastomosis, post-gastrectomy syndromes, and complications.

The Liver

A. Anatomy, Embryology, Physiology, Investigations

1. Embryology of the liver and relationship to other foregut structures

2. Extrahepatic anatomy of the liver

• Lobes, sectors, segments

• Nomenclature systems

• Ligaments, fissures and incisures

• Anomalies

3. Anatomy of the porta hepatis

• Portal vein, hepatic artery

• Bile duct, gall bladder

• Variants of normal and anomalies

• Lymphatic drainage and lymph nodal anatomy

• Nerves

4. Anatomy of the retrohepatic space

• IVC and its branches

• Adrenal, kidney, diaphragm 5. Intrahepatic anatomy

• Hepatic veins and variants of normal

• Portal triad structures and segmental anatomy

• Histology of the normal liver

6. Physiology of the liver

• Bilirubin metabolism

• Coagulation

• Other clinically relevant metabolic pathways

7. Haematologic, biochemical, and histologic investigations (assessment) of the liver

Transaminases and markers of cholestasis

• Measures of liver function

(a) Static: including INR (PT), Factors V and VII, bilirubin, albumin

(b) Dynamic: including clearance tests, e.g. ICG, galactose, aminopyrine, lidocaine (MEGX)

• Indications for liver biopsy

8. Imaging of the liver

• Ultrasound and Doppler, Computerized Tomography (CT) Scans, Magnetic Resonance Imaging (MRI) Scans

• Nuclear tests: Proton Emission Tomographic (PET) Scans, Liver/Spleen scans, Biliary excretion (e.g. HIDA) scans, RBC scans

9. Application of investigations to hepatic surgery

Congenital and Acquired Non-neoplastic Liver Disease

1. Paediatric liver diseases, Biliary atresia, and Alagille's syndrome

(a) Presentation, evaluation, and natural history

(b) Treatment options and indications for intervention

2. Liver cysts and abscesses a. Solitary liver cysts

• Presentation, evaluation, and natural history

• Distinguish from cystic neoplasm

• Treatment options and indications for intervention b. Polycystic liver disease • Associated abnormalities

• Presentation, evaluation, and natural history

• Treatment options and indications for intervention

c. Pyogenic and fungal liver abscess

▪ Potential bacterial and fungal pathogens and sources

• Presentation, evaluation

▪ Treatment and indications for surgical drainage of liver abscess including amoebic abscess

d.Tuberculous abscess

• Presentation, evaluation, and natural history

• Treatment options and indications for intervention

. Echinococcal liver cyst • Life cycle, epidemiology, target organs

• Presentation, evaluation, and natural history

• Treatment options and indications for intervention

3. Liver failure

• Hepatitis and acute liver failure

▪ Causes of acute liver failure

▪ Investigation and prognosis

▪ Classification systems including MELD and King's College criteria

▪ Treatment strategies

▪ Role of liver support systems

▪ Role of liver transplantation

▪ 4. Cirrhosis and portal hypertension

(a) Causes of cirrhosis, diagnosis, and natural history, staging, and treatment options (including indications for liver transplantation) for each

i. Viral hepatitis B, C, D

ii. Alcoholic liver disease

iii. Non-alcoholic fatty liver disease and steatohepatitis

iv. Autoimmune liver disease

v. Primary biliary cirrhosis

vi. Primary sclerosing cholangitis

vii. Haemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency

viii. Budd–Chiari syndrome

(b) Portal hypertension

i. Pathophysiology

ii. Interpretation of haematologic and biochemical tests and imaging

iii. Non-operative treatment options and strategies

iv. Portosystemic decompression

1. Indications and sequelae

2. Risks and benefits of TIPS

3. Surgical shunts, types

4. Devascularisation procedures

v. Indications for liver transplantation

. Neoplastic Liver Disease

a. Benign neoplasms of the liver

• Presentation, investigation, diagnosis, and natural history of haemangioma, hamartoma, adenoma, focal nodular hyperplasia

• Histology and indications for biopsy

• Treatment options and indication for ablation or resection

b. Primary malignancies of the liver

1. Hepatocellular carcinoma (HCC)

▪ Aetiology, presentation, investigation, diagnosis, and natural history of HCC

▪ Role of screening and staging systems for HCC

▪ Treatment options and the risk–benefit ratio for each: resection, transplantation, ablation, chemotherapy with or without embolization, radiation 2. Cholangiocarcinoma (intrahepatic or peripheral)

• Diagnosis, investigation, and staging

• Treatment options including palliative procedures

3. Epithelioid haemangioendothelioma, lymphoma, sarcoma, and other neoplasms • Diagnosis, investigation, and staging

• Treatment options

c. Secondary malignancies of the liver

❖ Colorectal primary

• Pathogenesis, staging of colorectal cancer

• Investigation and staging

• Treatment options

➢ Indications, and risk-benefit ratio of ablation/resection

➢ Neo-adjuvant, downstaging, and adjuvant chemotherapy

❖ Neuroendocrine and other primaries

• Investigation and staging • Treatment options

➢ Indications, and risk-benefit ratio of ablation/resection

➢ Neoadjuvant and adjuvant therapy

Liver Surgery Types of liver resection

• Nomenclature of liver resections (Brisbane system)

• Laparoscopic, laparoscopic-assisted, open laparotomy

• Non-anatomic, segmental, lobectomy, extended lobectomy

• Vascular control: none, Pringle maneuver, total vascular isolation

• Vascular resection and reconstruction

• Staged resections

• Combination with ablation Preoperative assessment and the cumulative risks to the proposed procedure

• Patient comorbid conditions (cardiopulmonary and other)

• Hepatic risk

(a) Assessment of liver function, portal hypertension

(b) Volumetric assessment of liver remnant

• Prophylaxis against common complications such as DVT, infection

• Neuroendocrine hormonal blockade

Detailed operative plan based on preoperative imaging Liver resection

1. Anaesthetic considerations: Agents, coagulation, CVP

2. Blood loss conservation including cell saving and blood product administration

3. Laparoscopic techniques (a) Patient and port placement (b) Hand port

4. Parenchymal transection techniques (a) Relative advantages and disadvantages (b) Normal, fatty, fibrotic, and cirrhotic parenchyma (c) Laparoscopic or open

5. Concomitant resection and reconstruction of the

(i) Diaphragm

(ii) IVC

(iii) Portal vein

(iv) Bile duct and

(v) hepatic artery Post-operative management Complications and management, including liver failure

. Liver Transplantation

• History of Liver Transplantation

• Liver Transplantation in India

• Indications and Contraindications for Liver Transplantation

• Organ Preservation in Liver Transplant

• Anesthetic Management in Liver Transplantation

• Immunology of Liver Transplantation

• Pediatric Liver Transplant

• Liver Transplantation in Acute Liver Failure

• Deceased Donor Liver Transplantation

• Living Related Liver Transplantation

• Complications in Living Donor Liver Transplantation

• Machine perfusion, split liver transplants, reduced size organ transplants, domino transplants

5.5 The Biliary Tract including Gallbladder A. Anatomy, Embryology, Physiology, Investigations

1. Embryology of the biliary tract

• Relationship to the liver, pancreas, and other portal and foregut structures

2. Anatomy of the hepatic duct and biliary plate

• Segmental anatomy and variants of normal • Blood supply and lymphatic drainage

• Relationship with other portal structures

3. Anatomy of the gallbladder and cystic duct

• Blood supply and lymphatic drainage

• Variants of normal and anomalies

4. Anatomy of the bile duct

• Blood supply, lymphatic drainage, and regional lymph nodes

• Variants of normal and anomalies

• Relationship with other portal structures and the pancreatic duct

• Sphincter of Oddi and ampulla of Vater

5. Bile metabolism and biliary physiology

• Bile-salt dependent and independent bile production

• Hormonal influences

• Biliary epithelium and gallbladder function

• Sphincter of Oddi motility

6. Interpretation of biochemical investigations

7. Imaging

• Axial and body imaging techniques: U/S, CT scan and MRI scan, including MRCP • Endoscopic U/S

• Direct contrast imaging

(a) Percutaneous transhepatic cholangiogram (PTC) and cholecystography

(b) Endoscopic retrograde cholangiopancreatography (ERCP)

• Endoscopic assessment of the ampulla of Vater

• Nuclear biliary excretion imaging (HIDA scan) – qualitative and quantitative

Congenital and Non-neoplastic Biliary Disease

a. Congenital and pediatric Choledochal cyst, Caroli's disease, congenital hepatic fibrosis, biliary atresia, and Alagille's syndrome

1. Presentation, classification, evaluation, and natural history

2. Treatment options and indications for intervention

b. Gallstones

1 Pathogenesis

2 Presentation and investigation of biliary colic, cholecystitis, cholangitis, Mirrizzi's syndrome, gallstone ileus

3 Treatment: Percutaneous, laparoscopic and open

4 Cholecystectomy-related biliary injuries

(a) Mechanism of injury and classification

(b) Associated injuries (

c) Management

c. Benign strictures

1 Primary sclerosing cholangitis (PSC)

(a) Aetiology, pathophysiology, natural history, and nonoperative management

(b) Complications and management

i. Screening for cholangiocarcinoma

ii. PTC with biliary drainage (PTBD), ERCP with endo-biliary stent

iii. Resection iv. Transplantation

(2) Post-traumatic and idiopathic

(a) Mechanism of injury and classification

(b) Management options d. Intrahepatic stones

1. Pathophysiology, presentation, and investigation

2. Common infectious bacteria

3. Surgical options including liver resection and biliary access (Hutson) choledochojejunostomy, hepaticojejunostomy with transhepatic stents

C. Neoplastic Biliary Disease a. Gallbladder

(1) Polyps 1. Presentation, natural history

2. Indications for resection

3. Principles of resection

(2) Adenocarcinoma

1. Presentation, staging (including histology), and natural history

2. Investigation

3. Surgical options: Extent and timing of resection

4. Chemo and radiotherapy including neo- and/or adjuvant therapy

5. Palliative care options

b. Bile duct

(1) Adenoma of ampulla of Vater

1. Presentation, natural history, investigation

2. Resection options: Endoscopic, transduodenal resection, and reconstruction

(2) Adenocarcinoma

1. Location: Hilar (Klatskin), intrapancreatic, ampulla

2. Type: papillary, sclerosing

3. Presentation, investigation, and staging, including laparoscopic staging

4. Resection and reconstruction: indications and contraindication

5. Palliative options 1. PTBD or endoscopic stent 2. Surgical bypass

5.6 The Pancreas and Duodenum

A. Anatomy, Embryology, Physiology, Investigations

• Embryology of the pancreas and duodenum (

1) Relationship to the liver, bile duct, and other foregut structures

(2) Aetiology of anomalies including pancreas divisum and annular pancreas

• Anatomy of the pancreas

(1) Spectrum of normal anatomy and variants

(2) Arterial supply and venous drainage

(3) Lymphatic drainage and regional lymph nodes.

(4) Relationship with:

• Portal structures: duodenum, bile duct, hepatic artery, portal vein, splenic and superior mesenteric veins, and their branches

• Retroperitoneum: IVC and its branches, aorta, and SMA and their branches, adrenal gland, kidneys

• Adjacent organs: stomach, spleen, colon, small intestine

• Anatomy of the pancreatic duct

• Variants of normal and anomalies

• Anatomy of the duodenum (

1) Spectrum of normal anatomy and variants

(2) Arterial supply and venous drainage

(3) Lymphatic drainage and regional lymph nodes.

(4) Relationship with:

▪ Portal structures: bile duct, hepatic artery, portal vein, splenic and superior mesenteric veins, and their branches.

▪ Retroperitoneum: IVC and its branches, aorta, and SMA and their branches, adrenal gland, kidneys.

▪ Adjacent organs: pancreas, stomach, spleen, colon, small intestine

• Pancreatic metabolism and physiology

(1) Exocrine enzyme physiology

(a) Synthesis, excretion, and activation

(b) Neural and hormonal influences

(2) Endocrine metabolism

(a) Islet cell function, neuroendocrine hormones

• Duodenal physiology

(1) Motility

(2) Neuroendocrine ("gut") hormone physiology

(3) Biochemical investigation and interpretation

• Biochemical investigations

(1) Markers of pancreatic injury

(2) Measures of pancreatic exocrine function

(3) Urinary and serum neuroendocrine hormones

• Imaging (1) Axial and body imaging techniques: U/S, CT scan, and MRI scan, including MRCP

(2) Endoscopy and endoscopic U/S

(3) Direct contrast imaging: Endoscopic retrograde cholangiopancreatography (ERCP) (4) Nuclear studies:

▪ PET scan

▪ Neuroendocrine imaging (Octreotide scan)

(5) Application of investigations and imaging to pancreatic and duodenal surgery

B. Congenital and Acquired Non-neoplastic Pancreatic Disease

1. Pancreatitis

(1) Acute

1. Pathogenesis, staging, and prognosis

2. Management, including surgical options and complications

3. Indications for surgical intervention

(2) Chronic

1. Pathogenesis, complications, and nonoperative management

2. Pancreatic stents and endoscopic/percutaneous drainage procedures

3. Surgical options and indications

4. Pain control

2. Pancreas divisum

(1) Pathogenesis, staging, and prognosis

(2) Management, including surgical options and complications

(3) Indications for surgical intervention

3. Annular Pancreas

(1) Pathogenesis, staging, and prognosis

(2) Management, including surgical options and complications

(3) Indications for surgical intervention

C. Neoplastic Diseases

1. Benign cysts and neoplasms of the pancreas

(1) Microcystic serous cystadenoma