Gastroenterology, hepatology and general surgery are an estimated 8% of PLAB 1, about 14 of 180 questions. Expect GI bleeding, peptic ulcer disease, IBD, the acute abdomen, biliary and pancreatic disease, liver disease, hernias, anorectal conditions, jaundice, nutrition, breast and thyroid surgery. UK hooks include bowel screening at 50 to 74 and AAA screening for men at 65. The weight is an editorial estimate.
Scope and time budget
About fourteen questions means fourteen minutes. The domain mixes medical and surgical thinking: the F2 doctor who sees a patient with abdominal pain must decide whether this is a medical, surgical or emergency problem, order the right first tests and involve the surgical team at the right time. The exam favours that judgement over detailed operative knowledge.
What is tested
- Upper GI. Upper gastrointestinal bleeding and variceal haemorrhage, peptic ulcer disease and Helicobacter pylori eradication, reflux, Barrett's oesophagus and oesophageal cancer, dysphagia and weight loss work-up.
- Bowel. Inflammatory bowel disease, irritable bowel syndrome, coeliac disease and malabsorption, colorectal cancer, bowel screening and 2-week-wait referral, diverticular disease and mesenteric ischaemia, anorectal conditions, stomas and nutrition including refeeding syndrome.
- Acute abdomen. Appendicitis, obstruction and perforation, hernias including strangulation, gallstone disease, cholecystitis, cholangitis and biliary colic, acute and chronic pancreatitis.
- Liver. Cirrhosis, ascites, hepatic encephalopathy and spontaneous bacterial peritonitis, viral hepatitis A, B and C, autoimmune and alcohol-related liver disease, jaundice interpretation.
- Cancer and endocrine surgery. Pancreatic and hepatobiliary cancers, breast lumps and the breast cancer pathway, thyroid and parathyroid surgical conditions.
UK points to anchor your answers
- Bowel screening: ages 50 to 74, home test kit every 2 years. People 75 and over can request a kit.
- Breast screening: ages 50 to 70, and women over 70 can self-refer. A symptomatic woman is not a screening question: she follows the urgent referral route.
- AAA screening: men at age 65, and older men can self-refer.
- Referral and drugs: NICE sets the suspected cancer referral criteria and the BNF sets the doses. We could not verify these on the sites for this page, so check them at source.
- Consent and capacity: a patient needing emergency surgery who lacks capacity raises the framework in the professional domain, so revise the two together.
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How the questions are framed
Gastro and surgery stems often start from a symptom: haematemesis, melaena, abdominal pain, jaundice, change in bowel habit, dysphagia or weight loss. The question asks what to do first, which test confirms the diagnosis or which treatment is indicated. Some ask which drug to stop, such as an anticoagulant or non-steroidal anti-inflammatory drug in a bleeding patient. Others ask about complications, such as a patient with cirrhosis who becomes confused, or a post-operative patient who stops passing wind.
In the acute abdomen, the exam rewards resuscitation first. A patient who is shocked needs fluids, access, bloods and senior surgical review before a scan. A patient with peritonitis needs urgent surgical assessment. Know the differences between obstruction, perforation and ischaemia as presented in the stem.
What examiners ask about each group
- GI bleeding. Resuscitate, assess risk, decide on endoscopy timing, and choose the right drug for a suspected variceal or non-variceal source. Recognise when to stop anticoagulants or anti-inflammatory drugs.
- Peptic and reflux disease. Treat, test for and eradicate Helicobacter pylori, and recognise alarm features that call for urgent endoscopy.
- Inflammatory bowel and functional disease. Distinguish Crohn's disease from ulcerative colitis, manage a flare, and avoid diagnostic anchoring on irritable bowel syndrome when alarm features are present.
- Acute abdomen. Identify the likely cause from the site, pattern and signs, and decide on imaging, antibiotics and surgical referral.
- Hepatobiliary disease. Separate biliary colic, cholecystitis and cholangitis, and recognise the urgency of cholangitis. Interpret liver tests in pre-hepatic, hepatic and post-hepatic jaundice.
- Cirrhosis and complications. Treat ascites, spot infected ascites, manage encephalopathy and avoid drugs that harm the liver or kidneys.
- Cancer and nutrition. Identify red-flag symptoms, follow the referral route, and prevent refeeding syndrome by recognising who is at risk.
Most items reward a short mental routine: stable or unstable, medical or surgical, urgent or routine. Run it on every stem before you look at the options.
Time and exam technique
Abdominal stems can be long, with a history, an examination and several results. Read the final sentence first. If it asks for the next step, scan the stem for stability, then for the one result that would change management. Resist the urge to work through every number. If two options remain, ask which one a surgical registrar would want done before they arrive, and which one waits until they have seen the patient.
Three typical traps
- Scanning before resuscitating. A shocked patient with a bleed or perforation needs stabilising first. Imaging follows when the patient is safe to travel.
- Confusing screening with diagnosis. A person with symptoms is not a candidate for the screening programme. The stem will say "invited for" or "presents with", and that wording decides the pathway.
- Missing the drug cause. Many GI bleeds, liver problems and acute kidney injuries have a drug trigger. Read the medication list in the stem before the options.
How to revise it
- Make a symptom-to-test table for haematemesis, melaena, jaundice, dysphagia, rectal bleeding and abdominal pain.
- Learn the liver complications as a set: ascites, encephalopathy, spontaneous bacterial peritonitis, variceal bleeding and hepatorenal problems, each with the first action.
- Compare Crohn's disease and ulcerative colitis in one table: site, pattern, complications, drugs and surgery.
- Revise post-operative problems alongside the acute domain.
- Learn the screening facts above, and add the urgent referral route to each cancer.
- Do 20-question timed blocks and log each error as knowledge, reading or sequencing.
Link this domain to acute and emergency care for the shocked patient and to infection, cancer and palliative care for oncological emergencies.
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Frequently asked questions
How many gastro and surgery questions are in PLAB 1?
The GMC publishes no weights. Our editorial estimate is about 8%, roughly 14 of 180 questions, with more abdominal content inside acute care and cancer.
What are the NHS bowel screening ages?
The NHS offers bowel screening at ages 50 to 74 with a home test kit every 2 years, and people 75 and over can request a kit. Check the NHS page for the current position.
Is the 2-week-wait referral tested?
Referral for suspected cancer is part of the colorectal, breast and upper gastrointestinal subtopics. Learn the current NICE referral criteria from the source, as we could not verify them for this page.