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MRCP has been slowly replacing endoscopic retrograde cholangiopancreatography (ERCP) as investigation of choice. MRCP is highly accurate in diagnosing the biliary system, pancreatic duct and accessing surrounding solid organs. Several advantages offered by MRCP is its non-invasive nature, less costly, requires less examination time when compared to ERCP (30 minutes), fewer staff required, and does not require any ionising radiation.
MRCP is used to diagnose gallstones. It can also diagnose choledochal cysts very reliably. Besides providing information regarding the biliary system, MRCP also provides information regarding surrounding solid organs and blood vessels, thus useful for planning the resection of pancreatic cancer and look for complications of primary sclerosing cholangitis such as liver cirrhosis and cholangiocarcinoma.
Subject is needed to fast for at least four hours to ensure the biliary system is maximally distended with fluid while keeping the fluid in the gastrointestinal system at a minimum. However, clear fluid and routine medication is allowed before the scan. Negative oral contrast such as pineapple juice, date syrup, ferumoxsil, Açaí juice and water are useful in decreasing T2 signal intensity, thus minimising signals from stomach and duodenum from interfering with signals from the biliary system.
MRCP makes use of heavily T2-weighted MRI pulse sequences. These sequences show high signal in static or slow moving fluids within the gallbladder, biliary ducts and pancreatic duct, with low signal of surrounding tissue. Secretin is also given to a patient to increase ductal compliance, making imaging easier.
Magnetic resonance cholangiopancreatography (MRCP) is a medical imaging technique. It uses magnetic resonance imaging to visualize the biliary and pancreatic ducts non-invasively. This procedure can be used to determine whether gallstones are lodged in any of the ducts surrounding the gallbladder.
The MRCP(UK) Part 1 is the entry-level exam accessible to doctors with a minimum of 12 months’ postgraduate experience in medical employment. It covers a broad range of topics to ensure the level of knowledge is appropriate to physicians at the beginning of postgraduate training.
MRCP(UK) tests the acquisition of a representative sample of medical knowledge, skills and behaviour as specified in the UK Specialty Training Curriculum for Core Medical Training / Internal Medicine Training. Part 1 is the first component of a sequence of assessments intended to match the progression of trainees undertaking the Core Medical Training / Internal Medical Training programme in the UK, adding unique information and building on previous assessments.
Knowledge as an essential base for the practice of clinical reasoning
Knowledge is vital as a basis for learning during postgraduate training, to develop understanding of disease processes and their treatment. Building on knowledge of basic medical science gained in undergraduate education, the purpose of Part 1 is to test knowledge and understanding of common and important disorders, as outlined in the UK curriculum, as well as clinical science. Knowledge and understanding of UK national guidelines is also required.
Success in the Part 1 indicates you not only retained the knowledge acquired during undergraduate training, but that your knowledge of medicine has expanded and kept pace with developments that have occurred since graduation, and continues to provide an appropriate basis for clinical decision making. Part 1 is a valuable milestone during training, and helps to prepare you for the more challenging Part 2 Written and Clinical Examinations.
Clinical science forms the basis of all medical practice, and so it is an important component of the Part 1 exam. Wherever appropriate, clinical science questions will include a clinical stem, although this will not invariably be the case if such a stem would not be justified due to the nature of the question.