Prior knowledge, skills, and attitudes acquired during the pre-clerkship experience should include:
Students should be able to define and describe:
- The pathogenesis, clinical features, typical course, and complications of the common causes of liver and biliary tract disease, including cirrhosis, acute and chronic hepatitis (both viral and non-viral), and gallbladder disease.
- Preventive measures for decreasing the risk of transmission of viral hepatitis, including vaccination and safe-health and –sexual practives.
Students should demonstrate specific skills, including:
- History-Taking Skills: Students should be able to obtain, document, and present an age-appropriate medical history, that suggests the diagnosis of:
- liver or biliary disease (including constitutional symptoms)
- abdominal pain, and
- the use of (illicit, OTC and prescribed) drugs or alcohol.
- Physical Exam Skills: Students should be able to perform a physical exam to diagnose liver or biliary tract disease, including accurate recognition of:
- stigmata of cirrhosis
- signs of liver failure
- Differential Diagnosis: Students should be able to generate a differential diagnosis of liver and biliary tract diseases by recognizing the specific history and physical exam, and laboratory findings that differentiate these disorders
- Laboratory Interpretation: Students should be able to interpret:
- tests of liver function (serum albumin, prothrombin time)
- tests of hepatocellular damage (ALT, AST, ggT)
- screening tests for hepatobiliary disease (serum bilirubin, alkaline phosphatase)
- tests of ascetic fluid components, and
- serologic tests for viral hepatitis.
- Students should be familiar with diagnostic tests for the common types of chronic hepatitis. Students should be able to identify common drugs that can initiate or exacerbate liver disease. Students should be able to identify the indication for a liver biopsy.
- Communication Skills: Students should be able to: explain the diagnosis, management plan, and prognosis to patients and their families; identify risk factors; and educate patients regarding high risk behaviors.
- Management Skills: Students should be able to develop an appropriate evaluation for a patient with abnormal liver function tests, and develop a management plan for acute and chronic liver and biliary tract disease.
- Clerkship Seminar, “Abnormal Liver Function,” J. Ahluwalia, MD
- Internal Medicine Clerkship Guide, Mosby, 2003, pp 276-287
- Pratt and Kaplan. Evaluation of Abnormal Liver-Enzyme Results in Asymptomatic Patients. NEJM, 342(17), 1266-1271
- Does this Patient Have Acute Cholecystitis?, Robert L. Trowbridge, MD, Nicole K. Rutkowski, MD, Kaveh G. Shojania, MD, JAMA, January 1, 2003-Vol.289, No.1