SIU School of Medicine

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Department of Internal Medicine

Gastroenterology Rotation

Students should report to MMC D-417 at 8:00 am the first day of your GI rotation and ask for Nancy Walker or Tracey Taylor.

  1. Each student will be assigned to one established patient on Monday, with more patients assigned later in the week.
  2. Each student will be assigned to attend the two general GI clinics each week on Monday & Wednesday.
  3. Each student will be expected to round on the patients and formulate ideas regarding diagnosis and management during attending rounds.
  4. Each student will work approximately half of the weekend which includes consults and ward rounds on Saturdays. After rounds and consults are seen on the weekend days - students have the rest of the day off. Students are responsible for being available both weekends of this rotation. Each student will also take call two times per week. Students will be off both Sundays during this rotation.
  5. Attending rounds will take place every AM in the GI division conference room. Prior to GI rounds, the student is requested to have reviewed the results of all x-ray studies and other tests performed the day prior.
  6. Conferences:
    • Weekly Internal Medicine Grand Rounds @ 8:00 am every Tuesday, starting in September
    • Weekly Journal Club/Path Conference Thursdays 8-9am - 1st Thursday of each month @ SJH (Radiology Conference Room) and 2,3,4 Thursdays @ MMC (D-228)
  7. Endoscopic experience will be tailored to the consultation.

EDUCATIONAL OBJECTIVES

THE ESOPHAGUS
Objectives

The trainee should be able to:

  1. take and interpret a history of the esophagus;
  2. understand the pathology of, and clinical findings that indicate the major esophageal diseases;
  3. understand diagnostic approaches to the major esophageal diseases; and
  4. identify the treatment options for these diseases.

DISEASES OF THE STOMACH & DUODENUM
Objectives

The trainee should be able to:

  1. describe how gastric acid secretion is controlled and the pharmacological means of inhibiting it;
  2. discuss the symptoms of peptic ulcer disease and its major complications;
  3. list three diseases or conditions that increase the risk of peptic ulcer or increase the rate of recurrence;
  4. explain the epidemiology, transmission, clinical association, and methods of diagnosis of Helicobacter pylori infection; and
  5. understand the pathology, symptoms, evaluations and treatment approaches for stress bleeding, gastric ulcer, gastric lymphoma, and bezoars.

GASTROINTESTINAL BLEEDING
Objectives

The trainee should be able to:

  1. state the differences between hematemesis, melena, maroon stools, and hematochezia with regard to site and rate of bleeding.
  2. state the four most common causes of upper and lower GI bleeding;
  3. be able to perform a directed history and physical examination in patients with acute GI bleeding and determine the likely location of bleeding; and
  4. explain the steps in the diagnostic evaluation of acute upper and lower gastrointestinal bleeding.

GALLBLADDER DISEASE
Objectives

The trainee should be able to:

  1. name the principal ingredients of bile and understand how changes in their relative amounts may lead to formation of gallstones;
  2. name the symptoms and signs of biliary colic, acute cholecystitis, and cholangitis; and
  3. understand the uses of US, OCG, CT, PTC, DISIDA, and ERCP in the diagnosis of gallbladder and biliary diseases.

LIVER DISEASE
Objectives

The trainee should be able to:

  1. classify a patient as having acute, subacute, or chronic liver disease;
  2. define cirrhosis and liver failure;
  3. realize that while patients may present with symptoms, an abnormal physical examination, or abnormal liver tests, the physician must consider each of these three components in the initial assessment and plan;
  4. memorize the history to be taken from a patient with suspected liver disease;
  5. recognize the physical examination findings of liver disease and interpret their presence;
  6. interpret liver chemistry tests;
  7. understand hepatitis A, B, C and delta virus infection;
  8. generate a differential diagnosis in a patient with a clinical presentation of chronic hepatitis;
  9. order the appropriate serologies and chemistries to evaluate a patient with chronic hepatitis;
  10. understand the clinical presentation of fatty liver, alcoholic hepatitis and alcoholic cirrhosis; and
  11. list the main complications of cirrhosis, their pathogenesis, and clinical presentation.

PANCREATIC DISEASE
Objectives

The trainee should be able to:

  1. understand the symptoms of acute and chronic pancreatitis and the causes of each;
  2. describe how chronic pancreatitis can cause malabsorption; and
  3. explain why pancreatic cancer is so hard to diagnose and cure.

DISEASES OF THE SMALL INTESTINE
Objectives

The trainee should be able to:

  1. describe the normal pathways of nutrient absorption by the small intestine;
  2. classify diarrhea based on the findings gained from stool examination;
  3. give several examples of diseases that cause diarrhea in each classification;
  4. understand which organisms cause diarrhea by invasion of the bowel, and which produce enterotoxins; and
  5. differentiate Crohn's disease from ulcerative colitis.

DISEASES OF THE COLON & ANORECTUM
Objectives

The trainee should be able to:

  1. take the history of a patient with suspected colonic disease;
  2. understand the information which can be gained from rectal examination and examination of the stool;
  3. outline reasonable methods for screening and diagnosing colon cancer;
  4. list the symptoms of diverticulitis and its complications;
  5. list four differences between UC and Crohn's colitis; and
  6. explain the symptoms of ischemic colitis.

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