Medical Degree Program Admissions Application Criteria & Process Admission Requirements How to Apply FAQs Transfer Policy & Procedures Information for Incoming Students Contact Us Curriculum Electives Student Support 630F - Gastroenterology The course is available to UCI students only. Home Education Medical Education Medical Degree Program MD Programs Curriculum Internal Medicine Elective > 630F - Gastroenterology Course Director, Coordinator and General Administrative Information Faculty & Staff Email Director: Lydia Aye, DO ayel@hs.uci.edu Coordinator: Lanette Guerrero mlguerr1@hs.uci.edu DESCRIPTION During the Gastroenterology elective the student will be exposed to patients with esophageal disorders, peptic ulcer disease, inflammatory bowel disease, gastrointestinal bleeding, pancreatitis, and acute and chronic liver diseases. The student will observe and participate in the diagnostic workup of these patients, their plan of therapy, and in their follow-up. The student will observe and assist in gastrointestinal diagnostic and therapeutic endoscopy and in the acute care of gastrointestinal emergencies. The student will work closely with the attending on the Gastroenterology Service and with the Fellows in training. There are three types of teaching activities within the division. These include bedside rounds, teaching conferences and outpatient clinics. They are attended by the students, residents, and Fellows in Gastroenterology and are conducted by the attending faculty member. They are designed to elucidate the important clinical features of the patient’s problem and correlate them with known pathophysiological considerations. PREREQUISITES This course is intended for 4th-year students enrolled in the undergraduate medical education program at UCI School of Medicine. RESTRICTIONS This course is intended for 4th-year students enrolled in the undergraduate medical education program at UCI School of Medicine. COURSE DIRECTOR Dr. Lydia Aye is the current Program Director for the Gastroenterology Fellowship at UCI Medical Center. She has been a faculty member at UCI since July of 2020. She is triple board certified in Internal Medicine, Gastroenterology, and Transplant Hepatology. Lanette Guerrero is the course coordinator for MS3 Mini-Elective and serves as program coordinator for the Gastroenterology Fellowship. INFORMATION FOR THE FIRST DAY Please report to the first-floor physician workroom in Building 22C (Comprehensive Digestive Disease Center, CDDC) at the UCI Medical Center on your first day at 7 am. Please call or text the fellow on GI consults if they are not in the workroom. The attached e-mail will have the names and phone numbers of the GI consult fellow. If you are unable to reach any fellows, please page the General GI fellow at 714-506-3015. EXPECTATIONS FOR THE ELECTIVE The medical student will be assigned 1-2 patients to follow daily. The student will pre-round on the patients with the fellow, present the patients on rounds, discuss assessments and plans on rounds, and communicate with the primary teams after rounds. New consults will be assigned to the medical student and the medical student will follow and learn about these new patients. Medical students will give 1-2 short presentations (5-10 minutes) to the fellows or on rounds regarding GI topics of their choice during this rotation. Week Rotation 1 GI Consults 2 GI Consults 3 Ambulatory/Procedures 4 Liver Consults SITE: UCI Medical Center DURATION: 2-4 weeks Scheduling Coordinator: UCI students please call (714) 456-8462 or e-mail the course coordinator to schedule the elective. Periods Available: The time of the course must be pre-approved by the course director at least 3 months prior to the start of the course. No exceptions. NUMBER OF STUDENTS ALLOWED: 1 per rotation block WHAT STUDENTS SHOULD DO TO PREPARE FOR THE COURSE See APPENDIX. COMMUNICATION WITH FACULTY Questions regarding the logistics of the elective should be directed to the Course Coordinator. Direct questions, comments, or concerns about the course can be directed to the Course Director. Contact information is provided at the top of the page. The Course Director is also available to meet in person. Please email mlguerr1@hs.uci.edu to arrange an appointment. To ensure that your email will not be lost in the large volume of email received, please use the following convention for the subject line: SUBJECT: COURSE NAME, your last name, your issue SUBJECT: COURSE NAME, your last name, your issue (e.g. XXX, Smith, Request for appointment). Course Objectives and Program Objective Mapping The following are the learning objectives for the 630F course. Students are expected to demonstrate proficiency in these areas in order to satisfactorily complete the course. In addition, the extent of a student's mastery of these objectives will help guide the course evaluation and grade. Course Objective Mapped UCI School of Medicine Program Objective Sub Competency Core Competency Be experienced in conducting a history and physical for gastroenterology patients. B-1. The ability to competently conduct a medical interview and counseling to take into account patient health beliefs, patient agenda and the need for comprehensive medical and psychosocial assessment B-2. The ability to competently perform a complete and organ-system-specific examination including a mental health status examination Medical Interview Physical Exam Skillful Be experienced at writing up and presenting gastroenterology patients. B-3. The ability to articulate a cogent, accurate assessment and plan, and problem list, using diagnostic clinical reasoning skills in all the major disciplines Patient Management Skillful Be knowledgeable in the basic concepts of gastrointestinal pathophysiology and the clinical aspects of gastrointestinal disorders. A-2. Knowledge of the pathogenesis of diseases, interventions for effective treatment, and mechanisms of health maintenance to prevent disease Disease Pathogenesis and Treatment Knowledgeable Be knowledgeable in the planning and performance of diagnostic procedures for the evaluation and treatment of gastroenterology patients. A-2. Knowledge of the pathogenesis of diseases, interventions for effective treatment, and mechanisms of health maintenance to prevent disease Disease Pathogenesis and Treatment Knowledgeable Demonstrate professionalism by attending all rounds, conferences and lectures assigned. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations Professionalism Altruistic Acquire an understanding of some of the most common problems seen by family physicians. A-2. Knowledge of the pathogenesis of diseases, interventions for effective treatment, and mechanisms of health maintenance to prevent disease Disease Pathogenesis and Treatment Knowledgeable Course Resources TEXTS AND READINGS: SUGGESTED See APPENDIX Major Exams, Assignments and Grading MANDATORY SESSIONS 7:00 am to 8:30 am – GI Modules, ZOOM session Link to be sent by Course Coordinator MAJOR ASSIGNMENTS AND EXAMS None. GRADING Medical Students are graded using the following scale: Honors (H), Pass (P), Fail (F), and Incomplete (I). For further information, please review the Grading Policy. You have 30 days from the date of the grade to appeal any aspect of this grade. Please contact your clerkship/course director should you have any questions Requirements for “Pass” To receive a grade of Pass, students must demonstrate successful performance in all of the following areas: Knowledge Patient Care Practice-Based Learning Interpersonal & Communication Skills Professionalism Systems-Based Practice Requirements for “Honors” To receive a grade of Honors, students must demonstrate exceptional performance in all of the following areas: Knowledge Patient Care Practice-Based Learning Interpersonal & Communication Skills Professionalism Systems-Based Practice Grounds for “Incomplete” You will not be issued a grade until all elements of the course have been completed. REMEDIATION Remediation, if needed, will be designed by the course director to suit the issue at hand. Grounds for “Fail”: You will receive a grade of "Fail" if the requirements for passing the course have not been met. Please refer to the Grading Policy for the impact of the "Fail" grade to the transcript. Appendix Please review this list of commonly encountered conditions in the field of gastroenterology. For each topic, we have included relevant clinical questions and a corresponding guideline or article that can be referenced for the answer. Many of these guidelines can be found through the four main GI societies websites. If students have issues accessing these documents, please let the fellow or course director know. We hope that students will have a broad exposure to relevant GI procedures and knowledge. They will develop skills that will aid them in lifelong self-directed learning. Major GI Societies: American Association for the Study of Liver Diseases (AASLD) American College of Gastroenterology (ACG) American Gastroenterology Association (AGA) American Society for Gastrointestinal Endoscopy (ASGE) Guidelines from each society can be accessed through their main website. GI Bleeding Topic Learning Objectives Resources for Self-Directed Learning Nonvariceal Upper GI Bleeding Understand the importance of volume resuscitation for all patients with GI bleeding. Understand the data behind the recommendation for a restrictive transfusion strategy. Recognize the guideline recommendations for standard timing of endoscopy for UGIB. Be able to list features of GI bleeding that would warrant earlier timing of endoscopy. Understand the role of PPI treatment before endoscopy and its impact on need for endoscopic therapy, mortality, rebleeding, and need for surgery. Recognize what three features seen on endoscopy constitute high-risk stigmata and require continued hospitalization after endoscopy. Recognize what two features seen on endoscopy do not require hospitalization after endoscopy. ACG 2012 Guideline “Management of Patients with Ulcer Bleeding” Understand the data behind the recommendation for a restrictive transfusion strategy. International Consensus Group’s 2019 Guideline “Management of Nonvariceal Upper GI Bleeding: Guideline Recommendations from the International Consensus Group” published in Annals of Internal Medicine Understand the sensitivity of nasogastric lavage for risk stratifying upper GI bleeding. Know how to interpret different results of gastric aspirate (blood, coffee grounds, nonbloody material) from NG lavage. ASGE 2012 Guideline on “The role of endoscopy in the management of acute non-variceal upper GI bleeding” Variceal Upper GI Bleeding Know what physical exam findings, lab findings, imaging findings, medical history would lead you to suspect variceal bleeding. ASGE 2014 Guideline on “The role of endoscopy in the management of variceal hemorrhage” Peptic Ulcer Disease Understand the role of PPI treatment before endoscopy and its impact on need for endoscopic therapy, mortality, rebleeding, and need for surgery. Cochrane 2012 Review “Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper GI bleeding” Lower GI Bleeding Understand the importance of volume resuscitation for all patients with GI bleeding. Recognize the importance of adequate bowel preparation for colonoscopy for GI bleeding. Be able to list three items on the differential for lower GI bleeding and associated features of presentation or history that would lead you to include them on the differential. ACG 2016 Guideline “Management of Patients with Acute Lower GI Bleeding” Know what radiologic studies are or are not appropriate for localization of lower GI bleeding. ACR (American College of Radiology) Appropriateness Criteria for Radiologic Management of Lower GI Tract Bleeding – Summary Table & Narrative File Colonic Ischemia Be able to list common presentations for colonic ischemia. Recognize the diagnostic Identify risk factors for colonic ischemia in a patient’s past medical history and medication list. Be able to diagnose severe colonic ischemia (physical exam, imaging findings, lab findings, endoscopic findings) and indications for surgical consultation. Recognize the role of antibiotics for moderate or severe colonic ischemia. ACG 2016 Guideline “Management of Patients with Acute Lower GI Bleeding” Miscellaneous Topics Topic Learning Objectives Resources for Self-Directed Learning Nonvariceal Upper GI Bleeding Understand the importance of volume resuscitation for all patients with GI bleeding. Understand the data behind the recommendation for a restrictive transfusion strategy. Recognize the guideline recommendations for standard timing of endoscopy for UGIB. Be able to list features of GI bleeding that would warrant earlier timing of endoscopy. Understand the role of PPI treatment before endoscopy and its impact on need for endoscopic therapy, mortality, rebleeding, and need for surgery. Recognize what three features seen on endoscopy constitute high-risk stigmata and require continued hospitalization after endoscopy. Recognize what two features seen on endoscopy do not require hospitalization after endoscopy. ACG 2012 Guideline “Management of Patients with Ulcer Bleeding” Understand the data behind the recommendation for a restrictive transfusion strategy. International Consensus Group’s 2019 Guideline “Management of Nonvariceal Upper GI Bleeding: Guideline Recommendations from the International Consensus Group” published in Annals of Internal Medicine Understand the sensitivity of nasogastric lavage for risk stratifying upper GI bleeding. Know how to interpret different results of gastric aspirate (blood, coffee grounds, nonbloody material) from NG lavage. ASGE 2012 Guideline on “The role of endoscopy in the management of acute non-variceal upper GI bleeding” Variceal Upper GI Bleeding Know what physical exam findings, lab findings, imaging findings, medical history would lead you to suspect variceal bleeding. ASGE 2014 Guideline on “The role of endoscopy in the management of variceal hemorrhage” Peptic Ulcer Disease Understand the role of PPI treatment before endoscopy and its impact on need for endoscopic therapy, mortality, rebleeding, and need for surgery. Cochrane 2012 Review “Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper GI bleeding” Lower GI Bleeding Understand the importance of volume resuscitation for all patients with GI bleeding. Recognize the importance of adequate bowel preparation for colonoscopy for GI bleeding. Be able to list three items on the differential for lower GI bleeding and associated features of presentation or history that would lead you to include them on the differential. ACG 2016 Guideline “Management of Patients with Acute Lower GI Bleeding” Know what radiologic studies are or are not appropriate for localization of lower GI bleeding. ACR (American College of Radiology) Appropriateness Criteria for Radiologic Management of Lower GI Tract Bleeding – Summary Table & Narrative File Colonic Ischemia Be able to list common presentations for colonic ischemia. Recognize the diagnostic Identify risk factors for colonic ischemia in a patient’s past medical history and medication list. Be able to diagnose severe colonic ischemia (physical exam, imaging findings, lab findings, endoscopic findings) and indications for surgical consultation. Recognize the role of antibiotics for moderate or severe colonic ischemia. ACG 2016 Guideline “Management of Patients with Acute Lower GI Bleeding” Pancreatic & Biliary Disease Topic Learning Objectives Resources for Self-Directed Learning Cholangitis What is Charcot’s triad? Is Charcot’s triad more sensitive or more specific for acute cholangitis? What is the Tokyo Guidelines 2018 diagnostic criteria for acute cholangitis? What is the difference in criteria between suspected diagnosis and definite diagnosis? What is the definition of Grade I, II, and III acute cholangitis? What is the data shared in the Tokyo Guidelines about urgent or early drainage for these classes? Tokyo Guidelines 2018: Diagnostic Criteria and Severity Grading of Acute Cholangitis Tokyo Guidelines 2018: Initial Management of Acute Biliary Infection and Flowchart for Acute Cholangitis Recognize the difference between MRI noncontrast, MRI with IV contrast, MRCP. Recognize which studies are or are not appropriate for evaluation for common bile duct stones, ductal stones, and masses. American College of Radiology Statement about ACR Appropriateness Criteria re: Jaundice EASL Clinical Practice Guidelines on the prevention, diagnosis, and treatment of gallstones (2016) Acute Pancreatitis What are the diagnostic criteria for acute pancreatitis? Recognize why an abdominal ultrasound is recommended for all patients with acute pancreatitis. Be able to list five different causes of pancreatitis. What is the definition of severe acute pancreatitis by the revised Atlanta criteria (2013)? What is the definition of aggressive IV hydration that is recommended for patients in the first 24 hours of presentation? What fluid is preferred for these patients? What is the data related to prophylactic antibiotics for infected necrosis as described in the guidelines? When should enteral nutrition be restarted in acute pancreatitis? ACG Guidelines 2013 “Management of Acute Pancreatitis” Liver Disease Topic Learning Objectives Resources for Self-Directed Learning Acute Liver Failure What is the definition of acute liver failure? AASLD Position Paper: The Management of Acute Liver Failure: Update 2011 Abnormal LFTs Be able to distinguish between cholestatic injury and hepatocellular injury. What is a healthy normal ALT in men and women? How long do anti-HCV antibodies take to become positive after exposure? Understand how to interpret hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (Anti HBs), hepatitis B core antibody total (Anti HBc total) for patients with chronic hepatitis B, passive immunity to hepatitis B, active immunity to hepatitis B. Understand scenarios where HBV DNA, hepatitis B e antigen (HBeAg), Hepatitis B e antibody (Anti HBe) are indicated. ACG Guideline 2017 “Evaluation of Abnormal Liver Chemistries” Inflammatory Bowel Disease Topic Learning Objectives Resources for Self-Directed Learning Ulcerative Colitis Flare What is the definition of acute liver failure? What is the definition of a severe UC flare (compared to a mild flare) based upon Truelove & WItts criteria? Recognize the difference between induction therapy and maintenance therapy for UC. Be aware of the risk of colectomy in patients with severe disease. AGA 2020 Guidelines “Management of Moderate to Severe Ulcerative Colitis” Recognize the poor outcomes associated with NSAIDs in patients with UC. Recognize the importance of pharmacologic VTE prophylaxis in patients with acute flare. Recognize signs and symptoms of toxic megacolon. ACG 2019 Guidelines “Ulcerative Colitis in Adults” Be familiar with various inpatient protocols for hospitalized patients with UC flares. University of Michigan Severe Ulcerative Colitis Protocol (2017) Society of Hospital Medicine’s “Inpatient Management of Acute Severe Ulcerative Colitis” (2019) Be able to recognize bowel wall thickening on a CT scan. Radiology Assistant https://radiologyassistant.nl/abdomen/bowel-wall-thickening-ct-pattern Clostridium difficile infection Understand how toxin enzyme immunoassays (EIA) work. Understand how glutamate dehydrogenase (GDH) immunoassays work. Understand how nucleic acid amplification tests (NAAT) work. Recognize how these tests compare in terms of sensitivity & specificity. Understand the limitations of these tests. IDSA 2018 Clinical Practice Guidelines for C Difficile Infection Miscellaneous topics Topic Learning Objectives Resources for Self-Directed Learning Dysphagia Learn how to obtain a good history for dysphagia. Recognize pertinent questions to help distinguish between mechanical causes versus motility causes of dysphagia. What esophageal diameter is associated with dysphagia? ASGE Guideline 2014 “The role of endoscopy in the evaluation and management of dysphagia” Nausea and vomiting Identify elements of a history that would distinguish between GI causes and non-GI causes of nausea and vomiting. Understand how a gastric emptying study is performed, and what the diagnostic criteria for gastroparesis is. Understand the long-term risks related to metoclopramide and how to counsel patients about use of this drug. ACG Guidelines 2018 “Chronic nausea and vomiting: evaluation and treatment” AGA Technical Review on Nausea and Vomiting (2001) Chronic abdominal pain What are the diagnostic criteria for narcotic bowel syndrome? What are the diagnostic criteria for functional abdominal pain syndrome? Clinical Gastroenterology & Hepatology 2008 article by Dr. Douglas Drossman “Severe and refractory chronic abdominal pain: treatment strategies” What are the diagnostic criteria for functional dyspepsia? What are the diagnostic criteria for cyclic vomiting syndrome? Gastroenterology 2016 article by Stanghellini et al “Gastroduodenal disorders” Diarrhea What is the evidence surrounding empiric antimicrobial therapy for acute diarrhea infections? ACG Guidelines 2016 “Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults” What is the definition of chronic diarrhea? What are alarm features that warrant further testing for chronic diarrhea? Clinical Gastroenterology & Hepatology 2017 article by Schiller et al “Chronic Diarrhea: Diagnosis and Management”