Gastroenterology and Hepatology
Overview
Gastroenterology encompasses the evaluation and treatment of patients with disorders of the
gastrointestinal tract, pancreas, biliary tract, and liver. It includes disorders of organs within the
abdominal cavity and requires knowledge of the manifestations of gastrointestinal disorders in
other organ systems, such as the skin. Additional areas include knowledge of nutrition and
nutritional deficiencies, and screening and prevention, particularly for colorectal cancer.
The general internist should have a wide range of competency in gastroenterology and should be
able to provide primary and in some cases secondary preventive care, evaluate a broad array of
gastrointestinal symptoms, and manage many gastrointestinal disorders. The general internist is not
expected to perform most technical procedures with the important exception of flexible
sigmoidoscopy. However, he or she must be familiar with the indications, contraindications,
interpretation, and complications of these procedures.
Common Clinical Presentations
·
Abdominal distention·
Abdominal pain·
Abnormal liver function test·
Anorectal discomfort, bleeding, or pruritus·
Anorexia, weight loss·
Ascites·
Constipation·
Diarrhea·
Excess intestinal gas·
Fecal incontinence·
Food intolerance·
Gastrointestinal bleeding·
Heartburn·
Hematemesis·
Indigestion·
Iron-deficiency anemia·
Jaundice·
Liver failure·
Malnutrition·
Melena·
Nausea, vomiting·
Noncardiac chest pain·
Swallowing dysfunctionProcedure Skills
·
Flexible sigmoidoscopy·
Paracentesis·
Placement of nasogastric tube·
Sengstaken-Blakemore tube (optional)Primary Interpretation of Tests
·
Fecal leukocytes·
Test for occult bloodOrdering and Understanding tests
·
24-Hour esophageal pH monitoring·
Assays for Helicobacter pylori·
Bernstein test·
Biopsy of the gastrointestinal mucosa·
Blood tests for autoimmune, cholestatic, genetic liver diseases·
Colonoscopy·
Computed tomography, magnetic resonance imaging, ultrasound of the abdomen·
Contrast studies (including upper gastrointestinal series, small-bowel follow through, bariumenema)
·
Culture of stool for ova, parasites·
D-xylose absorption test and other small bowel absorption tests·
Endoscopic retrograde cholangiopancreatography·
Esophageal manometry·
Examination for stool for ova, parasites·
Fecal electrolytes·
Fecal osmolality·
Gall bladder radionuclide scan·
Gastric acid analysis, serum gastrin level, secretin stimulation test·
Viral hepatitis serology·
Lactose and hydrogen breath tests·
Laparoscopy·
Laxative screen·
Liver biopsy·
Mesenteric arteriography·
Percutaneous transhepatic cholangiography·
Qualitative and quantitative stool fat·
Scans of gastric emptying·
Serum B12 and Schilling tests·
Upper endoscopy