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Download Gastrointestinal, Liver and Nutrition Dr D Duerksen
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Gastrointestinal, Liver and Nutrition Dr D Duerksen Principles for New GI Curriculum Integration of basic science with clinical GI/Hepatology/Nutrition ◦ Starting in M1 Generalism ◦ Cover topics that are common, clinically important Integration of ‘themes’ into GI curriculum GI/Nutrition Committee Discipline Committee Member Course Leader Donald Duerksen Education Coordinator Suzanne Doyle Anatomy/Histology Maria Vrontakis Pathology Marc Dupre Radiology Jeff Mottola Hepatology Steven Wong General Surgery Jason Park Generalism ? Student/resident ? Pharmacology Peter Thomson Nutrition Brenda Hotson Themes relevant to GI Theme Topic Oncology Colon cancer (pancreatic, liver, esophagus, stomach) Genetics Colon cancer, pancreatic cancer, pancreatitis Clinical Health Psychology Functional GI disorders and CBT Pediatrics Congenital disorders, IBD, functional Palliative Care GI malignancies Geriatrics Chronic constipation Patient Safety Endoscopic complications Infectious Disease Infectious diarrhea and all the other themes as well courses M1 Anatomic Approach ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Oral cavity and esophagus Stomach and duodenal bulb Pancreas Liver Gallbladder and biliary tract Small intestine Large intestine Anorectum M1 Anatomy and Histology ◦ Case based approach ◦ Integrate with radiology, surgery and endoscopy Demonstrate normal cross sectional anatomy Demonstrate laparoscopic anatomy Integrate endoscopic anatomy with histology M1 Physiology ◦ Case based using common GI disorders to demonstrate abnormalities in physiology ◦ Demonstrate common pathophysiologic concepts with relevant diagnostic testing M1 Physiology Relevant Pathophysiology Test Esophagus Achalasia, GERD Motility Test, 24 hour pH test Stomach Peptic Ulcer Disease, HP C14 urea breath Small Intestine Celiac disease Oral rehydration solutions Tests for malabsorption Large intestine Infectious Diarrhea, Bile salt diarrhea C diff and microbiome Stool analysis Stool osmole gap Liver Cirrhosis Liver function tests Pancreas Chronic pancreatitis 72 h fecal fat, pancreatic function tests Biliary Tract Gallstones Fatty meal U/S Anorectum Fecal Incontinence Anorectal motility testing M2/M3 Anatomic Disease Based Approach Common GI Symptoms/multi organ problems ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Acute and Chronic diarrhea Abnormal LFTs Constipation Acute Abdomen Chronic Abdominal Pain Upper GI Bleed Lower GI bleed Jaundice Ascites Vomiting Gaps in Current Curriculum Abdominal trauma Bariatric surgery ◦ Needs to be integrated into obesity management Clinical Nutrition Clinical Nutrition – M1 ◦ Digestion and absorption Macronutrients – causes of malabsorption Vitamins, minerals, trace elements – deficiency syndromes Water ◦ Malnutrition in Hospitalized Patient Prevalence Etiology Types of malnutrition Nutrient Requirements Management of the malnourished patient EN TPN Clinical Nutrition in GI Block – M2 Clinical Nutrition in GI Block ◦ ◦ ◦ ◦ ◦ ◦ ◦ Acute Pancreatitis – role of enteral nutrition Crohn’s disease – role of enteral nutrition Chronic Liver disease – protein requirements Role of diet in IBS – fiber, FODMAP diet Short bowel syndrome and Home TPN Home enteral nutrition support Post operative nutrition support Clinical Nutrition Clinical Skills Nutrition Assessment ◦ Subjective Global Assessment Clinical Nutrition Potential Gaps ◦ Diet Therapies Weight loss diets – e.g. Adkins Mediterranean diet Vegetarian diet ◦ Obesity Management (covered in Endocrine) ◦ Nutrition management of critically ill patients ◦ Functional Foods Flax, plant sterols, fatty acids (CLA, omega 3) etc Clinical Nutrition Potential Gaps ◦ ◦ ◦ ◦ Nutrigenomics Sports nutrition Role of nutrition and exercise therapies Nutrition in disease states Kidney disease Hypertension Cardiovascular disease Diabetes Eating disorders Cancer ◦ Role of clinical dietitian
