Gastroenterology induction booklet was contributed by the following;
Written by Dr Khuram Khan
Reviewed by Dr Deepa Rattehalli
Updated by Dr Claudia Conroy
Select the booklet titles below to expand the table to view more information.
Gastroenterology Ward
Problem Lists
C7 staff on the ward are so helpful and will really look after you. It is also an excellent job, as it is the perfect mix of challenging work and supportive, available senior staff.
Junior doctor duties mainly lie with ward patients. As there are such a large number, the juniors are not expected to look after outliers routinely. You are encouraged to write regular problem lists in the notes summarising the patient’s current issues and investigations. This should be updated on a day to day basis after reviewing results of recent investigations completed.
It’s also very useful for you to update the treatment each patient is on. For example, ‘Metronidazole day 3’ or ‘Pabrinex day 1’ can be useful ways to keep track of patients’ management and for your own learning. A thorough and concise version of the problem list can be used on the handover document (found on Microsoft teams) which is updated daily and is particularly important for the weekend handover.
TTOs
TTOs are an important document summarising the patient’s inpatient stay to the GP. It is important that the information contained in the TTO is precise and accurate as inaccurate TTO can lead to GP complaints. TTOs are completed on Sunrise now. The problem lists used on daily ward round should be summarised on the TTO. Any changes to medication should also be summarised (i.e. were any drugs stopped; were any drug doses changed; were any new drugs commenced and why).
Results of all investigations requested during the inpatient stay should be followed up by the referring consultant (i.e. consultant who’s care the patient was admitted under). It is not the responsibility of the GP to follow-up pending investigation results. Follow-up instructions should be clearly stated on the discharge summary. Please check with the consultant of the week, who follow-up should be with, as many patients attending the ward will already be under regular follow up with a gastroenterologist. Where urgent follow-up is required, it may be worthwhile emailing the consultant’s secretary directly. Please check electronically to see who the patient is under before arranging follow up. All investigations during the admission should be requested under the original consultant’s name as reports after discharge will be sent to the consultant in charge of the patient.
Ward Rounds
Ward round documentation is completed online. You can find this by searching ‘ward round’ in the document tab. This helpfully automatically copies forward the ‘diagnoses’ and ‘current problems’ parts of the proformas. These should be regularly updated. This involves a history, investigation results, ward round findings and plan.
Physician Associate
Asem is the gastroenterology physician associate and is an incredible team member. He acts up to an SpR level, and has an incredible knowledge base and skillset. At present he sees gastroenterology referrals, so doesn’t spend much time on the ward. I would encourage you to spend time with him wherever possible, as he can teach you a lot about how C7 works and how to do your job as efficiently and safely as possible.
Gastroenterology Team
Currently the gastroenterology consultants and secretaries are as follows;
| Consultant | Secretary | Extension |
|---|---|---|
|
Dr Fisher - |
Bev Cross |
2147 |
|
Dr Mahmood |
|
2073 |
|
Dr Frost |
Leanne Cadby |
2112 |
|
Dr Rattehalli |
Tara Moore |
2370 |
|
Dr Harborne |
Tara Moore |
2370 |
|
Professor Ishaq |
Debbie Hill |
2074 |
|
Dr De Silva |
Debbie Hall |
2074 |
|
Dr S Shetty |
Leanne Cadby |
2370 |
|
Dr King |
Adele Westwood |
2263 |
|
Dr Egbuonu |
Adele Westwood |
2263 |
Support Secretary: Jodie Smart: Extension – 2574
The junior team currently consists of:
- 3 Speciality registrars
- 1 Core Trainee
- 2 MTI Doctors (Level 1 and Level 2)
- 1 Trust Grade doctor
- 1 FY2
- 1 FY1
- 1 Physician Associate
However, this is variable depending on the trainee intake for the rotation.
Gastroenterology Tips
Gastroenterology Booklet
At the specialty induction you will be provided with a gastroenterology booklet and this will give you really useful guidance on how to manage common gastrointestinal conditions which you can refer to.
Clinical Guidelines
There are clinical guidelines available through the hub with hospital specific advice written by For example, Dr Frost has written a useful guide on how to manage alcohol withdrawal which would be well worth referring to. It can be found through searching for ‘identification and management of alcohol use disorders at Russells Hall Hospital guideline’.This also gives advice on how to prescribe a chlordiazepoxide reducing regime.
Ward Rounds
It is preferable that ward round notes always include history, examination, diagnosis and management plan. If possible, a list of active problems and past medical issues. On Fridays, a week-end management plan should be included, and where possible, an estimated date of discharge, and whether medically fit to outlier should also be clearly documented. A typed handover enables good communication as one consultant of the week hands over to the next.
Death Certificates
All death certificates should be discussed with the responsible consultant. The cause of death should be clearly documented in the notes along with who the cause of death was discussed with. This is mandatory and will be audited. Mortality audit forms should be completed in bereavement at the time of writing the death certificate. All cases will be discussed in the mortality MDT.
All death certificates, OPA (FU) and referrals to other consultants, including ITU must be discussed with the above persons or consultants prior to any action.
Further Learning
If you have an interest in taking gastroenterology further, there are several meetings you may wish attend: Wednesday lunchtime is the Upper GI Cancer group, and the lower GI cancer meeting on Monday lunchtime. On the first Wednesday of every month Dr Frost holds a primary and secondary care nutrition MDT on C7 at 08:45. Friday morning 9-10 meeting rotates between IBD, mortality, x-ray and histology meetings in the clinical education centre.
There is also teaching every Friday lunch-time which is organised by Dr King and you are encouraged to participate in this.
Your time with this firm is an excellent opportunity to not only learn diagnosis and management of gastroenterology, but also to practical procedures, such as diagnostic ascitic taps, therapeutic paracentesis. Many other general medical procedures can also be performed. We would encourage you to come to the GI unit to observe diagnostic and therapeutic endoscopies taking place.
Team, L. M. (n.d.). Gastroenterology Group of Central NJ | Michael Lupovici MD. Michael Z Lupovici MD. Retrieved June 14, 2023, from https://www.lupovicimd.com
Handovers
Weekly handovers take place on Thursdays at around 1pm in the seminar room. You should print off a couple of updated handover sheets.
Audits
Audit is an important part of clinical work, and you are all expected to perform/ take part in an audit project during your rotation with us. (Dr Mahmood is audit lead for Gastroenterology and he may advise on appropriate audits, as well as the other consultants if specific to sub-speciality). Appraisals are essential and are your responsibility to organise at the relevant time.
Gastroenterology Investigations
It will be useful to read the following information on common investigations in gastroenterology. This will help you on ward rounds to understand what you are investigating for, and benefit your learning.
Select the titles in red below to find out further information.
Common liver/gastro investigations
Viral
- Hep A, B,C
- CMV
- EBV
Copper
- Ceruloplasmin
- 24hUrine
Iron studies
- Ferritin
- HFE Gene
AFP
Alpha1antitrypsin
Auto-immune
- ANA
- Anti-sm AB
- Anti-mitochondrial
- Anti-LKM
Immunoglobulins
- IgA, M,G
- Bands
N.B Sunrise electronic prescribing/ordering has some helpful order sets. “Pathology” contains most screening tests. There are also “AKI” and “liver screen” order sets which are very practical.
Pugh Score
Maddreys Score
Discriminant function: 4.6 X (Patient’s PT – Control PT) + bilirubin
MELD (Model of End Stage Liver Diseases) Score
Determines prognosis and prioritises receipt of liver transplantation. Available online through MDCALC.
Decompensated Cirrhosis Care Bundle – First 24 Hours
Decompensated cirrhosis is a medical emergency with a high mortality. Effective early interventions can save lives and reduce hospital stay. This checklist should be completed for all patients admitted with decompensated cirrhosis within the first 6 hours of admission.
Click view checklist as a PDF >> (This will open in a new browser)
The recent NCEPOD report 2013 on alcohol related liver disease highlighted that the management of some patients admitted with decompensated cirrhosis in the UK was suboptimal. Admission with decompensated cirrhosis is a common medical presentation and carries a high mortality (10-20% in hospital mortality). Early intervention with evidence-based treatments for patients with the complications of cirrhosis can save lives. This checklist aims to provide a guide to help ensure that the necessary early investigations are completed in a timely manner and appropriate treatments are given at the earliest opportunity.
- Decompensated cirrhosis is defined as a patient with cirrhosis who presents with an acute deterioration in liver function that can manifest with the following symptoms:
- Jaundice
- Increasing ascites
- Hepatic encephalopathy
- Renal impairment
- GI bleeding
- Signs of sepsis / hypovolaemia
- Frequently there is a precipitant that leads to the decompensation of cirrhosis. Common causes are:
- GI bleeding (variceal and non-variceal)
- Infection/sepsis (spontaneous bacterial peritonitis, urine, chest, cholangitis etc)
- Alcoholic hepatitis
- Acute portal vein thrombosis
- Development of hepatocellular carcinoma
- Drugs (Alcohol, opiates, NSAIDs etc)
- Ischaemic liver injury (sepsis or hypotension)
- Dehydration
- Constipation
When assessing patients who present with decompensated cirrhosis please look for the precipitating causes and treat accordingly. The checklist shown overleaf gives a guide on the necessary investigations and early management of these patients admitted with decompensated cirrhosis and should be completed on all patients who present with this condition. The checklist is designed to optimise a patient’s management in the first 24 hours when specialist liver/gastro input might not be available.
Please arrange for a review of the patient by the gastro/liver team at the earliest opportunity. Escalation of care to higher level should be considered in patients not responding to treatment when reviewed after 6 hours, particularly in those with first presentation and those with good underlying performance status prior to the recent illness
Gastroenterology Learning Opportunities
Try to attend at least two meetings during your rotation. All meetings are in the Clinical Education Centre.
Colorectal MDT
Monday 1pm-2pm (room 4/5 education centre); please email: colorectalmdt@nhs.net for any patients that need to be discussed; usually a proforma will be emailed back to you to complete with a full summary of the patient should be given and the clinical question to be answered; a member of the team should attend the meeting to discuss the patient.
Upper GI MDT
Wednesday 1245pm – 2pm (room 4/5 education centre); please email uppergimdt@nhs.net for any patients that need to be discussed; a full summary of the patient should be given and the clinical question to be answered; a member of the team should attend the meeting to discuss the patient; cut of time for histology to be discussed is 9am Monday morning; if the patient is to be seen by the upper GI CNS please contact Helen Knott or Eleanor Traverse
IBD MDT
Need to check VTE forms first thing, as CoW will be getting emails from Sarah Hughes complaining at you for non-completion.
QE Hepatobiliary MDT
The cut off time for the QE MDT is Wednesday 9am; if referrals are not received before this time they will not be discussed in the QE MDT on Thursday; email dgft.uppergimdt@nhs.net for all QE referrals, c.c. The on-call consultant, ward SpR and consultant who the patient is under
Grand Rounds
Grand rounds are weekly on Thursdays between 13:00-14:00 in the education centre. These are lectures presented by different clinicians in the trust on useful and important
On-call
During your time on this rotation, you will also be rostered on to the general medical on-call rota. At present, FY1s take part in both medical and surgical on-calls, regardless of what their home specialty is. On-call rotas are on Medirota – it will tell you the type of shift you are doing, timings, and also tells you your ‘off days’ (days off you are given pre- and post-on-calls). If you are not on-call or on an off day, you will be on C7.
Audits
There are plenty of opportunities to participate in audits, whether this is mandatory trust audits or a new You will always be welcomed to present audits once completed. Speak to your Clinical Supervisor if you want to get involved in one.
Teaching
As you can imagine, there are always medical students around to Some consultants have groups of medical students they teach weekly and may ask you teach them one week. Alternatively, if they don’t offer you can always ask! Teaching experience is always useful for your portfolio. Take feedback forms with you if you do teach!
Health and Wellbeing
Staff that are happy and thriving in their working environment will inevitably have a more enjoyable experience in the workplace, contributing to the provision of excellent health care for all of our patients. The Dudley Group recognises our commitment to staff wellbeing in a variety of ways.
Select the link below to find out more how the Trust can support you.
