My Senior Gastroenterology Elective

Hi all,
I am three weeks into my Senior Gastroenterology elective. This is a great elective for anyone going into Family Practice, Internal Medicine, Pediatrics, Emergency Medicine or General Surgery. If you are a primary care physician, many of your patients are going to seek your help for gastrointestinal problems such as Gastroesophageal Reflux Disorder (GERD) or recurrent heartburn. It has been great to look at the actual tissue in a living human without making an incision. Being able to treat this common disorder and understand its impact on life quality has been good for me.
I have cauterized a couple of bleeders during esophagogastroduodenoscopy (EGD) while in the MICU for patients who had HIV related GI bleeding and severe gastritis secondary to Nonsteriodal Anti-inflaminant Drug (NSAID) use. It was fun to get used to doing bedside procedures in this unit. The EGD procedure is done under conscious sedation and takes about 15 minutes complete with biopsy and cauterizations. Esophogeal candidiasis lookes very interesting from the view of the scope. You can see why these patients have so much pain with swallowing (odynophagia).
The colonoscopy procedures are great to observe too. I feel like I am walking through the colon as I am moving the scope. Since a colonoscopy is routine maintenance for many of us because of age or family background, it is not a terrible test at all. I think the routine Gyn stuff is worse. :0
My day usually starts around 9am with reviewing the charts of patients who are scheduled for EGD or colonoscopy as in-patient or out-patient. We run two endoscopy suites so there is plenty of lag time to get the chart reviews done. The patients get an IV line and oxygen after making sure that bloodwork is OK. The very light anesthesia is injected through IV and the patients are monitored by EKG, oxygen saturation and blood pressure.
After sedation, the patient is positioned properly, and a local anesthetic is applied to the back of the oropharynx (Cetacaine Spray). A mouthpiece is inserted so that the patient does not “bite” the scope and the fiberoptic scope is slowly inserted. The oral cavity, oropharynx, epiglottis, esophagus, EG junction, stomach, and duodenal bulb are visualized slowly. We take mucosal biopsies and biopsies of any growths or abnormalities. If there is bleeding, we can cauterize these spots.
The colonoscopy is done from via the anal opening with a colonoscope. The scope is inserted into the anus, through the rectum, sigmoid colon to the cecum. Any polyps or tumors are biopsied along the way. We also take photographs of the mucosal surface especially at important landmarks like the hepatic flexure or splenic flexure of the colon. The patient usually sleeps through the whole procedure.
After doing the procedures, we discuss our consults that have been received for the day and see each patient. The nice thing about Gastroenterology is that we have to evaluate one system pretty thoroughly. I have really learned to focus on problems like difficulty swallowing (dysphagia), vomiting, diarrhea, blood in stool etc. I even do a more informed rectal examination. After looking at many colons on colonoscopy, I have more of an idea of what to look for on rectal exam.
GI problems are common and may potentially affect any patient from pediatric to geriatric. There are problems with dysphagia in patients who have undegone radiation therapy for cancer and patients who have congenital disorders or post-stroke. We have seen patients in consultation for upper gastrointestinal bleeding or lower intestinal bleeding in the emergency room. I am surprised at how commonly patients present with these problems.
Gastroenterology is one of the sub-specialties of Internal Medicine. It is a fellowship that is done after completing a three-year residency in Internal Medicine. The focus of this specialty is the medical treatment of gastrointestinal disorders. There is also a Hepatology fellowship above the Gastroenterology fellowship that focuses on treatment of liver disorders specifically but Gastroenterologists treat liver diseases too. Gastroenterology generally attracts people who like to do both procedures and medical management. There isn’t much intensive care but you do get to treat patients at bedside in the ICU. GI docs also consult with surgeons, interventional radiologists and internists regularly. These people are your friends.
After seeing our patients on consultation, the team will generally discuss a topic such as acute Pancreatitis or alcoholic liver disease. We then break for home. :)
Gastroenterologists enjoy a good lifestyle and have plenty of money-making potential even in inner-city hospitals. Financial compensation is on par with interventional cardiologists. They have a good mix of office work and hospital-based procedures. Most hospitals have specific gastroenterology suites.

Natalie, does this mean you’re actually getting time to sleep? You must feel like you’re only working part-time with the schedule you’re used to! :D

That’s the first time someone’s actually made GI sound interesting to me! By the way, I just spent 5 minutes trying to say “esophagogastroduodenoscopy”…