Conditions of the Gastrointestinal System
General Competencies
1. Understand basic and clinical knowledge of gastrointestinal (GI) anatomy and
pathophysiology of common GI diseases
2. Relevant history and physical examination, documentation of findings,
differential diagnosis generation and plan for further evaluation and
management
3. Use evidence based knowledge regarding primary and secondary prevention
of gastrointestinal diseases
4. Knowledge of current practices regarding the care of patients with
gastrointestinal diseases and develop plans to improve care.
5. Work with physicians, nurses, pharmacists, dieticians and other health care
professionals to improve patient care
Topic List
1. Acute abdominal pain
a. Surgical vs. Non surgical abdomen
2. Chronic Abdominal Pain
3. Gastroesophageal reflux disease
4. Dyspepsia
5. Gastric ulcers
6. Gastritis
7. Gastric cancer
8. Peptic ulcer disease
9. IBD
a. Ulcerative colitis
b. Crohns disease
c. Extra intestinal manifestations
10. Diarrhea
a. Acute causes
i.
Infectious
ii.
Antibiotic induced
b. Chronic causes:
i.
IBD
ii.
IBS
iii.
Malabsorptive syndromes
iv.
Immunocompromise
v.
Medication use/abuse
11. Gastrointestinal (GI) bleed:
a. Hemodynamically stable vs. unstable patients
b. Causes of upper and lower GI bleeds
12. Hepatitis
a. Obstructive type
b. Hepatocellular type (including infectious)
c. Infectious hepatitis
13. Cirrhosis
14. Dehydration
15. Weight loss
a. Intentional vs. unintentional
b. Potential causes of unintentional:
i.
GI
ii.
Metabolic
iii.
Infectious
iv.
Malignant
For each topic area
1. Epidemiology
2. Anatomy
3. Pathophysiology/Etiology
4. Risk factors
5. History and physical exam
6. Diagnostic Tests
7. Differential diagnosis
8. Management
9. Psychosocial implications
Highlighted teaching points
1. Risk Factors
a. GI bleed
i.
Look for patients at higher risk for GI bleed (e.g., previous GI bleed,
intensive care unit admission, NSAIDs, alcohol), modify risk factors
2. History and Physical Exam
a. Abdominal pain
i.
Location and chronicity
ii.
Acute vs. chronic pain
iii.
Surgical vs. non-surgical abdomen
b. Extra intestinal manifestation of inflammatory bowel disease (IBD)
c.
Diarrhea
i.
ii.
3.
4.
5.
Determine hydration status
Use history to establish possible etiologies (e.g., infectious contacts,
travel, recent antibiotic or other medication use, recent
hospitalization, common eating place for multiple ill patients).
d. Chronic or recurrent diarrhea
i.
Gastro-intestinal vs. extra-intestinal causes
e. Dyspepsia
i.
Red flags (e.g. cardiac history, gastrointestinal bleeding, weight
loss, dysphagia)
f. Gastrointestinal bleeding
i.
Upper vs. lower origin
ii.
Rule out other causes (e.g., beet ingestion, iron, Pepto-Bismol)
g. Hepatitis
i.
Focus on new drugs, alcohol use, body-fluids exposure, risk for viral
hepatitis
h. Dehydrated patient
i.
Assess the degree of dehydration using reliable indicators
ii.
Signs and symptoms of dehydration in acutely ill patients
iii.
Identify the precipitating illness or cause
i. Weight loss
i.
Maintain an ongoing record of patients’ weights to accurately
determine when weight loss has occurred
Diagnostic tests
a. Hepatitis
i.
Interpretation of abnormal liver enzymes (obstructive vs cellular)
Differential Diagnosis
a. Acute and chronic abdominal pain.
b. Abdominal pain in special groups: infancy, childhood, pregnancy, elderly
c. Include cardiovascular disease in the differential diagnosis for dyspepsia
Management
a. In a woman with abdominal pain
i.
Rule out pregnancy if she is of reproductive age
ii.
Suspect gynecologic etiology for abdominal pain
iii.
Pelvic examination, if appropriate.
b. Chronic or recurrent abdominal pain
i.
Manage symptomatically with medication and lifestyle modification
(e.g., for irritable bowel syndrome)
ii.
Always consider cancer in a patient at risk
c.
d.
e.
f.
Acute diarrhea
i.
Counsel about the timing of return to work/school (re: likelihood of
infectivity).
GI bleeding:
i.
Stable patient with lower GI bleeds: rule out serious cause (e.g.
malignancy, inflammatory bowel disease, ulcer, varices) even with
known cause (e.g., do not attribute a rectal bleed to hemorrhoids or
to oral anticoagulation).
Hepatitis:
i.
Hepatitis B and/or C,
1. Assess infectiousness
2. Determine human immunodeficiency virus status
3. Hepatitis C antibody positive:
a. Identify chronic infection due to greater risk for
cirrhosis and hepatocellular cancer.
4. At risk for Hepatitis B and/or Hepatitis C exposure
a. Counsel about harm reduction strategies, risk of other
blood borne diseases
5. Vaccinations
6. Exposure or possible exposure to Hepatitis A or B
a. Provide post‐exposure prophylaxis
b. Periodically look for complications (e.g., cirrhosis,
hepatocellular cancer) in patients with chronic viral
hepatitis, especially hepatitis C infection
Dehydrated patient:
i.
Determine the appropriate volume replacement of deficiency and
ongoing losses
ii.
Use the appropriate route of fluid replacement (oral vs IV)
iii.
Severe dehydration:
1. Use objective measures (e.g., lab values) to direct ongoing
management.
iv.
Identify and treat the precipitating illness concurrently
v.
Treat the dehydrated pregnant patient aggressively to prevent
additional risks of dehydration in pregnancy
g. Persistent weight loss of unknown cause
i.
Follow‐up and re-evaluate in a timely manner in order to decide on
necessity of action
References:
1. College of Family Physicians of Canada. (2010). Defining Competence for the
purposes of certification by the College of Family Physicians of Canada: The
evaluation objectives in family medicine. Mississauga, ON.