Clerkship

ESOPHAGUS

GASTRO-ESOPHAGEAL REFLUX

1. Describe the common presenting symptoms associated with gastro-esophageal reflux.
2. Discuss the relationship of reflux to chronic asthma and aspiration. 
3. Discuss the appropriate diagnostic work-up of a patient with suspect reflux.

WHAT IS THE ROLE OF:

• barium swallow
• endoscopy
• manometry
• 24 hour pH testing
4. Discuss the evaluation of dysphagia. 
5. Discuss the treatment of esophageal stricture.
6. What are the risks of dilation? 
7. Discuss Barrett’s esophagus and its implications.
8. What are the risks of malignancy?
9. Who needs surgical management
10. Discuss the pathophysiology and treatment of achalasia and diffuse esophageal spasm.

• Mallory-Weiss tear
• Achalesia
• Variceal Bleeding
• Zenker’s Diverticulum
• Perforation

STOMACH

• Peptic Ulcer disease
• Perforation
• Gastritis
• Gastric outlet Obstruction
• Carcinoma
• Upper and Lower GI hemorrage

1. Outline the initial management of a patient with an acute GI hemorrhage.   
2. Discuss indications for transfusion, fluid replacement, and choice of fluids.
3. Differentiate upper vs. lower GI hemorrhage. 
4. Discuss history and physical exam abnormalities. 
5. Discuss diagnostic studies.
6. Discuss the differences in evaluation and management of the patient presenting with:  hematemesis,  melena,  hematochezia,  guaiac positive stool.