Outpatient Hepatology/Inpatient Transplant Hepatology

Overview

• Fellows are exposed to general Hepatology during Inpatient Consult Service, during outpatient Liver Clinics, and during their own Fellow’s Continuity Clinic.
• 4 month rotation in outpatient Transplant Hepatology in the second year
• 2 month rotation in inpatient Transplant Hepatology in the second year
• 2 month rotation in inpatient Transplant Hepatology in the third year. This provides a more intense and focused exposure to the management of the pre- and post-transplant patient with liver disease.  Currently there are approximately 50 liver transplants performed per year.
• The fellow may be involved in the supervision of any medical residents or students electing the rotation in Hepatology.

Principal Teaching / Learning Activities

For the Outpatient Rotation

• Participate in a general Hepatology clinic each week, during which they see from 2-3 new outpatient consults per session, and 4-6 follow up visits
• Participate in 2-3 half-day multidisciplinary Transplant Hepatology Clinics per week
• Perform complete history and physical examinations, review laboratory data including actual Radiology studies, formulate differential diagnoses, and formulate a plan or set of recommendations, including timing of intervention and/or follow up
• After presentation and review with the Attending physician, the fellow will generate documentation for the encounter
• Fellows will participate in any procedures, including liver biopsy if interested, for these patients during their rotation
• Participate in Liver Transplant Selection Committee meetings and present patients that the fellow has evaluated to the multidisciplinary team

For the Inpatient Rotation

• Participate in teaching rounds with the Attending Hepatologist, which involves the inpatient care of imminently pre-transplant patients, and the post-operative liver-transplant recipients
• Serve as a supervisory consultant to any house officers and/or mid-level providers on the inpatient Liver service, while the service is staffed by a board certified Transplant Hepatologist
• Write daily progress notes during the week days for these patients. Order entry will remain the responsibility of the house officers and/or mid-level providers on the Liver service, and will not be the responsibility of the rotating GI fellow.

Problem Mix / Patient Characteristics / Types of Encounters

The fellow is exposed to a wide variety of liver diseases:

• Acute and chronic viral hepatitis
• Aalcoholic hepatitis
• Autoimmune hepatitis
• Cholestatic liver diseases (primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced liver disease, etc.)
• Fatty liver and non-alcoholic steatohepatitis
• Hemochromatosis
• Wilson’s disease
• alpha-1 antitrypsin deficiency
• Infiltrative liver diseases
• Inpatients of various levels of clinical acuity, as well as ambulatory outpatients are seen
• Complications of cirrhosis including bleeding of portal hypertensive origin, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, coagulopathy, fulminant hepatic failure, and hepato-pulmonary complications will be encountered.