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An unusual cause for hyperamylasaemia

17 Apr, 17 | by abhichauhan

A 79-year-old man with an extensive previous heart history was admitted electively for investigation of weight loss and deterioration of renal function.
Whilst an inpatient he developed severe epigastric pain and an initial blood test revealed an acutely raised amylase (> 2000) and deranged liver function tests. A non-contrast CT scan was done.
What is the diagnosis ?

Dr Vasileios Galanakis

#FGDebate: The Role of Critical Care in Cirrhosis: Futility vs Opportunity?

7 Apr, 17 | by Kelly Horwood, BMJ

The Role of Critical Care in Cirrhosis: Futility vs Opportunity?

Date: Tuesday 11th April
Time: 8-9pm GMT
Guest: Dr Philip Berry @philabery

 

Philip Berry is a consultant hepatologist at Guy’s & St Thomas’ NHS Foundation Trust, London. His interests include the management of decompensated cirrhosis and approaches to ethical dilemmas on the ward. He writes a regular blog on medical ethics and the psychology of doctors.

 

 

 

Themes:

  • Identifying which patients will benefit from escalation to ICU
  • The place of early palliative care in hepatology
  • ‘Rescue’ situations
  • Alcohol dependence and its influence on medical decision making
  • Futility thresholds on ICU

 

 

A simple IBD flare?

1 Mar, 17 | by abhichauhan

33 year old male with ulcerative colitis presents with a 5-day history of fever, night sweats, abdominal pain and increased stool frequency. Medications include mesalazine M/R 1g once daily, 6-mercaptopurine 75mg once daily and a two week course of prednisolone 40mg once daily. Bloods revealed a leukopenia and c-reactive protein of 23. Based on the flexible sigmoidoscopy (figure) findings what is the most likely diagnosis? How would this change your management?

Submitted by Matthew Armstrong, Tom Thomas, Tariq Iqbal, Ralph Boulton and Jason Goh .

Gastroenterology department, University Hospital Birmingham, Birmingham, UK.

Another portal vein thrombosis?

13 Jan, 17 | by abhichauhan

 

Figure 1

Figure 2

A 62 year old male was undergoing antiviral therapy for HCV cirrhosis. He was asymptomatic with normal liver function tests and a normal alpha fetoprotein level. Routine liver ultrasound suggested a new portal vein thrombosis. CT imaging (figure1) and subsequent pathology specimen (figure 2) demonstrate a unique lesion. What’s in the portal vein?

Submitted by

J.Doherty, C.Braniff, S.Oon, J. O’ Neill, P A. Mc Cormick.

Liver transplant Unit, St Vincent’s University Hospital, Dublin.

#FGDebate: How to Get the Most Out of Your Endoscopic Training

6 Jan, 17 | by Kelly Horwood, BMJ

How to Get the Most Out of Your Endoscopic Training: Ask the Experts

Date: Thursday 12th January 2017
Time: 8-9pm GMT
Guest: Dr Brian McKaig @braincmckaig

Dr Brian McKaig
MBChB, PhD, PGCMEDr Briandr-mckaig McKaig is a Consultant Gastroenterologist working at the Royal Wolverhampton NHS Trust since 2002, having qualified from Glasgow University in 1991 and training in Nottingham gaining a PhD in 2001.
His clinical interests lie in lower GI endoscopic therapy and Bowel Cancer Screening.
He has a long standing interest in education and endoscopy training and was awarded PGCME from Wolverhampton University 2004. He has been the Director of the West Midlands Endoscopy Training Centre since 2005 delivering over 20 courses per year. He is a member of the JAG QA-T workgroup, currently focusing on development of training pathways within endoscopy. He has previously been Chair of the Federation of Training Centres and has delivered endoscopy training throughout the UK and has led JAG / BSG / WGO international training developments in Europe and Africa. He has worked in collaboration to develop many of the current JAG approved endoscopy courses currently run in the UK.
Brian is the current Colonoscopy Professional Clinical Advisor for the West Midlands BCSP and sits on the BCSP Accreditation Panel and National BCS QA committees.

Case of the month: Jelly belly?

15 Nov, 16 | by abhichauhan

85150564_b

Case of the month:

A 75 year old man presents with a 2 month history of abdominal distension and lethargy. Clinical examination demonstrates shifting dullness and investigations reveal he has a microcytic anaemia with raised tumour markers (CA19-9-208 U/ml , CEA-88 µg/L)  Ascitic aspiration yields a gelatinous fluid, the coronal section of his abdominal CT scan is shown above. What is the diagnosis (hint:the arrows point to the primary pathology)

Submitted by N. Patodi

#FGDebate GI Consequences of Cancer

30 Sep, 16 | by Kelly Horwood, BMJ

GI Consequences of Cancer: Cancer cured – all back to normal now?’

Date: Tuesday 4th October 2016
Time: 8-9 BST
Guest: Dr Ana Wilson @GIWolfsonunit

Dr Ana (Ignjatovic) Wilson BA(Hons) MD MRCP
Consultant Gastroenterologist and Endoscopist

Dept:   Wolfson Unit for Endoscopy
Tel:      020 8869 5277
Email:  smita.patel5@nhs.net

wilson-ana-1Dr Ana Wilson is out featured guest for this months #FGDebate on GI consequences of cancer. Dr Ana Wilson is a luminal gastroenterologist and specialist gastrointestinal endoscopist. Her specialist interests include early diagnosis, prevention and treatment of pre-cancerous lesions and cancer, through colonoscopy, in patients with inflammatory bowel disease and those at increased risk of developing colorectal cancer. Dr Wilson specialises in advanced endoscopic imaging and complex therapeutic

endoscopy. She has a special interest in managing patients with gastrointestinal consequences of cancer treatment (eg. Low anterior resection syndrome, pelvic radiation disease) and leads the service at St Mark’s Hospital.

Dr Wilson qualified from University of Oxford in 2002. She obtained Membership of the Royal College of Physicians in 2005 and trained in gastroenterology and general internal medicine in Oxford Deanery. She spent three years at the Wolfson Unit for Endoscopy, St Mark’s Hospital undertaking research in the use of colonoscopy in diagnosis and assessment of dysplasia under the supervision of Prof Brian Saunders that led to an MD thesis at the Imperial College, London, and has published widely on the subject. After completing her training, Dr Wilson specialised further in management of complex inflammatory bowel disease and endoscopy at University College Hospital, London. She was appointed as Consultant Gastroenterologist and Specialist Endoscopist at St Mark’s Hospital in December 2012.

She has been an invited speaker at numerous national and international meetings and has contributed to a number of guidelines on the use of advanced imaging in lesion recognition including in inflammatory bowel disease.

 

Case of the month-A scalp lesion with anaemia?

6 Sep, 16 | by abhichauhan

Melanoma_stitched

A 79 year old man underwent a upper GI endoscopy for dark stools and anaemia (top left), histology from lesions (top right) is presented. Further examination revealed a scalp lesion (bottom left), which was also biopsied (bottom right). What is the unifying diagnosis?

Submitted by GJ Webb.

Assessment strategies in gastroenterology by Neel Sharma

22 Aug, 16 | by abhichauhan

All doctors regardless of specialty are assessed regularly – after all assessment drives learning. From a UK standpoint assessment comprises the MRCP (UK) examinations and SCE. During GI training there is the JAG accreditation of simple and more advanced endoscopic intervention as well as portfolio based records.

In the field of medical education there are currently talks concerning the lack of potential value in a high stakes examination. In essence the current argument is that such a form of assessment can potentially limit a supervisor’s judgement if the candidate is unsuccessful. In this regard, the concept of programmatic assessment has come to the forefront where in essence a more holistic judgement of a candidate’s performance takes place. In brief continuous forms of learning, assessment and feedback are offered. And all elements of the learning/ assessment process are compiled to provide a fairer judgment of a learner’s abilities.
The next movement that has occurred in the US is that of entrustment or entrustable professional activities. Whilst competency based medical education has been cemented for some time, there have been concerns with the lack of entrustment decisions. Here supervisors would make the added assessment of when a learner can be entrusted to perform a competency unsupervised. The GI curriculum in the US has embedded this approach and it is likely that this phenomenon will snowball globally.

Further reading
Van der Veluten et al. A model for programmatic assessment. https://www.amee.org/getattachment/AMEE-Initiatives/ESME-Courses/AMEE-ESME-Face-to-Face-Courses/ESME/ESME-Online-Resources-China-Dec-2015/A-model-for-programmatic-assessment-fit-for-purpose.pdf

Neel Sharma is currently a gastroenterology trainee in Singapore having worked in a medical education setting across the UK, Asia and the US

‘The flipped classroom’-future of endoscopic training?

8 Aug, 16 | by abhichauhan

Read our latest blog on pedagogical strategies in gastroenterological training from Dr Neel Sharma. Neel Sharma is currently a gastroenterology trainee in Singapore having worked in a medical education setting across the UK, Asia and the US

Medical education is now a well-recognised academic discipline. However, compared to traditional basic science it is still fairly premature having recently celebrated 50 years in the making.

Despite this prematurity, we must start to understand the advances in the field and attempt to uncover the potential evidence or lack of in terms of pedagogy. Here I highlight some current trends in the hope that the GI community can determine their potential worth.

Team based learning is one example where by learners are provided cases and problem solve with the addition of written assessments and expert feedback. In gastroenterology there has been little formal research into the value of TBL. One of its positives is that of feedback, unlike its counterpart PBL where feedback was typically lacking.

The next movement making waves is that of the flipped classroom. In fact this approach has been adopted wholeheartedly by Harvard Medical School during their recent curriculum reform. In brief videos are provided to learners pre class, with class time spent problem solving. Its potential benefits have been the ability to receive the so called ‘homework’ element before class so that in class learners can focus more on problem solving applications. Again little has been done in the form of flipped learning in gastroenterology.

How can such pedagogies be utilised? Well countless examples exist but one potential use is in image enhanced endoscopy – with the advances in NBI, confocal imaging and OCT, problem solving cases could prove useful, particularly as the classification systems in endoscopy become more complex.

I look forward to further movement in the field.

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