MGI

Welcome to the UF Health Inpatient MGI Service. 

During your rotation you will learn about many illnesses within the realm of gastroenterology and hepatology. On the hepatology side you will get to care for liver transplant recipients, those awaiting liver transplantation and those undergoing work-up for causes of liver failure. For the remainder of the GI tract you will experience everything from malabsorption syndromes, GI bleeds, inflammatory bowel disease, esophageal motility disorders and diseases of the pancreas.

This rotation can be one of the more demanding inpatient rotations due to the coordination with two attendings and the complexity and acuity of the patients. However, it is an excellent and unique experience for becoming familiar with managing these patients and developing your efficiency and ability to learn new information quickly. In general, expect to work 6am to 5pm most days. Some interns arrive at 5-6am depending pre-rounding efficiency style and whether you like to have notes near complete prior to rounds, etc. Barring catastrophe, you should not be at the hospital past 7pm.

MGI Specifics

• Workroom: 8th floor outside west elevators, Code 12354.

• The team will consist of 2-3 interns, 1 resident, 2 attendings (liver and GI), 2-3 med students (one of which is usually a sub-I).

  • Off days: 1 weekday off per week for seniors, 1 weekend day off per week for interns. 

• Team cap is 16 patients. There is no daily admission cap. You may receive up to 3 holding notes daily.

• Admissions occur all days of the week with time cutoffs of 5pm on weekdays, 3pm on weekends/holidays. 

• Didactic requirement: Noon conference and grand rounds. Excused from morning report.

Rounds

There are two sets of rounds which vary in time and order depending on the attendings on service. Typically, liver rounds will be first and will be aroud 8am. It will be important for the senior resident to communicate daily with the attendings for roundings times and relay this to the rest of the team.

The weekends are covered by a different attending and most times one attending will cover the entire service. This runs smoothly provided good plans have been set in motion on Friday. These attendings are also busy because they typically cover consults as well as portable endoscopies.

Common MGI patient problems

• Luminal/GI – Small and Large bowel, Biliary Ducts, IBD, Pancreas 

  • Non-variceal GI bleeds

  • Pancreatitis and pancreatic masses

  • IBD/autoinflammatory/mast cell disorders

  • GI malignancy work-ups

  • Post-advanced GI procedural observation patients

• Liver 

  • Chronic liver failure “decompensated cirrhosis”

  • History of OLT (orthotopic liver transplant) and post-transplant complications

  • New/acute liver failure

Scheduling procedures

As the resident you will be expected to order general endoscopic procedures (upper endoscopy, colonoscopy) on your inpatients who need them. You are not expected to order advanced GI procedures on patients that need them; this should be performed by the advanced endoscopy team.

Ordering an inpatient upper or lower endoscopy (EGD or colonoscopy):

1. Order sets>GI inpatient> Email scheduler

   • after 5pm you must also contact anesthesia on-call so your patient can be pre-oped. 

   • same day add-on will need to discuss with endoscopy charge nurse

2. If you want to know when your patient will get scoped: 

   • At the top of EPIC there is a tab that says “Today’s Cases”, click it> on the right choose GNV RN ST GI and select RUN 

   • This will show a tentative list of times, or at least the order for that day 

3. When these are ordered the likelihood that they will be done by your current attending is small, therefor when scheduling make sure to note 2 important things in the comments of the ordered procedure: 

   • BIOPSIES – do you want them? IBD patients typically need them, otherwise they only biopsy obvious abnormalities 

   • ALTERED ANATOMY – have they had a gastric bypass, roux-n-y, partial resection, etc. 

Pre-rounding for GI and Liver Patients

• Daily, you should present your patient’s vital signs, weight, ins and outs, procedure/imaging, microbiology and labs 

• When presenting a new patient, you should know:

  • primary GI/Liver physician, when were they last seen, what was the last plan, etc.

  • GI-specific meds (spironolactone, lasix, lactulose, rifaximin, etc for cirrhotics, immunosuppressants for transplant patients, biologics for IBD patients, etc)

  • Most recent scopes and GI imaging studies

  • If a liver transplant patient you should know who, when and why they were transplanted.