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.

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

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.

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.