Core Knowledge

Appendicitis Obstruction Constipation/Encopresis Perianal lesions Hirschsprung Disease Intussusception vs. Meckel’s diverticulum Radiation enteritis Irritable Bowel Syndrome Rumination Know gastrointestinal manifestations of food allergy Know how endocrine disorders affect the gut Know the GI presentations of Munchausen by proxy Know the indications for intestinal transplantation Know the pathophysiology, clinical manifestations, differential diagnoses, diagnosis and management of hepatic disorders including: Neonatal obstructive jaundice, in particular extrahepatic biliary atresia Noncholestatic hyperbilirubinemia Congenital hepatic infections Viral hepatitides (A, B, C) Bacterial and parasitic infections Drug-induced hepatic injury, in particular acetaminophen, antituberculous drugs, anticonvulsants, methotrexate Fulminant liver failure Tumors Metabolic disorders including Glycogen storage disease, Amino Acid metabolic disorders, disorders of lipid metabolism, Urea cycle defects Alpha-1-antitrypsin deficiency Wilson’s Disease Idiopathic cholestasis (Byler’s, Alagille, Aagenaes) Peroxisomal disorders Reye syndrome Disorders of bile acid metabolism Hemochromatosis Vascular disorders (Budd-Chiari syndrome) Chronic hepatitis/cirrhosis Know the indications for hepatic transplantation Know the pathophysiology, clinical features, differential diagnoses, diagnosis and management of biliary tract and gallbladder diseases including: Cholecystitis Cholangitis Choledochal cysts Primary sclerosing cholangitis Know the pathophysiology, clinical manifestations, differential diagnoses, diagnosis and management of pancreatic disorders including: Cystic fibrosis Tumors Pancreatitis (acute & chronic) Know how to interpret frequently ordered laboratory tests, as they pertain specifically to GI Recognize straightforward abnormalities in imaging studies Have an understanding of the mechanism of action, indications of commonly used GI drugs Have an understanding of nutritional requirements and indications for parenteral nutrition and special diets.

Understand the etiology, pathophysiology and management of obesity Understand the etiology and management of eating disorders Know normal anatomy, physiology and development of the gastrointestinal tract, liver and pancreas Know the common gastrointestinal signs and symptoms including pathophysiology of the following: Growth failure and malnutrition Vomiting and Regurgitation Acute and chronic abdominal pain Colic and gas Acute and chronic diarrhea Malabsorption Constipation GI Bleeding Abdominal Mass Peritonitis Jaundice Liver failure Hepatomegaly Ascites Dyspepsia Dysphagia Know pathophysiology, clinical manifestations, differential diagnoses, diagnosis and management of esophageal disorders including: Congenital anomalies, such as tracheoesophageal fistula, stenosis Gastroesophageal reflux and esophagitis Motility disorders such as achalasia Infection in immunocompromised children Caustic and foreign body ingestions Varices Hiatal hernia Know the pathophysiology, clinical manifestations, differential diagnoses, diagnosis and management of gastric and duodenal disorders including: Gastritis/Peptic ulcer disease Duodenitis Ingestions Motility disorders such as gastroparesis Structural lesions such as pyloric stenosis, pancreatic rest Portal HTN gastropathy Celiac disease Know the pathophysiology, clinical manifestations, differential diagnoses, diagnosis and management of intestinal disorders including: Infections (bacterial, viral, fungal, parasitic) Inflammatory Bowel Disease (will be able to distinguish between Crohn’s and UC) Protein-losing enteropathy Inflammatory conditions (HUS, HSP) Necrotizing enterocolitis Short Gut Syndrome Enzyme deficiencies (congenital and secondary) including lactose intolerance Bacterial overgrowth syndrome Villus atrophy Motility disorders such as pseudoobstruction (neuropathic and myopathic) Neoplasms Polyposis syndromes (Familial, Gardner’s)

It is expected that during the course of the 2^nd and 3^rd year of fellowship, the Fellow will continue to pursue self-education, along with attendance of mandatory didactic sessions in order to hone one’s fund of knowledge.  The ongoing opportunities for performing procedures during the entire fellowship should enable the Fellow to also perfect their procedural skills.  The Fellow should demonstrate increasing confidence and competence in the management of common gastroenterology disease, as well as performance of procedures.  During the last year of fellowship, it is expected that the Fellow should be able to manage common gastroenterology problems with minimal Attending intervention. At the end of the fellowship, Fellows are expected to have completed 1) the minimum number of endoscopic procedures as outlined in the NASPGN Training Guidelines, JPGN, vol. 29, Suppl.1, 1999: S19 (which is included in this handbook), 2) all inpatient and outpatient responsibilities, including rotations in the other prescribed disciplines above, and 3) a project worthy of publication in some manner.