DepartmentName

Facilities

UCSD Hillcrest Medical Center

THE UCSD MEDICAL CENTER in Hillcrest serves as a county hospital-type rotation with a large portion of medically indigent care as well as a tertiary referral hospital for solid organ transplantation (including liver), chronic liver disease, HIV/AIDS, trauma, and OB/GYN services. Fellows are exposed to a wide variety of inpatient GI and Hepatology patients. Common GI consult indications include upper GI bleeding (variceal and non-variceal, lower GI bleeding), iron-deficiency anemia, suspected GI malignancy, pancreatico-biliary diseases (pancreatitis, choledocholithiasis, gallstone disease), and GI complications from pregnancy. Common Hepatology consult indications include complications of end stage liver disease (ascities, encephalopathy, subacute bacterial peritonitis), liver transplant evaluations, fulminate hepatic failure, hepatic complications of pregnancy, and chronic liver diseases such as hepatitis B and C. There are also GI and Hepatology clinics at UCSD Hillcrest Medical Center, including GI continuity clinics. The most commonly performed procedures include EGD, colonoscopies, PEG placement, paracentesis, and liver biopsy. The motility and GI physiology clinical labs are located at this hospital, and the main surgical pathology department is located in this hospital. UCSD has full radiological (CT, MRI, US), pathologic, and surgical services for patient care.

Veteran's Administration Medical Center San Diego (VAMC)

The VAMC serves as a source of medical care for the United States military veterans. Fellows are exposed to a wide variety of general GI and liver diseases. This includes elderly patients, patients with chronic diseases related to smoking and alcohol, as well as military-related disabilities. There is also an opportunity to do a high volume of endoscopies, especially screening colonoscopies, while doing outpatient rotations. There is some exposure to advanced pancreatico-biliary procedures (EUS and ERCP). Common GI consult indications include upper GI bleeding (variceal and non-variceal), lower GI bleeding, iron-deficiency anemia, suspected GI malignancy, and pancreatico-biliary diseases (pancreatitis, choledocholithiasis, gallstone disease). Common Hepatology consult indications include complications of end stage liver disease (ascities, encephalopathy, subacute bacterial peritonitis), and chronic liver diseases such as hepatitis B and C. There are also GI and Hepatology continuity clinics here. The most commonly performed procedures include EGD, colonoscopies, PEG placement, and liver biopsies. Fellows are also exposed to nutrition training during weekly nutrition rounds with a dedicated GI nutrition faculty member and to esophageal motility disorders and capsule endoscopy. The VAMC has full radiological (CT, MRI, US), pathologic, and surgical services for patient care.

Fellows in their first clinical year mainly do inpatient service, while those in their second and third years primarily do outpatient rotations. Outpatient rotations allow fellows to do high volumes of routine colonoscopies and upper endoscopies with less Attending assistance than a first-year fellow and also teaches them practice management techniques of triaging referrals and follow-up pathology.

UCSD Thornton Hospital

The UCSD Thornton Hospital serves as a tertiary referral center, cancer center, and hospital for geriatric patients. Because the UCSD Moores Cancer Center is located adjacent to UCSD Thornton Hospital, there is a large volume of both GI cancer patients (esophagus, stomach, colorectal, and pancreato-biliary) as well as GI complications of non-GI cancers (graft vs. host disease in bone marrow transplant patients, biliary or bowel obstruction from metastatic tumors). UCSD Thornton Hospital also serves as a regional GI referral center for inflammatory bowel disease, hereditary colon cancer, pancreatico-biliary diseases (pancreatitis, choledocholithiasis, gallstone disease), and advanced interventional GI procedures (such as ERCP, EUS, capsule endoscopy, Barrett's ablation, and small bowel double balloon enteroscopy). As this rotation is typically assigned to third-year fellows, it is assumed that they have more autonomy running the service than on other inpatient GI rotations. All cases are presented to attending GI physicians and rounds occur on a daily basis. During all endoscopic procedures, there is a GI Attending in the room supervising the fellow. UCSD Thornton Hospital has full radiological (CT, MRI, US), pathologic, and surgical services for patient care.

Kaiser Permanente Hospital

KAISER PERMANENTE San Diego (Kaiser) is an inpatient consultative GI experience mainly for second- and third-year fellows at a busy integrated healthcare delivery system. Most of the patient demographics here are working and middle class patients with a variety of general GI and liver diseases. Common consults include non-variceal upper GI bleeding, lower GI bleeding, occult blood in stool, choledocholithiasis, pancreatitis, and elevated liver tests. The most common endoscopic procedures include EGD, colonoscopies, PEG, and ERCP. Fellows present and discuss all patients with staff gastroenterologists. There are teaching conferences at Kaiser. Kaiser has full radiological (CT, MRI, US), pathologic, and surgical services for patient care.