Introduction to Gastrointestinal Physiology

Module details

Title

Introduction to Gastrointestinal Physiology

Type

Rotation

Module code

SPS302

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with a generalised body of knowledge that will introduce and underpin the work based rotation of Gastrointestinal Physiology.

This rotation will enable trainees to gain the underpinning knowledge, skills and experience of Gastrointestinal (GI) Physiology by introducing the range of GI diagnostic services provided in the specialism and the  interaction with patients and patient-centred practice. Trainees will be expected to perform some routine GI investigations and develop and build their professional practice.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Control infection risks in accordance with departmental protocols.	Action View
# 2	Learning outcome 1,2	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 3	Learning outcome 1	Competency Select suitable technology for breath testing, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient.	Action View
# 4	Learning outcome 1,2	Competency Obtain a suitably completed request form, greet the patient, and check patient identity and recent clinical history.	Action View
# 5	Learning outcome 1	Competency Prepare the environment, equipment and patient for breath testing, performing a risk assessment and giving a chlorhexidine mouthwash if required.	Action View
# 6	Learning outcome 1	Competency Calibrate equipment according to manufacturer’s instructions, with appropriate test gas and within the recommended period.	Action View
# 7	Learning outcome 1,2	Competency Gain informed consent for blood glucose testing and non-invasive breath testing under supervision.	Action View
# 8	Learning outcome 1,2	Competency Undertake blood glucose monitoring in adults, recording and interpreting the results.	Action View
# 9	Learning outcome 1	Competency Perform non-invasive breath test with an adult patient.	Action View
# 10	Learning outcome 3	Competency Review the results from non-invasive breath testing, taking into account artefacts, necessary adjustments of values and planned/unplanned events occurring during the test.	Action View
# 11	Learning outcome 3	Competency Compare the values/traces obtained with the normal range/values related to non-invasive breath testing and produce an accurate and succinct written report.	Action View
# 12	Learning outcome 1	Competency Explain the results to the patient, describing the post-test process and ensuring the patient resumes medication.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Perform breath testing and produce a report	DOPS
Undertake glucose monitoring on a diabetic patient	DOPS

Learning outcomes

1. Plan and perform non-invasive breath tests under direct supervision (hydrogen, methane – if there is a methane analyser available – and urea breath testing) and explain the post-investigation process to the patient.
2. Plan, perform and interpret the results of blood glucose monitoring in adult patients.
3. Interpret the results of hydrogen, methane – if there is a methane analyser available – and urea breath tests and produce a concise written report.

Learning outcomes

1. Describe the anatomy and physiology of the gastrointestinal system, including the parasympathetic and sympathetic nerves, intrinsic nerve plexuses and concept of neurotransmitters and hormones in relation to the gastrointestinal tract.
2. Describe the action and control of saliva, gastric acid and pepsin, pancreatic enzyme and bicarbonate, and bile salts and bicarbonate.
3. Describes the enzymatic breakdown of protein, polysaccharides and sugars, solubilisation and hydrolysis of fat, mucosal digestion and transport, water and fat-soluble vitamins and vitamin B12 in relation to digestion and absorption.
4. Describe techniques used in the investigation of the motility of the gastrointestinal tract.
5. Explain the test protocols relating to non-invasive breath tests.
6. Know the clinical concepts of intubation of the gastrointestinal tract, including infection control and asepsis.
7. Discuss intubation and extubation techniques and complications in the investigation of benign gastrointestinal disease.

Indicative content

Anatomy and physiology: structure and function of the GI tract

• Action of sphincters
• Peristalsis
• Segmenting and mixing waves
• Voluntary and involuntary movement and striated muscle within the GI tract

Neurophysiology

• Parasympathetic and sympathetic nerves
• Intrinsic nerve plexuses and concept of neurotransmitters and hormones in relation to GI tract

Pathology: functional intestinal disorders

• Fructose or lactose malabsorption
• Detection of small intestinal bacterial overgrowth syndrome
• Rapid orocaecal transit
• Gluten sensitivity

Pharmacology

• The effect of H2 receptor antagonists
• Prokinetics
• Proton pump inhibitors
• pylori eradication regimen
• Lidocaine
• Calcium antagonists
• Nitrates
• Laxatives (bulk forming, osmotic, )
• Loperamide o Prucalopride o   Amitriptyline

Device design and technology

• Types of hydrogen
• Methane and urea breath testing analysis equipment available
• Glucose monitoring equipment
• Impedance and pH sensors
• Electrode characteristics and function
• Programmable functions and monitoring devices, including telemetry
• Safe storage and handling of catheters, probes and transducers
• Electrical safety of
• Traceability of implanted devices

Intubation technique, risks and complications

• Environmental requirements and considerations
• Equipment required
• Intubation of the upper and lower GI tract procedures and techniques
• Measurements and checks taken at implantation and their significance
• Documentation requirements
• Cessation of medication
• Early and late complications of intubating the GI tract and their significance

Follow-up

• Data upload
• Equipment and personnel
• Clinic design
• Databases and patient records
• Patient support material
• Emergency equipment
• Troubleshooting
• Optimal monitoring procedures

Paediatric considerations

• Indications
• Intubation and complications

Associated regulations

• Conduct of clinical trials
• Ethical aspects of device implantation

Activities

• Observe a range of routine investigations undertaken in Gastrointestinal Physiology and critically evaluate how these investigations contribute to the diagnosis, management and care of patients, and the range of needs of people with disabilities within a typical care pathway for a patient with gastrointestinal disease.
• Attend outpatient clinics and/or inpatient ward rounds and discuss with your supervisor the care pathways linked to Gastrointestinal Physiology, including cancer services, benign upper gastrointestinal disease, functional gastrointestinal disorders (FGID), colorectal functional disorders, nutrition, asthma, cystic fibrosis, steatorrhoea, carbohydrate malabsorption, small bowel overgrowth, malabsorption, coeliac disease and other conditions with villous atrophy.
• Attend outpatient clinics and/or inpatient ward rounds to gain experience of the linkages between Gastrointestinal Physiology and other clinical specialisms in the investigation of diseases of the gastrointestinal system, and discuss the importance of a multidisciplinary approach to patient care.