GIT and Nutrition (Block 3) - Guts and glory

The Gastrointestinal tract and Nutrition (GIT) block... I almost died in this block. Not so much from the content, rather the encephalitis I had. As a result of me being in ICU for a few days I missed quite a bit of the block and I still managed to pass, so it's not such a bad block!

The GIT block is divided into seven weeks. It's quite a long block. I have mixed feelings about the block, for obvious reasons, but I'm sure you'll enjoy it. Although it might be difficult to stomach near the end.

The first week is the bread and butter of paediatrics in the clinical years. Malnutrition. In this week you'll learn that the terms marasmus and kwashiorkor is not used, because it is now seen as a spectrum of disorders, rather than separate entities. The preferred term is protein energy malnutrition. As random as it may seem, this week also deals with lactation. Food for thought (was that pun in bad taste...?).

Week two is all about gastro-oesophageal reflux disease (GORD). It will be repeated (get it?) again in surgery in your clinical years. It's super important. It also covers upper GI bleeds, which is devastating. I've seen a couple of patients succumb to this. The treatment of peptic ulcers will be covered as well. Try to embed the eradication therapy of Helicobacter pylori (the culprit that causes peptic ulcer disease) well. Surgeons love asking it, especially on ward rounds. The pharmacology is pretty much the same stuff from PCMS.

Week three is quite a mouth full. It covers a lot of important topics in very little time. Inflammatory bowel disease (Crohn's disease and Ulcerative colitis), disorders of the pancreas and obesity and its effects on the liver. The important thing here is to know the differences, both clinically and pathologically, between Crohn's and Ulcerative colitis. Both for MCQ and SACS papers. This is probably the week with the most content. It's a tough one.

So week four isn't great, either. Here infections of the GIT are discussed. It has a huge amount of pharmacology in the course pack. Don't panic. Have a general approach to the mechanisms of action, but don't get too bogged down in the detail. I found it simply too much. Read through it a couple of times and be able to recognise it in MCQs. Personally, I don't think this is a great way to study pharmacology, but anyway... The lectures were really useful in this week, so know them well.

The fifth week deals with cancers. GIT malignancies are devastating. In an elderly patient with anaemia, you MUST rule out malignancy first and foremost. Remember that for clinical practice. The course pack is great. Recognise the importance of certain genetic disorders and their propensity to cause neoplastic change in the gut. The course pack also covers oesophageal cancer. What a terrible disease. It has a dismal prognosis. The molecular basis of neoplastic change is discussed. They love asking this as well, so know it! The lectures are pretty meh...

Ahhh the liver. The organ that endures a lot of abuse from students. This is what weeks six and seven cover. It's quite difficult and, again, a lot of information to cram. So try to have the first five weeks covered by the weekend before this starts. It will just make your life easier. Week six handles alcohol and the liver. You'll find out that binge drinking is perhaps more detrimental to the liver than chronic alcohol abuse. (I'm pretty sure PubCrawl counts.) It also gives information about the hepatitidies. Remember, Hep A = Acute, Hep B and C are chronic. Hep C = Cirrhosis. Unfortunately only Hep A and B have vaccines. Hep C is often a co morbidity with HIV infection.

Week seven is a mean week. Seriously, you'll see. It's so much information, and it's all covered in the last week. I have no idea why it's done this way. Jaundice is the main topic and it's important to understand the differences between pre-, intra- and posthepatic jaundice and the causes thereof. Also remember the specific biochemical differences. Oh, porphyria is also covered here. It's in the course pack and it is a serious amount of detail. I tried really hard to study it all, but don't waste time. Get a general idea of what it is and some key differences. Don't aim to become an expert in porphyria just yet.

As always, I hope this helps. All the best!

Muskuloskeletal (Block 2) - Do you even lift?

The musculoskeletal block has changed quite a bit from when I did it. I want to make sure the blog is current, so I'll find out what has changed and update this entry.

Endocrine (Block 1) - Raging hormones and you

My favourite block of GEMP II. It's quite short, consisting of only five weeks. What I really enjoyed about the block is the logic behind everything. For the most part the hypothalamus, pituitary gland and then the target organs (thyroid gland, gonads, adrenal glands, etc.) are involved. What's nice about this is the feedback loops and axes. I'll give an example below. Oh, and the textbook I used and found super useful was Clinical chemistry by WJ Marshall & SK Bangert. Really great and not too much detail.

Week one is all about the thyroid. We all have a family member who ate just a little too much over Christmas and now suddenly has an "underactive thyroid". Usually not the case (yeah, we all saw the extra helpings, Aunty), but obviously you shouldn't say anything. It won't bode well, trust me. The thyroid axis is a great example of the feedback loops I spoke of. The hypothalamus detects that the body has low levels of thyroid hormone. It then produces thyrotropin releasing hormone (TRH) into what is called the portal circulation (the one in the brain, not the liver), which stimulates the pituitary gland to produce thyroid stimulating hormone (TSH). The TSH enters the systemic vasculature and reaches the thyroid gland (the target organ) and tells it to produce some more thyroid hormone. Once the thyroid hormone levels are replenished, it feeds back to the hypothalamus and says "K, thanks, bye." and the hypothalamus stops producing TRH. Week one doesn't have a course pack. So grab a textbook and make your own one. It won't take all that long.

Week two really should have been week one. The course pack gives the basic details you'll need for the block. Growth hormone is the name of the game. You'll learn of acromegaly and it is said to be relatively uncommon, but you might be lucky enough to see a patient with growth hormone secreting tumours. We did and I was taller than him. Oh, I'm two meters tall, by the way. So I'm easy to spot in the wards if you have any questions.

Ahh 'roid rage!! Week three covers steroids in the body. The biosynthetic pathway is very important and is, of course, not really well done in the course pack. I used Clinical chemistry and Harrison's and Google to get a comprehensive understanding of the entire pathway. Make sure you know this pathway really well. It's a favourite in the exams, both MCQs and written papers. Just a heads up - you'll notice different sources give certain enzymes different names. Try to use as many sources as possible, because you never know which one will pop up in the exam.

Week four and five are very much the same. It handles diabetes mellitus and metabolic syndrome. There are no real problems here with either week. The pharmacology here is really important. It's the bread and butter (low GI and low fat, of course) of endocrinology.

The work isn't all that bad, really. I would just advise you to try and commit the information into your long term memory. The next block was by far my biggest struggle. You will not have time to redo all of endocrine to study for the exams after block two. If you're a graduate who has never done anatomy (I know it was studied for the WAPT, but that was short term memory) I would advise you to make a point of being a boss in endocrine. It will take the pressure off.

Enjoy!