Green Service

(Hepatobiliary and Pancreatic Surgery - (HPB))

Course Director                                                                  Todd Bauer, M.D.

Attending                                                                               Reid Adams, M.D.

The HPB team is primarily responsible for the care of patients with non-transplant related hepato-biliary-pancreatic disease.  Drs. Adams and Bauer are the primary HPB attendings with participation from Drs Pruett.  Drs. Bauer and Adams also have an interest in soft tissue sarcoma. Residents assigned to this service will include a PGY-5 (Chief), a PGY-4, and a PGY-1 resident.  The administrative duties of the service overall will be the responsibility of the Chief resident, which includes care oversight of the patients.  The Chief resident will distribute cases and responsibilities for the other members of the team.  The Chief and PGY-4 are encouraged, but not required, to participate in the liver transplants.  The PGY-1 residents will participate in providing care for all patients on the service as delegated by the Chief resident.

 

Learning Objectives

Upon completion of this rotation all medical students should be able to:

  • 1. Perform a focused history and examination in a patient with hepatobiliary disease or soft tissue sarcoma
  • 2. Develop a plan of care for all in-house surgical patients with whom they come in contact. This includes data collection, ordering and interpreting appropriate diagnostic tests, and working to provide a patient centered plan consistent with the resident's level of training
  • 3. Evaluate and develop a plan for patients seen in consultation in the emergency room or inpatient service
  • 4. Recognize significant changes in patient status
  • 5. Achieve a knowledge base in basic science and clinical management appropriate to their level of training. This will include knowledge of:
  • a)Pathophysiology of injury and the immune response
  • b)Diagnostic workup of a patient with jaundice
  • c) Initial evaluation and treatment of the surgical patient
  • 6. Be able to develop appropriate diagnostic and treatment algorithms for common surgical emergencies
  • 7. Present a problem based summary of all admissions and consults to the attending /chief resident and to discuss complications occurring in patients for whom they had the primary responsibility.
  • 8. Discuss the pathophysiology and associated medical problems of liver disease, diseases of the pancreas and diseases of the biliary tree.
  • 9. Develop an understanding of the importance of the multidisciplinary approach   to patients with gastrointestinal malignancies.   A critical part of this experience is participation in the Multidisciplinary GI Cancer conference on Thursdays at 7am.
  • 10. Develop an understanding of the importance of the multidisciplinary approach to patients with soft tissue sarcoma.   A critical part of this experience is participation in the Multidiscliplinary Sarcoma conference on Tuesdays at 4:30 pm.
  • 11. Describe the work-up, staging, multidiscliplinary management of and indications and contraindications for surgical treatment of soft tissue sarcoma and cancers of the hepatobiliary system and pancreas.

 

Responsibilities

Medical students should participate in all patient care activities. These include:

  • 1. Providing all appropriate inpatient care for patients admitted to the service under the HPB attendings or attendings on call when the HPB team is on call.
  • 2. Providing all appropriate outpatient care and follow-up, assisted by the support staff for the HPB team (nurse practitioners and transplant coordinators) for the above patients, as well as those outpatients seen in the clinics and in consultation with attendings from the HPB service.
  • 3. Providing appropriate surgical treatment of diseases of the liver, biliary system, and pancreas and soft tissue sarcoma.
  • 4. Performing appropriate preoperative evaluation and approach to patients with problems of the liver, biliary tree, and pancreas and sarcoma.
  • 5. Being involved in the operative care of patients on the service when their on-call responsibilities do not preclude such participation.  You should be completely prepared for every OR case prior to scrubbing in.  This means that you have reviewed the patient's history and know the results of all laboratory, radiology, and pathology studies.  In addition you will be expected to read about the patient's disease process, the treatment options, and the details of the proposed surgery, including relevant anatomy and the surgical techniques involved.
  • 6. Seeing every patient daily, examining every patient including wounds, reviewing appropriate laboratory and study data results, reporting the status of each patient and their studies on rounds, and write a daily progress note in the chart.
  • 7. Attending clinic for the preoperative and postoperative care and evaluation of patients unless specific conditions exist related to problems with inpatients on the service that preclude such participation.