Gastrointestinal cases may involve bleeding, infection, obstruction, inflammation, liver dysfunction, or malignancy. A strong presentation organizes the case around stability, timeline, anatomic localization, objective evidence, and the next clinical decision.
The goal is not to list every symptom. It is to make the syndrome and its urgency immediately understandable.
Begin With A One-Line Summary
Include:
- Age and relevant patient characteristics
- Major gastrointestinal or hepatic history
- Timeline
- Dominant symptom or syndrome
- Key objective findings
- Current stability
Example:
“A 58-year-old woman with cirrhosis presents with two episodes of hematemesis, tachycardia, hypotension, and a 3-g/dL decline in hemoglobin, concerning for an acute upper gastrointestinal bleed with a possible variceal source.”
State Stability Early
Report:
- Blood pressure
- Heart rate
- Mental status
- Oxygenation
- Signs of poor perfusion
- Ongoing bleeding
- Urine output when relevant
Useful phrases include:
- “The patient is hemodynamically stable.”
- “The patient remains hypotensive despite initial fluid resuscitation.”
- “There is evidence of ongoing gastrointestinal bleeding.”
- “The patient is protecting the airway.”
- “The patient has altered mental status and may require airway protection.”
If the patient is unstable, do not hide that information near the end of the presentation.
Characterize The Dominant Symptom
For Abdominal Pain
Include:
- Location
- Onset
- Quality
- Radiation
- Duration
- Relationship to meals
- Bowel or urinary symptoms
- Associated fever, vomiting, bleeding, or jaundice
For Gastrointestinal Bleeding
Include:
- Hematemesis, coffee-ground emesis, melena, or hematochezia
- Estimated frequency and volume
- Associated dizziness or syncope
- NSAIDs
- Aspirin
- Anticoagulants
- Antiplatelet agents
- Alcohol use
- Cirrhosis
- Previous bleeding or endoscopy
For Diarrhea
Include:
- Duration
- Frequency
- Stool consistency
- Blood or mucus
- Nocturnal symptoms
- Fever
- Antibiotics
- Travel
- Sick contacts
- Immunosuppression
For Liver Disease
Include:
- Jaundice
- Ascites
- Encephalopathy
- Bleeding
- Alcohol use
- Medication and supplement exposure
- Viral risk factors
- Previous decompensation
Present The Examination With Interpretation
Do not say only that the abdomen is “normal” or “tender.”
Describe:
- Distention
- Location of tenderness
- Guarding
- Rigidity
- Rebound
- Bowel sounds when relevant
- Hepatomegaly
- Splenomegaly
- Ascites
- Jaundice
- Asterixis
- Edema
For example:
“The abdomen is mildly distended with epigastric tenderness but no guarding, rebound, or rigidity.”
Select The Most Relevant Data
Depending on the syndrome, include:
- Hemoglobin trend
- Platelets
- INR
- Urea nitrogen and creatinine
- AST and ALT
- Alkaline phosphatase
- Bilirubin fractions
- Albumin
- Lipase
- Lactate
- Stool studies
- Imaging
- Endoscopic findings
Interpret rather than merely list.
For example:
“The predominant alkaline phosphatase elevation with direct hyperbilirubinemia suggests a cholestatic pattern.”
Distinguish Injury From Function
When presenting liver tests, distinguish:
- AST and ALT → hepatocellular injury
- Alkaline phosphatase → cholestatic injury
- Bilirubin → excretory dysfunction or cholestasis
- INR and albumin → information related to synthetic function
This terminology makes the assessment more precise.
Present The Assessment By Priority
A useful problem list might include:
- Acute upper gastrointestinal bleeding
- Hemodynamic instability
- Acute blood-loss anemia
- Possible variceal source
- Anticoagulant exposure
- Cirrhosis and risk of decompensation
Then identify what needs to happen first.
End With A Clear Plan
The plan may include:
- Stabilization
- Intravenous access
- Laboratory reassessment
- Blood products
- Medication management
- Gastroenterology consultation
- Endoscopy
- Imaging
- Infection assessment
- Monitoring and disposition
The plan should correspond to the severity and suspected mechanism.
Ask Focused Questions
Instead of asking:
“Do you think this is a GI bleed?”
Try:
“Given the hematemesis, melena, and hemodynamic changes, should we prioritize resuscitation and urgent endoscopic evaluation for an upper gastrointestinal source?”
Focused questions connect the evidence to a clinical decision.
Professional Conduct During An Observership
An observership is generally a shadowing experience without hands-on patient contact. Responsibilities and permitted activities vary by institution, and observers must follow local privacy and documentation rules.
Do not independently examine, counsel, document, or access protected information unless specifically authorized.
Conclusion
A strong gastrointestinal presentation answers five questions:
- Is the patient stable?
- What syndrome is present?
- Where is the process most likely located?
- Which evidence supports the assessment?
- What needs to happen next?
The best presentation does not contain the most information. It makes the most important information easy to act upon.
References
- Laine L, et al. ACG Clinical Guideline: Upper Gastrointestinal And Ulcer Bleeding. American Journal of Gastroenterology. 2021.
- American Medical Association. Guidelines For Establishing An Observership For International Medical Graduates.
- American Medical Association. Finding An Observership: Frequently Asked Questions.