We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
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The Internal Medicine Teaching Unit is led by the Internal Medicine Department and its various care units (General Internal Medicine, Hepatology, Autoimmune System Diseases, Infectious Diseases), with participation from the Cardiology, Respiratory Medicine, Neurology, Haematology, Oncology, Intensive Care Medicine and A&E Departments.
Internal Medicine training itinerary
Internal medicine is a core medical speciality that is practised primarily in hospital settings, providing comprehensive care to sick adults. It uses a medical approach in the prevention, diagnosis, therapeutic indication and follow-up of diseases in adults, including during their rehabilitation and palliative care. Internists are the backbone of the hospital, offering their versatility in acute and emergency hospitalisation; carrying out consultancy roles in primary care; and offering innovation in areas other than conventional hospitalisation and in the socio-health field.
The teaching unit is made up of 3 different departments. These include the Internal Medicine Department, which is broken down into the Systemic Autoimmune Disease Department, the Internal Medicine - Hepatology Department and the Infectious Disease Department. The Internal Medicine department is made up of different units which independently treat patients suffering from complex pathologies (Pleural Unit, Thromboembolic Diseases Unit, Autoinflammatory Diseases Unit and the Autoimmune Diseases unit).
In daily practice, resident medical staff visit patients together alongside specialist physicians. During these visits, medical records are drawn up and physical examinations are carried out. Visits can also entail clinical ultrasounds, diagnostic-therapeutic examinations (thoracentesis, paracentesis, arthrocentesis, liver biopsy, etc.) as well as differential diagnoses and the provision of diagnostic guidance. The pertinent examinations are requested and the treatment is duly adjusted.
During the IMR training, internal medicine residents learn how to diagnose and manage the most commonly found diseases on hospital wards and in internal medicine consultations. They will also learn about the most commonly treated pathology in other medical fields, obtaining a comprehensive and multi-disciplinary training that will allow them, upon the completion of their residency programme, to tackle a wide range of clinical scenarios with complete independence.
Moreover, in terms of specific areas of interest, residents will learn how to manage immunosuppressive therapies and patients suffering from cirrhosis, HIV and nosocomial infections, amongst other pathologies.
On-duty shifts are carried out in the A&E department in combination with inpatient care, preparing the Internal Medicine resident to treat critically ill patients in a fully independent manner upon the completion of their IMR training. It should be noted that residents treat patients suffering from a broad range of medical pathologies, meaning experience is gained in the management of patients suffering from conditions such as shock, respiratory failure (intubation and mechanical ventilation) and cardiac arrest.
Healthcare, teaching (sessions) and research tasks are carried out on a daily basis in all Internal Medicine departments. The Internal Medicine IMR will be progressively incorporated into these sessions, and will also participate in the research groups of his/her interest.
It is a chronic inflammatory disease of the oesophagus caused and prolonged due to an allergic reaction. It is typified by difficulty swallowing (dysphagia) any food blockages in the oesophagus (food impaction) and rupturing of the oesophageal wall (oesophageal perforation).
The most common symptoms are:
If the inflammation of the oesophagus and related symptoms are left untreated, they will continue from childhood to adulthood. This inflammation causes structural changes to the oesophagus by remodelling the tissue. This can lead to fibrosis and oesophageal stricture. This means functional deterioration that significantly affects the patient’s quality of life.
From the first recorded case in 1993, eosinophilic oesophagitis has been found to affect 45 out of every 100,000 people, and has an incidence rate of 3.7 cases for every 100,000 people a year. This makes it the most common cause of dysphagia, spontaneous oesophageal perforation and food impaction in young patients.
For appropriate diagnosis, a gastroscopy must be carried out to take multiple biopsies from the oesophagus, since inflammatory alterations can be distributed unevenly. This technique also allows the response to treatment to be assessed.
Endoscopic analysis of the oesophageal mucous membranes is not sufficient to reach a firm diagnosis, as 10-15% of patients will have normal results of a endoscopy.
Treatment for EoE is based on three alternative therapies:
Early diagnosis is important to prevent complications arising from EoE. Early treatment and clinical and endoscopic monitoring is also essential.
An autoimmune disorder, coeliac disease is the genetically predisposed reaction to ingesting gluten; a protein found in wheat, rye, barley, oats, spelt, kamut, and triticale. For coeliacs, ingesting gluten damages the villi in the small intestine, affecting their capacity to absorb nutrients from food (proteins, carbohydrates, fats, vitamins and minerals). People of any age may have the condition, and although people from any part of the world may be affected, it appears to be most common among white people whose ancestors were from Northern Europe. The most recent studies show the disease affects around 1 person in 100, and it is currently considered the most common chronic intestinal disorder in the western world.
Although some coeliacs may not show any symptoms, the most common are:
It is not fully understood why someone may develop coeliac disease, but several genetic factors are known to make people predisposed to the condition. However, it appears that having a genetic predisposition does not necessarily lead to the disease and that certain environmental factors are required. Despite its genetic origin, we cannot say that it is an inherited disease, although if we look at the general population, the likelihood of someone having the condition is increased if a family member also has it. If there is a family history then the likelihood of having it is 10 %.
First-degree relatives of coeliacs and people with related illnesses such as type 1 diabetes or autoimmune diseases are at greater risk.
Coeliac disease may occur at any age and is more prevalent in women than in men. In Catalonia 1 in every 204 citizens has the condition and it is more common in children than in adults.
The diagnostic process is based on clinical suspicion or recognising some of the risk factors. Serological markers such as anti-transglutaminase antibodies or deamidated gliadin peptide antibodies are used. If they are positive, an endoscopic intestinal biopsy should be performed to confirm diagnosis.
Genetic testing for HLA-DQ2 and HLA-DQ8 can also be carried out to identify people at risk of developing the disease.
Treatment for coeliac disease currently consists of completely and permanently eliminating gluten from the patient’s diet.
Coeliacs cannot eat any foods that contain wheat, oats, barley, or rye. In most cases, complete and lasting recovery from the intestinal damage is achieved, provided the patient does not go back to eating foods containing gluten. Avoiding gluten is only recommended for people with coeliac disease or non-coeliac gluten intolerance and is not necessary, nor recommended, for the general population.
Internal Medicine, General Hospital
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