You like the idea of poop, the digestive tract, and more poop.

你喜歡大便，消化道，還有更多的大便。

Let's debunk the public perception myths, and give it to you straight.

讓我們來揭穿公眾的認知誤區，直接給你說說。

This is the reality of gastroenterology.

這就是胃腸病學的現實。

Dr. Jubbal, MedSchoolInsiders.com.

朱波醫生，醫派內參網。

Welcome to our next installment in So You Want to Be.

歡迎來到我們下一期的《所以你想成為》。

In this series, we highlight a specific specialty within medicine, such as gastroenterology,

在這個系列中，我們將重點介紹醫學中的一個特定專業，如消化內科。

and help you decide if it's a good fit for you.

並幫助你決定是否適合你。

You can find the other specialties on our So You Want to Be playlist.

你可以在我們的 "所以你想成為的人 "播放列表中找到其他特產。

If you want to vote in upcoming polls to decide what future specialties we cover, make sure

如果您想在即將到來的民意調查中投票決定我們未來的專業內容，請確保

you are subscribed.

你已經訂閱了。

If you'd like to see what being a gastroenterologist looks like, check out my second channel, Kevin

如果你想知道作為一個胃腸病醫生是什麼樣子的，看看我的第二個頻道，凱文。

Jubbal, M.D., where we'll be covering a day in the life of a gastroenterologist soon.

Jubbal，醫學博士，我們很快就會報道消化科醫生的一天生活。

Gastroenterology is the specialty within medicine focusing on the gastrointestinal system, including

胃腸病學是醫學中專注於胃腸系統的專業，包括

everything from the mouth to anus along the alimentary canal.

沿著消化道從口腔到肛門的一切。

It's the only field that's truly mouth to anus, covering not only the entire gastrointestinal

這是唯一一個真正從口到肛門的領域，不僅覆蓋了整個胃腸。

tract, but also the pancreas and liver.

道，但也包括胰腺和肝臟。

Conditions you'll manage include inflammatory bowel disease, or IBD, not to be confused

您要處理的疾病包括炎症性腸病，或IBD，不要混淆。

with irritable bowel syndrome, or IBS, which you'll also treat.

與腸易激綜合症，或IBS，你也會治療。

Colon cancer, which, excluding skin cancer, is the third most common form of cancer among

大腸癌，不包括皮膚癌，是第三大常見癌症。

men and women in the United States, will also fall under your preventative screening and

美國的男性和女性，也將屬於您的預防性檢查範圍。

management.

管理；

Gastroenterologists deal with dysphagia, meaning trouble swallowing, and anything relating

胃腸科醫生處理吞嚥困難，即吞嚥困難，以及任何有關的問題。

to nutrition.

到營養。

After all, the gut is where we absorb nutrients and water.

畢竟，腸道是我們吸收營養和水分的地方。

Liver diseases, such as liver cancer, cirrhoses, and hereditary pathologies such as hemochromatosis

肝臟疾病，如肝癌、肝硬化、遺傳性病變如血色病等。

or alpha-1 trypsin deficiency fall under GI care, as do pancreatic diseases such as pancreatitis

或α-1胰蛋白酶缺乏症屬於消化道護理，胰腺炎等胰腺疾病也是如此。

or pancreatic cancers.

或胰腺癌。

Ultimately, gastroenterology is a subspecialty of internal medicine, and having a strong

歸根結底，胃腸病學是內科的一個亞專業，擁有強大的。

foundation in internal medicine is essential to be an effective GI doctor.

要想成為一名有效的消化道醫生，內科的基礎是必不可少的。

After all, many of the GI conditions and pathologies you'll encounter are closely involved with

畢竟，你會遇到的許多消化道疾病和病理都與以下情況密切相關。

other parts of the body.

身體的其他部位。

For example, the liver is intimately connected with the adrenal system and kidneys.

例如，肝臟與腎上腺系統和腎臟密切相關。

The brain-gut is another intimate association that can influence your patient's symptoms

腦-腸是另一個可以影響病人症狀的親密關聯。

and disease course.

和病程。

Gastroenterology is a unique subspecialty of internal medicine, as it combines a high

胃腸病學是內科的一個獨特的亞專業，因為它結合了高難度的胃腸病治療。

degree of clinical continuity and longitudinal care with procedural medicine, something that

程醫學的臨床連續性和縱向護理的程度，這一點

few other specialties provide — cardiology being another example.

很少有其他專科提供--心臟病學就是另一個例子。

While not a surgical subspecialty, you are working with your hands plenty.

雖然不是外科亞專業，但你的工作與你的手很多。

Gastroenterologists perform endoscopies, colonoscopies, ERCP's, and biopsy of virtually any abdominal

消化內科醫生進行內窺鏡、結腸鏡、ERCP和幾乎所有腹部的活檢。

organ via endoscopic ultrasound.

通過內鏡超聲檢查器官。

Moreover, it is now quite common to have many procedures, previously only addressed by surgeons,

此外，現在很多以前只有外科醫生才能解決的手術也很常見。

now performed endoscopically as it is often less invasive for sicker patients - these

現在，內窺鏡下進行，因為它通常對疾病患者的侵入性較小--這些都是在內窺鏡下進行的。

might include drainage of abscesses, placement of a luminal stent, or a nissen fundoplication.

可能包括膿腫引流、放置腔內支架或Nissen眼底手術。

You'll work with either pediatric or adult patients, and you'll be dealing with both

你將與兒童或成人患者一起工作，你將同時面對以下兩種情況。

acute and chronic processes.

急性和慢性過程。

Those acute processes will be anything but boring.

這些急性的過程將是什麼，但無聊。

Bleeding gastric ulcers are high acuity and can be life threatening, and foreign body

出血性胃潰瘍屬於高發疾病，可危及生命，異物

removals, such as toy cars or phallic shaped objects in someone's behind that they "accidentally

搬運，如玩具車或某人背後的法器，他們 "不小心 "搬走了。

slipped on" is a common occurrence.

滑 "的情況屢見不鮮。

From the top end, poorly chewed meat, dentures, chicken bones, and even silverware will require

從上端來看，咀嚼不良的肉、假牙、雞骨，甚至銀器都需要。

your expertise in removing safely.

您的專業技術安全去除。

There are a few ways of categorizing gastroenterology.

胃腸病的分類有幾種方法。

As an academic gastroenterologist, you'll be focusing on teaching students and GI fellows,

作為一名學術型消化科醫生，你將專注於教授學生和消化科研究員。

in addition to the academic side of medicine.

除了醫學的學術方面。

In academia, you typically see more variety in pathology, unique cases, and rare hereditary

在學術界，你通常會看到更多種類的病理，獨特的病例，和罕見的遺傳性的。

diseases.

疾病；

As a community gastroenterologist, working in a smaller institution, you'll be dealing

作為一名社區腸胃科醫生，在一個較小的機構中工作，你將處理的是

with more bread and butter cases that tend to be less complicated or unique.

與更多的麵包和黃油案例，往往不那麼複雜或獨特。

If you're at a county hospital, where patients often don't seek medical help until much later,

如果你在縣級醫院，病人往往要到很久以後才會尋求醫療幫助。

you might see more rare, advanced pathophysiology and presentations.

你可能會看到更多罕見的、先進的病理生理學和演示。

Private practice is the least common practice setting for a gastroenterologist, and usually

私家診所是消化內科醫生最不常見的執業環境，通常是

only occurs in smaller towns.

只發生在小城鎮。

It's more difficult to manage because there are multiple moving parts in a GI practice,

由於GI實踐中存在多個運動部件，管理起來比較困難。

including both acute and chronic as well as procedural and non-procedural.

包括急性和慢性，以及程序性和非程序性。

Coordinating staff, clinic, and most importantly patient safety, such as cleaning scopes, proper

協調工作人員、診所，最重要的是患者的安全，如清潔窺鏡、適當的。

sedation, and having state of the art equipment, makes private practice increasingly cumbersome.

鎮靜劑，並擁有最先進的設備，使得私人診所越來越麻煩。

As an outpatient gastroenterologist, you'll have the more standard 9 to 5 or 8 to 4 working

作為一名門診消化科醫生，你會有比較標準的朝九晚五或朝八晚四的工作時間。

hours and a predictable schedule.

小時和可預測的時間表。

This offers flexibility with your lifestyle, including better hours, and a high degree

這為您的生活方式提供了靈活性，包括更好的工作時間，以及高程度的

of clinic time and procedures, primarily in diagnostic screenings, such as a colon cancer

診所的時間和程序，主要是在診斷性篩查方面，如結腸癌

screening colonoscopy.

篩查結腸鏡檢查。

You'll generally spend 3 or 3 and a half days doing procedures each week, and 1 and a half

一般來說，你每週要花3天或3天半的時間做程序，1天半的時間

to 2 days in clinic.

到2天的診所。

The majority of your work will be outpatient in nature, but a few nights per month you'll

您的大部分工作將是門診性質的，但每個月有幾個晚上您會

be on call with the local hospital or academic setting for emergencies.

在當地醫院或學術環境中隨叫隨到，以應對緊急情況。

As an inpatient gastroenterologist, you're likely to be working in academia.

作為一名住院消化科醫生，你很可能在學術界工作。

Again, this translates to teaching medical students, residents, and fellows, and also

同樣，這也轉化為對醫學生、住院醫師和研究員的教學，同時也是

seeing more advanced pathologies.

看到更高級的病理。

You'll be busier than your outpatient colleagues, and patients will be sicker.

你會比門診的同事更忙，病人也會更病。

It's more rigorous, but for many the rewards pay off — primarily in teaching and involvement

這是更嚴格的，但對許多人來說，回報是有的，主要是在教學和參與方面。

with more intricate procedures, such as ERCP in dealing with the liver and pancreas.

與更復雜的程序，如ERCP處理肝臟和胰腺。

In terms of schedule as a GI in academia, you can expect typically 9 to 6 pm depending

在學術界作為GI的日程安排方面，你可以期待通常9點到6點，這取決於你的工作。

on inpatient rounds with some time on call at night each month.

對住院病人進行巡視，每月晚上有一定時間值班。

If you are a GI hospitalist, you can expect one week on and one week off, like an internal

如果你是消化道醫院的醫生，你可以像內科醫生一樣，一週上一週下。

medicine inpatient hospitalist.

內科住院醫師。

Gastroenterology is a fascinating field.

消化內科是一個迷人的領域。

After I was diagnosed with inflammatory bowel disease over 10 years ago, I was actually

10多年前，我被診斷出患有炎症性腸病後，我其實是

inspired to pursue pediatric gastroenterology so that I could help children with similar

受此啟發，我開始從事小兒腸胃病學的研究，以便能夠幫助有類似情況的兒童。

digestive disease processes.

消化疾病過程。

I was drawn to the procedural elements and found nutrition and digestion fascinating,

我被程序化的元素所吸引，覺得營養和消化很有魅力。

but I ended up pursuing plastic surgery.

但我最終還是選擇了整形手術。

That's another story told on my personal channel.

這是我個人頻道上講的另一個故事。

Many people think that because of the colonoscopies and other procedures within GI, it's a field

很多人認為，由於腸鏡等手術在消化內科，是一個領域的

that's hard on your nose.

這是很難在你的鼻子。

The truth is, it rarely smells bad because patients are generally prepped beforehand,

事實上，它很少有異味，因為患者一般都會事先做好準備。

meaning their colons are cleaned with laxatives to improve visualizing the colon walls.

意味著他們的結腸要用瀉藥清洗，以提高結腸壁的可視性。

While GI is technically mouth to anus, you'll find in practice that it more practically

雖然GI在技術上是口對肛門，但在實踐中你會發現，它更實際的是

begins at the upper esophageal sphincter.

始於食管上括約肌。

Above that, it's primarily ENT, also known as otolaryngology, although there is some

以上，主要是耳鼻喉科，也就是耳鼻咽喉科，雖然也有一些。

overlap between the two.

兩者之間有重疊。

And yes, digital rectal exams are important, and if you're a medical student or resident

是的，數字直腸檢查很重要，如果你是醫學生或住院醫師的話

don't shy away from them.

不要羞於啟齒

And for the rest of you, make sure you're comfortable with poop if you're considering

而對於其他人來說，如果你正在考慮，請確保你對大便的舒適度。

GI.

GI.

To become a gastroenterologist, you first complete 4 years of medical school, then 3

要成為一名胃腸科醫生，你首先要完成4年的醫學院學業，然後再完成3年。

years of internal medicine residency, and then 3 years of gastroenterology fellowship.

年的內科住院醫師培訓，然後是3年的消化內科獎學金。

That's a total of 6 years of postgraduate training after medical school.

也就是說，醫學院畢業後，總共要接受6年的研究所學生培訓。

Many gastroenterologists also pursue an additional 1 or 2 year fellowship to further subspecialize.

許多胃腸病醫生還額外進行1或2年的研究，以進一步分科。

Gastroenterology is one of the most competitive internal medicine fellowships, duking it out

消化內科是競爭最激烈的內科專業之一，對決的是

with cardiology.

與心臟病學。

They do consider all three USMLE scores, including Step 1, Step 2CK, and Step 3 in assessing

他們在評估USMLE成績時，確實考慮了所有三個步驟，包括步驟1、步驟2CK和步驟3。

your application.

您的申請。

Research is also highlighted, with the average matriculant having 11 research items, compared

同時突出研究性，預科生平均有11項研究，而

to 9 for cardiology.

心內科改為9。

This isn't so much a rite of passage, but rather highlighted because gastroenterology

這並不是什麼禮節，而是因為胃腸病學而凸顯出來的。

is a rapidly changing and evolving field.

是一個快速變化和發展的領域。

Hot topics in gastroenterology right now are related to new endoscopic surgical techniques

現在消化內科的熱點話題與內鏡手術新技術有關。

such as POEM, or Peroral Endoscopic Myotomy, an endoscopic procedure used to treat swallowing

如POEM，或口周內窺鏡肌切術，一種用於治療吞嚥的內窺鏡手術。

disorders, most commonly for Achalasia.

紊亂，最常見的是跟腱炎。

Another hot topic is the gut microbiome as it relates to various aspects of health including

另一個熱門話題是腸道微生物組，因為它與健康的各個方面有關，包括

the gut.

腸道。

There is also attention focused on developing oral medications rather than intravenous for

還有人關注開發口服藥物，而不是靜脈注射藥物。

ease of administration for patients, especially for those with inflammatory bowel disease.

便於患者，特別是炎症性腸病患者服用。

If pediatric gastroenterology is your goal, then you'd first complete three years of

如果你的目標是小兒胃腸病學，那麼你首先要完成為期三年的

pediatrics residency rather than internal medicine residency.

兒科住院醫師，而不是內科住院醫師。

After that, you would complete 3 years of pediatric gastroenterology fellowship.

之後，你將完成3年的小兒消化科獎學金。

If you're interested in doing surgery on the digestive tract, you want to look to general

如果你有興趣做消化道的手術，你要看一般的

surgery and its subspecialties, such as colorectal or hepatobiliary surgery.

外科及其亞專業，如結直腸或肝膽外科。

That's a separate residency training process, whereby you match into general surgery first

那是一個單獨的住院醫師培訓過程，你要先匹配到普外科去

and complete the relevant fellowship after.

並完成相關的研究金後。

As for the medical students who typically go for gastroenterology, they're usually the

至於醫學生一般都會去讀消化內科，他們一般都是

ones who enjoy a fast paced specialty, are efficient, yet are also laid back and can

喜歡快節奏的專業，效率高，但也是悠閒的，可以是一個很好的選擇。

handle the sometimes high acuity and stressful situations.

處理有時高尖銳度和壓力的情況。

They're adaptable and versatile, being able to turn on and quickly lock in for an acute

它們的適應性強，用途廣泛，能夠開啟並迅速鎖定急性

bleed, but also able to slow down for clinic.

出血，但也能夠慢下來進行診治。

Most of the gastroenterology fellowships are 1 year in duration, although some programs

大多數胃腸病學研究金的期限為1年，但有些項目的期限為1年。

are 2 years, particularly if they have a heavier focus on research.

是2年，特別是如果他們的研究重點比較重。

Note that with any of these fellowships, you'll still be treating general gastroenterology

請注意，在這些獎學金中的任何一個，你仍然會治療普通的胃腸病

conditions and performing screening colonoscopies in varying amounts.

狀況，並進行不同量的腸鏡檢查。

Interventional and advanced endoscopy focuses on endoscopic procedures, such as endoscopic

介入和先進的內窺鏡檢查主要是內窺鏡手術，如內窺鏡下。

retrograde cholangiopancreatography, or ERCP, to visualize the gallbladder, biliary system,

逆行性胰膽管造影術，或ERCP，用於觀察膽囊、膽道系統。

pancreas, and liver.

胰腺和肝臟。

You'll also be trained in endoscopic ultrasound, which is similar to endoscopy, but rather

你還將接受內窺鏡超聲的培訓，這與內窺鏡檢查類似，但更多的是。

than a camera at the end, you'll have an ultrasound probe.

比起末端的攝像頭，你會有一個超聲探頭。

Ultrasound is commonly done from the outside of the body, but endoscopic ultrasound offers

超聲檢查通常從身體外部進行，但內窺鏡超聲檢查可提供

internal imaging that's highly accurate, and is used to diagnose cancer, take biopsies,

高精度的內部成像，用於診斷癌症、取活檢。

or place enteral stents.

或放置腸道支架。

Advanced endoscopists do a great deal of stenting when cancers obstruct the GI passages, whether

高級內鏡醫生在癌症阻塞消化道時，會做大量的支架手術，無論是

in the esophagus, stomach, small intestine, or colon.

食道、胃、小腸或結腸中。

In these instances, your interventions are more therapeutic or palliative, rather than

在這些情況下，你的干預措施更多的是治療或緩解，而非

curative.

治療性的。

It's a highly rewarding subspecialty, but it comes with longer hours and is often inpatient

這是一個回報率很高的亞專業，但它的工作時間較長，而且經常是住院治療。

in nature.

性質上。

You'll also be wearing lead aprons for long periods of time for frequent use of x-rays,

頻繁使用X射線的你還會長期穿著鉛圍裙。

which can be tiresome, particularly when also maneuvering the scope.

這可能是令人厭煩的，特別是當還操縱範圍。

Inflammatory bowel disease is an autoimmune condition, consisting of two types: Crohn's

炎症性腸病是一種自身免疫性疾病，包括兩種類型。克羅恩病

disease and ulcerative colitis.

病和潰瘍性結腸炎。

With an autoimmune disease, the body is attacking itself, and these are the specialists in managing

有了自身免疫性疾病，身體就會自我攻擊，而這些都是管理的專家。

the heavy hitting and sometimes dangerous immunosuppressive agents that get this disease

重拳出擊，有時甚至是危險的免疫抑制劑，使這種疾病得到

under control.

受控。

It's a rapidly evolving field, taking a closer look at how the gut microbiome influences

這是一個快速發展的領域，仔細研究腸道微生物組如何影響

these conditions.

這些條件。

You'll also be dealing with awesome patients like me.

你也會和像我這樣的厲害的病人打交道。

In terms of lifestyle, hours are the more predictable and typical 9 to 5 in nature.

在生活方式上，時間是比較可預測的，典型的朝九晚五的性質。

Hepatology and transplant hepatology are the experts on the liver, dealing with liver cirrhosis,

肝病學和移植肝病學是肝臟方面的專家，處理肝硬化。

autoimmune diseases of the liver, hereditary diseases, and liver failure.

肝臟的自身免疫性疾病、遺傳性疾病和肝衰竭。

While the transplant surgeon will be doing the actual harvesting and surgery, you'll

當移植醫生將進行實際的採集和手術時，你將會

be evaluating the patient for liver transplant candidacy and will provide pre-op and post-op

評估患者是否適合進行肝臟移植，並提供術前和術後服務。

care.

照顧。

Often times, this includes stabilizing and improving a patient's health from first presentation

通常情況下，這包括穩定和改善患者的健康狀況，從第一次出現。

such that they are realistic liver transplant candidates.

以至於他們是現實的肝移植候選人。

This requires careful attention and nuance to medication management and peri and post

這就需要認真注意和細微地處理藥物管理以及圍手術期和術後。

operative care.

手術護理；

Motility is the least common of GI fellowships, dealing with peristalsis of the gastrointestinal

運動性是最不常見的消化道交誼，處理胃腸的蠕動。

tract, meaning the wavelike motion that propels food down the alimentary canal.

意思是說，食物在消化道中的波浪式運動。

These coordinated contractions push stomach contents into the small intestine, or help

這些協調的收縮將胃內容物推入小腸，或幫助胃內容物進入小腸。

the colon and rectum move feces prior to having a bowel movement.

在排便前，結腸和直腸會移動糞便。

Peristalsis is reliant on the nervous system, endocrine system, and balance between sympathetic

蠕動依賴於神經系統、內分泌系統和交感神經之間的平衡。

and parasympathetic systems.

和副交感系統。

Motility experts are often working with various systemic conditions that impair motility,

運動能力專家經常與各種損害運動能力的系統性疾病打交道。

such as neurologic diseases or scleroderma, an autoimmune connective tissue disease that

如神經系統疾病或硬皮病，這是一種自身免疫性結締組織疾病，它的特點是

causes hardening of the skin and other tissues.

導致皮膚和其他組織的硬化。

There's a lot to love about gastroenterology.

胃腸病學有很多優點。

It uniquely offers a good breadth of medical knowledge applied in both the acute and chronic

它獨特地提供了一個良好的醫學知識的廣度，應用於急性和慢性。

settings.

設置。

If you enjoy procedures but don't quite want to do surgery, consider this specialty.

如果你喜歡程序，但又不太想做手術，可以考慮這個專業。

If you're into exciting high acuity situations, there's plenty of GI emergencies through acute

如果你喜歡刺激的高敏度情況，有很多消化道急症通過急性

bleeds and foreign body ingestion.

出血和異物攝入。

On the other hand, you also enjoy longitudinal care and building relationships with your

另一方面，您還可以享受到長期的關懷，並與您建立關係。

patients, as many GI diseases are chronic in nature.

患者，因為很多消化道疾病都是慢性病。

Mastery is inherently rewarding, and my gastroenterologist friend says it's a very easy specialty to

掌握了這個專業本身就有收穫，我的消化科醫生朋友說，這是一個很容易的專業。

master, assuming you have a strong foundation in internal medicine first.

師，假設你先有一個堅實的內科基礎。

In terms of compensation, it's usually in the top 6 specialties, most recently at $419,000

在薪酬方面，一般都在前6名的專業中，最近一次是41.9萬元。

per year, which makes sense given its procedural nature.

每年，鑑於其程序性，這是有道理的。

You have flexibility with your lifestyle, and are able to have 9 to 5 hours while also

您的生活方式很靈活，可以朝九晚五，同時也可以有自己的生活方式。

making a very comfortable living.

使得生活非常舒適。

There's currently a widespread shortage of gastroenterologists in many cities, and therefore

目前很多城市普遍存在消化科醫生短缺的問題，是以

you'll be in high demand, giving you leverage in having the type of practice you want.

你會有很高的需求，讓你在擁有你想要的實踐類型的槓桿。

While GI is an amazing specialty, it's not for everyone.

雖然GI是一個神奇的專業，但並不是每個人都適合。

If you are disgusted by the idea of feces, look elsewhere.

如果你對糞便的想法感到厭惡，請到別處去找。

It's not a constant reality you'll be facing every minute of the day, but you'll be seeing