Gastrointestinal and Hepatobilitary System

COURSE OBJECTIVES

Students will be able to

identify and explain the nature of abnormalities seen in Gastrointestinal system in relation to normal structure and functions.
outline the principles of therapeutic and behavioural management of patient and families
correlate the normal structure and functions of Gastrointestinal system to the signs, symptoms patho-physiological states, diagnosis and management of the following common conditions: pain in abdomen (acute and chronic); diarrhoea; vomiting; worm infestation; jaundice; cirrhosis; dysphagia; Gl bleeding (upper and lower); ascites; parotid swelling; acute pancreatitis; peptic ulcer; Cancer of stomach; ulcerative colitis.

ANATOMY

Students will be able to

mention the parts of gut
explain the development of gut in general
explain the development of stomach, rotation of mid gut and derivatives of cloacae
mention the boundaries, parts and contents of mouth
explain the location, parts, structure of tongue; mention its development.
mention the types, parts, structure, eruption and neurovascular supply of teeth.
mention the position, relation, structure, surfaces borders of parotid glands and different structures traveling through it; explain its neurovascular supply and lymphatic drainage.
recall the parts, boundaries, structure and communications of pharynx if not discussed in respiratory system.
Mention the extent, relation, structure, constrictions and neurovascular supply of esophagus and correlate its constrictions in radiological examination.
Mention the extent, location, parts, relations, structure, neurovascular and lymphatic drainage of stomach and correlate with radiological examination.
Mention the extent, location parts, relations, structure, neurovascular and lymphatic drainage of duodenum and correlate with radiological examination.
Mention the differences between ileum and jejunum mention the extent, content and the structures crossed by root of mesentery.
Mention the location, extent, important relations, neurovascular supply and lymphatic drainage of caecum.
mention the position, neurovascular supply, structure of appendix and correlate with its pathological conditions.
mention the location, extent, extent, structure, relation and neurovascular supply and lymph drainage of colon and correlate with different pathological conditions.
mention the extent, relations, curvatures, structure and neurovascular supply of rectum and correlate with different common diseases arising on it.
mention the extent, structure neurovascular supply and lymphatic drainage of anal canal and correlate with different pathological conditions arising in it.
explain the normal anatomy of posterior abdominal wall.
describe the normal anatomy of ischeorectal fossa.
mention the size, shape, location, lobes, surfaces and relations of liver.
explain the peritoneal covering, bare area and different ligaments of liver.
explain the structure of liver lobule and mention different models of acini with pathological significance.
mention the blood supply and vascular segments of liver.
explain the architecture of intra hepatic biliary tree.
explain the extent, peritoneal relation and surgical importance of extra hepatic biliary tree.
mention the size, shape, parts, structure, neurovascular supply and clinical correlation of gallbladder.
mention the size, shape, parts, position, relation and structure of pancreas.
explain the neurovascular supply and lymphatic drainage of pancreas.

CLINICAL PHYSIOLOGY

Students will be able to

recall the different parts of digestive system and their function including Liver, Gallbladder and Pancreas
discuss mechanism of secretion and functions of saliva.
describe the mechanism of deglutition.
describe different types of gastric glands, the mechanism of gastric secretion including hyper and hypo chlorhydria, achlorhydria and peptic ulcer.
describe the function of pancreatic juice.
describe the secretion and functions of small intestine.
describe the function of large intestine.
Discuss the movements of stomach, small intestine, large intestine (factors affecting the movements)
discuss the physiology of constipation and diarrhoea.
describe the patho-physiology of vomiting.
describe gastro- intestinal hormones and their functions.
describe the functions of liver
describe bile formation, secretion and storage in gall bladder and expulsion of bile from gall bladder to intestine.
describe enterohepatic circulation of bile
describe different types of jaundice: Prehapatic, Hepatic and Post hepatic; differentiation through examination of blood, stool and urine, describe the physiological basis of liver function test.

CLINICAL BIOCHEMISTRY

Students will be able to

describe the process of digestion and absorption of fat in Gl tract;
list the importance of impaired absorption;
explain lipids as source of energy; describe oxidation of fatty acids (beta, alpha and omega oxidation);
describe the mechanism of ketone body formation and utilization;
describe de-novo synthesis of fatty acid indicating location and source of substrates;
explain the mechanisms of obesity;
explain the importance and consequences of creatinine metabolism (muscle cramp);
explain Refsum’s diseases and alpha oxidation of fats (neurological problem);
explain mechanisms of diabetic ketoacidosis;
describe the chemistry of cholesterol. State the normal level of cholesterol and its important functions;
describe the synthesis (in the body), excretion and regulation of cholesterol level.

Metabolic interrelationship

Students will be able to

define well fed state, early fasting state, early re-fed state, caloric homeostasis, energy requirements and reserves;
explain five phases of glucose homeostasis and complete starved cycle.
describe mechanism involved in switching the metabolism of the liver between the well fed state and the starved state;
describe metabolic interrelationships of tissues in obesity, exercise, pregnancy, insulin dependent and non-insulin dependent diabetes mellitus, stress, injury, liver disease, renal disease and acid-base disorder
explain kwashiorkor (protein malnutrition) Reye’s syndrome (hepatic mitochondrial damage), hyperosmolar hyperglycaemic coma, protein glyocosylation, diabetic polyol pathways,

Liver and its function

Students will be able to

recall normal anatomy of lobule of liver;
list the general functions of liver;
explain the carbohydrate, lipid and protein metabolism in liver;
describe synthesis of bile acids, cholesterol, steroids and conjugation with glucuronic acid and sulfuric acid;
describe various detoxifying reactions occurring with drugs and poisons (oxidation, reduction, hydrolysis, conjugation and methylation);
explain excretion of bile pigments and mechanism of jaundice;
define jaundice and classify them;
explain biochemical reasons in Gilbert syndrome, Crigler-Najjar syndrome and Dubin Johnson and Roter syndrome;
list the chemical test used in diagnosis of liver disease (Bilirubin, plasma protein and plasma enzymes);

PATHOLOGY

Students will be able to

apply the general concept of inflammation in the oral cavity, salivary gland and GIT.
list different preneoplastic conditions of oral cavity and tongue.
describe pathogenesis and morphology of leukoplakia and erythroplakia.
describe the gross and microscopic features of common types of malignant tumors of the oral cavity.
describe the gross and microscopic features of sialadenitis.
classify the tumors of salivary gland.
describe the gross and microscopic features of pleomorphic adenoma, Warthin tumor, mucoepidermoid carcinoma, and adenoid cystic carcinoma.
define esophagitis.
define gastroesophageal reflux diseases.
describe etiopathogenesis and morphology of chronic esophagitis.
define Barrett’s esophagus and describe its pathogensis and morphology.
describe the gross and microscopic features of common types of malignant tumors of the esophagus.
define acute and chronic gastritis.
describe etiopathogensis and morphology of acute and chronic gastritis.
describe the role of Helicobacter pylori in the pathogenesis of chronic gastritis, peptic ulcer and gastric carcinoma.
describe briefly on autoimmune gastritis.
define peptic ulcer.
list the causes of gastric ulcers; state the site of peptic ulcer.
describe the etiopathogenesis, gross and microscopic features and complications of peptic ulcer.
define adenoma and polyp in Gl tract.
define familial polyposis and HNPCC syndromes.
describe gross and microscopic features of different types of adenoma and polyps of Gl tract.
classify the tumors of stomach.
Describe the etiopathogenesis, gross and microscopic features of adenocarcinoma of stomach.
define inflammatory bowel disease and list different types of inflammatory bowel diseases.
describe the gross and microscopic features of Crohn’s disease, ulcerative colitis, tuberculosis of intestine, and amoebic colitis.
list the causes of intestinal obstruction.
define intussusception and volvulus microscopic features.
classify the tumors of intestine.
describe the pathogenesis of colorectal cancer.
describe the etiology, gross and microscopic features adenocarcinoma of intestine.
describe the etiopathogenesis, gross and microscopic features and chronic pancreatitis and list its complications.
describe the gross and microscopic features of common types of malignant tumors of head of pancreas.
differentiate between cholecystitis, cholangitis and cholelithiasis.
describe morphology of chronic cholecystitis.
describe the etiology and morphology of different types of gallstones and its complications.
list the tumors of gall bladder and common bile duct.
describe the gross and microscopic features of carcinoma of gall bladder.
list different types of hepatitis.
differentiate between amoebic hepatitis and infective hepatitis.
describe the pathogenesis, gross and microscopic features of viral hepatitis and its complications.
list the stages of alcoholic liver disease.
define and classify cirrhosis of liver.
list the complications of cirrhosis of liver.
describe the gross and microscopic features of cirrhosis.
classify the tumors of liver.
describe etiology, gross microscopic of hepatocellular carcinoma and hepatoblastoma.

CLINICAL MICROBIOLOGY

Students will be able to

list and describe the important pathogens affecting Gastro Intestinal system;
describe the morphology, pathogenesis, laboratory diagnosis, transmission and prevention of the following organisms:

Bacteria:

Salmonella
Shigella
Escherichia coli
Klebsiella
Proteus
Vibrio cholerae
Clostridia

Viruses:

Hepatitis
Rota
Adeno
Norwalk

Parasites:

Entamoeba hystolytica
Giardia lamblia.
Coccidian parasites and Cryptosporidium sps
Ascaris lumbricoides
Ankylostoma duodenale and Necator americanus
Enterobius vermicularis
Trichuris trichuria
Taenia species
Echinicoccus granulosus
Heminolepis nana

CLINICAL PHARMACOLOGY

Drugs used in peptic ulcer

Students will be able to

define the objectives of treatment of peptic ulcer.
list the drugs effective in peptic ulcer.
state the role of proton-pump inhibitors and H2 receptor antagonists in the management of acid-peptic disease.
name antacids and describe their role and indications in management of acid- peptic disease; explain the basis of combination of magnesium and aluminum compounds as antacids.
explain the basis for use of sucralfate, colloidal bismuth and prostaglandin analogues in the management of acid-peptic disease.
list the drugs and regimens effective against H. pylori.

Antispasmodics

Students will be able to

list the drugs used to reduce painful gastrointestinal smooth muscle contractions.
state the rationale for the use of such drugs.
describe the adverse reactions and contraindications.

Drugs used in diarrhoea

Students will be able to

define the objectives of treatment of diarrhoeal diseases.
state the specific roles of oral and parenteral rehydration.
list the conditions for use of antimicrobials in diarrhoea.
describe the mechanism by which nonspecific antidiarrhoeal agents exert their effects;
describe the harmful effects of antidiarrhoeal agents.

Drugs used in constipation

Students will be able to

define the objectives of treatment of constipation.
explain the difference between laxatives and purgatives.
classify these drugs with their general mechanism of action.
list their indications, contraindications and adverse effects.
describe the importance of non-pharmacological management in constipation.

Drugs used to induce and treat vomiting

Students will be able to

name the emetic agents and outline indications for the use of emetics.
list their adverse effects and contraindications.
list the antiemetics and give their mechanisms of action, indications adverse effects and contraindications.
list the important differences between the drugs.

Drugs used in amoebiasis and giardiasis

Students will be able to

List the drugs used in amoebiasis.
describe adverse reactions and contraindications of these drugs.
mention the objectives of management of different types of amoebic infection.
describe the drugs used in the treatment of giardiasis.

Drugs used in helminthic infection

Students will be able to

name common intestinal parasites.
list the drugs used in their management.
explain their mechanism of action and adverse effects.