Semester/Modul: 5. sem./5.3 Godkendt af studienævn: Omfang: 8 ECTS Titel: Ernæring og fordøjelsessystemet II Ansvarlig/koordinator: Cristian Pablo Pennisi Eksamensform: Skriftlig eksamen. Indstilling til eksamen forudsætter godkendt portfolio. Anbefalet pensumdækkende litteratur: Textbook of Medical Physiology. Guyton and Hall. 12th ed. Saunders Hovedets, Halsens og de Indre Organers Anatomi. Jørgen Rostgaard og Jørgen Tranum-Jensen, m.fl., 10. udgave. Munksgaard. Katzung BG et al, Basic and Clinical Pharmacology. 11th ed. McGraw Hill. Kathryn L. McCance, and Sue E Huether. Pathophysiology: The biologic basis of disease in adult and children. 7th ed. Mosby Schaechter s Mechanisms of Microbial Disease, 5th ed. Lippincott Williams & Wilkins Patologi, af Niels Marcussen, m. fl., 2. udgave. FADL's forlag. Læringsmål: Pensum indeholder læringsmål fra alle forelæsninger, studiesal øvelser, kliniske øvelser og cases. Følgende generelle principper gælder for læringsmålene, der er anført på denne pensumlist. Anatomi: Når du bedes redegøre for et organs anatomi omfatter det følgende parametre (som angivet i Anatomi-bøgerne fra FADL og Munksgaard): Navn på dansk og latin, kort beskrivelse af funktion, form, størrelse (vægt og mål), farve, overflade, konsistens, flader, kanter, fremspring og fordybninger, organets lejring og relationer til nærliggende organer og større strukturer, den indre struktur (herunder snitfladers udseende), karforsyning (arterier, vener, lymfekar), nerveforsyning Histologi: ved histologi skal gøres rede for celletype, struktur og funktion. Farmakologi: beskrivelsen af et bestemt lægemiddel omfatter: virkningsmekanisme, klinisk anvendelse, farmakokinetik, dosering og bivirkninger. For hvert lægemiddel, bør i det mindste to kommercielle præsentationer være kendt. Patofysiologi: en fyldestgørende beskrivelse af patofysiologien bør omfatte: en definition, en klassifikation (fx medfødt, erhvervet, idiopatisk, osv.), symptomer og kliniske fund, ætiologi (hvis kendt, eller bare hypotesen), patogenese (udvikingsmekanismer), epidemiologiske data (hvis relevant), og risikofaktorer (hvis relevant). 1
There is some overlap between the learning outcomes listed below, which is due to the fact that some learning outcomes are described in general and in detail, to emphasise the important sub elements. Anatomy, histology and physiology Describe the anatomy of the portal circulation. Describe anatomy and physiology of the adrenal glands. Describe the histologic and functional differences between the adrenal cortex and medulla. Explain the hypothalamic-pituitary-adrenal axis (HPA). Outline the role of the immune system in the intestinal tract. Describe the gut immune system, including Peyer s plaques and mesenteric lymph nodes (Mucosa-Associated Lymphoid Tissue, MALT). Account for the most important classes of immunoglobulin and their recruitment in the gut immune system. Explain the general immunological mechanisms by which the gut immune system can generate an immune response against a pathogenic microorganism but not to the normal intestinal flora or antigens. Describe the physiology of gut motility. Describe the physiology of the enteric nervous system. Describe the physiologic anatomy of the gastrointestinal wall. Describe the neural and hormonal control of gastrointestinal function Outline the main gastrointestinal reflexes Outline the role of the liver in drug metabolism. Outline the role of the liver in alcohol consumption. Microbiology Outline the role of gastrointestinal microbiological flora in health and disease (infection, inflammation). Outline the microbiology of major infectious agents involved in malabsorption and gastroenteritis. Identify implications of antibiotic use on gut flora. Give examples for common bacterial populations in the gut. Explain consequences of bacterial overgrowth. Pharmacology Outline the pharmacology of drugs acting on the bowel: anti-diarrhoeal drugs and drugs used in constipation therapy (laxatives). Explain the effects of opioid receptor agonists on the enteric nervous system. Understand the vicious circle of chronic laxative use. Explain the laxative abuse in eating disorders. Describe the consequences of excessive use of anti-diarrhoeals and laxatives. Explain phase I and phase II reactions. Explain the involvement of the cytochrome P450 enzymes in drug metabolism. Understand the consequences of CYP 450 enzyme induction and inhibition. Describe the first pass effect and the consequence for drug bioavailability. 2
Identify the role of drugs in liver damage (with particular reference to paracetamol). Identify the consequences of hepatic damage to drug metabolism and excretion. Outline vaccination and post-exposure prophylaxis for hepatitis A. Outline the pharmacology of corticosteroids. Understand mineralo- and glucocorticoid synthesis. Explain the regulation of synthesis and secretion of corticoids. Describe the different receptor mechanisms for corticoids. Differentiate between cellular and intracellular glucocorticoid receptor mechanisms. Outline the systemic and topical use of mineralo- and glucocorticoids. Outline the adverse effects of excess and deficiency of corticoids. Pathophysiology Describe the pathophysiology of inflammatory bowel disease. Distinguish the pathological features of Crohn s disease and ulcerative colitis. Describe the pathology and pathophysiology of gastritis. Describe the pathophysiology of malabsorption Identify the clinical, biochemical, histopathologic and haematological features of malabsorption. Outline the major causes of malabsorption. Revise the WHO definition of malnutrition. Define protein-energy malnutrition (PEM). Distinguish the difference between Marasmus and Kwashiorkor. Describe the major clinical consequences of malnutrition. Outline the manifestation, diagnosis and treatment of deficiencies of common vitamins. Describe the pathology of common diseases of the biliary system and pancreas. Describe the pathological processes and consequences of gallstones. Describe the development and consequences of neoplasms of the biliary system and pancreas. Describe the pathology of acute and chronic pancreatitis. Describe the pathology and pathophysiology of common diseases of the peritoneum. Outline the common causes of jaundice. Describe the pathophysiology of viral and alcoholic hepatitis. Outline the major causes of acute and chronic hepatitis. Describe the various effects of alcohol on health. Describe the pathological consequences caused on the liver by excessive alcohol intake (alcoholic liver disease). Outline the pathology of hepatic cirrhosis. Outline the clinical consequences of hepatic failure. Explain pathophysiology and mechanisms of drug toxicity. Describe risk factors for drug-induced hepatotoxicity. Outline the major causes and risk factors for gastrointestinal bleeding. Outline the epidemiology, clinical presentation and prognosis of cancers of the oesophagus, stomach, colon, rectum, and anus. 3
Describe the pathology of neoplastic diseases of the lower gastrointestinal tract. Describe the pathology and pathogenesis of bowel cancer. Describe the pathophysiology of disorders of the adrenal cortex (Cushing s disease and Addison s disease). Outline the pathophysiology of haemodynamic shock. Identify the key clinical features of haemodynamic shock. Clinical techniques and skills Relate location, quality and referral of abdominal pain to underlying pathology. Explain general characteristics of abdominal pain, like pain character and duration and involved triggering events. Distinguish pain of visceral or peritoneal origin. Conduct an appropriate examination of an individual in abdominal pain. Outline the common symptoms of inflammatory bowel disease. Describe examination techniques for inflammatory bowel disease diagnosis. Outline the principles of resuscitation and stabilization in severely malnourished children. Outline the serological consequences of viral hepatitis and relate this to investigation. Interpret liver histopathology for the most common liver diseases (hepatitis, drug injury, and neoplasms). Outline methods of visualizing the gastrointestinal tract. Summarize and compare the clinical manifestation of common bowel diseases. Outline laboratory investigations of the gastrointestinal function. Identify the clinical presentation of acute and chronic blood loss from gastrointestinal tract. Explain the main gastrointestinal bleeding signs, including hematemesis, melena and hematochezia. Outline the main approaches to the investigation of the gastrointestinal bleeding. Describe the rationale for the investigation of acute and occult blood loss, relating this to the age and clinical features. Outline the importance of disease staging in GI cancer. Outline the TNM staging system for colorectal cancers. Distinguish different causes and describe the essential signs for shock, including hypovolemic, neurogenic, anaphylactic, cardiogenic, traumatic and septic shock. Outline main elements in the management of shock. Understand endocrine investigation of adrenal disease. Population health and medicine Identify the importance of nutrition in chronic and acute illness. Relate main microbiological agents (bacteria, viruses, parasites) causing food poisoning to clinical progression and control. Identify principles of prevention for food poisoning. Identify major issues in food safety. Understand the food safety regulations in Denmark. Outline the major causes of food poisoning and the principles of disease control Give an overview of the social and medical consequences of alcohol consumption. 4
Discuss the social and medical differences between moderate and excessive alcohol intake. Consider what an effective health promotion strategy would be in relation to alcohol. Describe treatment options for alcohol abuse. Identify the scientific basis for linking diet to gastrointestinal cancer. Outline the main associations between diet and GI cancers. Outline major developments in management of gastrointestinal cancers including screening 5