Ateneo - UPO

The most common diseases and conditions in the practice of
Gastroenterology will be discussed starting from the epidemiology,
continuing with clinical manifestations at presentation, diagnosis and
opportunities for prevention. Finally, the rational,
physiopathologically based
treatment with pharmacological and non-pharmacological options
will be proposed. The agenda of the lessons will be in order of organ,
starting with gastrointestinal tract diseases, then diseases of the
pancreas, and finally diseases of the liver and biliary tract. The emphasis
will be on commonly encountered diseases in the practice of a
non specialist.

Malattie dell'apparato digerente Edizione 2022 2025. Harrison's Principles of Internal Medicine, 20/E McGraw-Hill Education (2018)

The course is aimed at the training of a prospect physician who, taking
into account the (necessarily limited) experience gained at this stage of
his/her career, is able to understand the principles of care of the most
common diseases of the alimentary tract, understanding the patient in its
complexity, from a multidisciplinary, interprofessional and integrated
point of view. At the end of the course the student must have:
• Gained knowledge useful for clinical practice regarding the most
common diseases of the alimentary tract such as, for example,
gastroesophageal reflux disease, irritable bowel syndrome and
inflammatory bowel disease; the achievement of this goal can be
measured through the performance in the ad hoc multiple choice quiz.
• Developed, for the same purpose, clinical abilities (eg, proper and
thorough history taking and physical examination, setting up of
laboratory and instrumental investigations) aimed at solving problems in
the single proposed case study (with regard to diagnosis, clinical
monitoring, therapy and involvement of the patient and the family in the
care process); the achievement of this objective is measurable through
the performance in the solution of a structured case study proposed ad
hoc;
• Learned to recognize and fill their limits through smart use of
references, such as tutors themselves, manuals and textbooks, electronic
resources (eg, UpToDate®);
• Understood systems in which the practice of medicine occurs, eg. the
relationship between hospital medicine and medicine in the community.
The achievement of these last two objectives is measured during clinical
clerkship.

To fully achieve the objectives of this course, the student should have
gained sufficient knowledge of the biological bases of gastrointestinal
diseases, the mechanisms of host response and the clinical approach to
the patient (recognition of symptoms and signs). Translated in terms of
pre-teaching, the ideal student for the course of Gastroenterology is the
one who has fully achieved the goals described in Immunology and
Fundamentals of Pathology, and Clinical Methodology, History taking and
Physical Examination.

The course consists of:
• Taught (frontal) classes lasting 120 minutes with slide presentations
available on the UPO DIR website (https://www.dir.uniupo.it/)
• N. = 25 hours of professional training, at the endoscopic department /
department of
Gastroenterology and Internal Medicine. SBAR, problem-solving, patient
approach (with
emphasis on physical examination skills) and major investigations and
procedures are taught (eg paracentesis, abdominal ultrasound,
endoscopy of upper and lower GI tract); the
active participation of the student the development of a critical spirit and
the progressive ability to manage problems independently are strongly
stimulated.
• Extensive use of the DIR platform, through which the student accesses
podcasts of the frontal lessons provided in the classroom during this
academic year as well as in previous courses, further study materials (eg,
international guidelines, video tutorials, etc. .), multiple choice quiz.

(Knowledge) Multiple choice quiz consisting of N. = 15 questions with N. = 5 possible answers, of which only one correct, as planned for the integrated course of Medical Pathology II (whose other disciplines are Hematology, Infectious Diseases and Endocrinology). The minimum threshold for passing the test is 9/15 (60%) of correct answers. A level of excellence is achieved with a correct answer to 14/15 (93%) or more of the questions. (Competence) A short clinical case, structured to address a major problem in contemporary clinical practice of Gastroenterology, will be discussed to verify the student's ability in problem-solving using clues from physical examination, laboratory and/or imaging investigations, and in suggesting the appropriate treatment and follow-up. The case used is always representative of a major medical problem for frequency response and impact on quantity and quality of life. (Cross Skills) Evaluation with immediate feedback during the professional internship period, in the departmental or outpatient setting with the teacher and / or the tutors.

1. Approach to the patient with (suspected) gastrointestinal disorder. Symptoms, signs and syndromes in gastroenterology: high and low dysphagia, acute and chronic diarrhea, constipation, fecal incontinence. Digestive hemorrhage of the upper and lower gastrointestinal tract. 2. Esophageal diseases. Recap of anatomy and function. Structural abnormalities: Zenker's diverticulum, hiatal hernia. Disorders of esophageal motility: gastroesophageal reflux disease, acalasia, diffuse esophageal spasm. Barrett's esophagus. Drug esophagitis. Infectious esophagitis. Esophageal cancer and differential diagnosis of esophageal dysphagia. 3. Diseases of the Stomach. Recap of anatomy and function.. H. pylori infection and its clinical consequences: peptic ulcer and gastritis. Functional dyspepsia. Zollinger-Ellison syndrome. Benign and malignant tumors of the stomach. Consequences of gastric surgery (resections, bariatric surgery): dumping syndrome and malabsorption. 4. Small bowel disease. Recap of anatomy and function. Malabsorption: a) Short intestine syndrome; b) bacterial overgrowth in the small intestine; c) celiac disease. Infectious gastroenteritis and enterocolitis: infections and food toxins, traveler's diarrhea, diarrhea and colitis from Clostridium difficile. Whipple disease. 5. Colorectal disorders. Recap of anatomy and function. Irritable bowel syndrome. Intestinal inflammatory diseases: Crohn's disease, Ulcerative colitis. Intestinal Ischemia: Acute Mesenteric Ischemia, Mesenteric Vein Thrombosis, Ischemic Colitis. Diverticular disease. Colon cancer (sporadic and familiar); surveillance of the patient with colon polyps. 6. Pancreatic disorders. Recap of anatomy and function. Topographical and radiological references. Acute and chronic pancreatitis: epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, therapy, prognosis. Pancreatic cancer. Breif description of autoimmune pancreatitis (IgG4 related) and on insufficiency of exocrine pancreas (definition and causes). 7. Diseases of the liver. Recap of anatomy and function. Couinaud segments and liver vascularization. Gallstones: cholelithiasis and its complications; biliary colic, acute cholecystitis, Mirizzi syndrome. Immune-related disorders: primitive sclerosing cholangitis, primary biliary colangitis, autoimmune hepatitis, overlap syndromes. Hereditary and metabolic liver disorders: primary and secondary iron overload, with particular regard to type 1 hemochromatosis; Wilson's disease, alpha-1- antitrypsin deficiency, non-alcoholic liver disease. Alcoholic liver diseases: metabololic dysfunction associated steatotic liver disease, alcoholic hepatitis. Portal hypertension and its complications: overt and covert hepatic encephalopathy, ascites and other conditions of altered renal function in cirrhosis, hemorrhage from esophageal varices and its prevention. Natural history of cirrhosis and estimation of prognosis. Acute liver failure. Liver transplantation: timing and indications. 8. Diagnostic procedures in Gastroenterology: indications, contraindications, how to perform, complications.

(Knowledge)
- Epidemiology, Clinical manifestations, Differential Diagnosis, Therapy,
Follow-up and Prognosis of the Most Commonly encountered disorders of
the intestine, the pancreas and the liver/biliary tract.
(Competence)
- Applying the principles of clinical reasoning to a specific clinical case by
choosing the most common diagnostic procedures, analyzing and
interpreting the results effectively and efficiently;
- Principles of the use of therepeutics,with an emphasys on the ability to
identify the patient who needs immediate evaluation and treatment;
- Ability to undertake adequate preventative and protective actions in
relation to the disease, while maintaining and promoting the health of the
individual, the family, and the community.
(Cross Competencies)
- knowing how to present a patient's problems in an orderly and
structured way;
- be able to read, understand and comment on technical material from
treats or manuals and point-of-care sources.
To achieve an advanced level, the student must demonstrate:
- be able to choose rational solutions for complex problems, using the
didactic resources made available, eg. UpToDate®
- to give the importance of cost containment, eg in the context of the
Choosing wisely program;
- Identify the need for patient monitoring and patient/family involvement
in processes such as diagnostic work-up and treatment.