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

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 andthorough 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 t utors 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 lastin 120 minutes with slide presentations available on the UPO DIR website (https://www.dir.uniupo.it/)
• N. = 25 hours of professional training, of which N. = 12.5 spent in the liver clinic and N. = 12.5 at the endoscopic department / department of Gastroenterology. SBAR, problem-solving, patient approach (with emphasis on physical examination skills) and major investigations and procedures are taught (eg paracentesis, abdominal ultrasound, transient elastography, liver biopsy, 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.

N/A

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 Endocrinology, Nephrology and Clinical Cases). 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. General Principles. Symptoms, signs, and syndromes in gastroenterology: oropharyngeal and esophageal dysphagia, acute and chronic diarrhea, constipation, and fecal incontinence. Upper and lower gastrointestinal bleeding.
2. Esophageal Diseases. Anatomical and functional overview. Structural abnormalities: hiatal hernia and Zenker's diverticulum. Esophageal motility disorders: gastroesophageal reflux disease (GERD), achalasia, and diffuse esophageal spasm. Barrett's esophagus. Drug-induced esophagitis. Infectious esophagitis. Esophageal carcinoma and the differential diagnosis of esophageal dysphagia.
3. Gastric Diseases. Anatomical and functional overview. Helicobacter pylori infection and its clinical consequences: peptic ulcer disease and gastritis. Functional dyspepsia. Zollinger–Ellison syndrome. Benign and malignant gastric tumors. Consequences of gastric surgery (gastrectomy and bariatric surgery): dumping syndrome and malabsorption.
4. Small Intestinal Diseases. Anatomical and functional overview. Malabsorption: (a) short bowel syndrome; (b) small intestinal bacterial overgrowth (SIBO); (c) celiac disease. Infectious gastroenteritis and enterocolitis: foodborne infections and food poisoning, travelers' diarrhea, and Clostridioides difficile-associated diarrhea and colitis. Whipple disease.
5. Colorectal Diseases. Anatomical and functional overview. Irritable bowel syndrome (IBS). Inflammatory bowel diseases (IBD): Crohn's disease and ulcerative colitis. Intestinal ischemia: acute mesenteric ischemia, mesenteric venous thrombosis, and ischemic colitis. Diverticular disease. Colorectal cancer (sporadic and hereditary); surveillance of patients with colorectal polyps.
6. Pancreatic Diseases. Anatomical and functional overview; topographic and radiologic anatomy. Acute and chronic pancreatitis: epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis. Pancreatic cancer. Overview of autoimmune pancreatitis (IgG4-related disease) and exocrine pancreatic insufficiency (definition and causes).
7. Liver Diseases. Anatomical and functional overview. Couinaud liver segments and hepatic vascular anatomy. Biliary diseases: cholelithiasis and its complications; biliary colic, acute cholecystitis, and Mirizzi syndrome. Differential diagnosis of liver diseases. Metabolic dysfunction–associated steatotic liver disease (MASLD). Alcohol-related liver disease (ALD). Autoimmune liver diseases: autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and overlap syndromes. Inherited and metabolic liver diseases: primary and secondary iron overload, with particular emphasis on hereditary hemochromatosis; Wilson disease; alpha-1 antitrypsin deficiency. Advanced chronic liver disease (ACLD). Portal hypertension and its complications: hepatic encephalopathy, ascites, esophageal variceal bleeding, and its prevention. Natural history of cirrhosis and prognostic assessment. Hepatocellular carcinoma (HCC). Acute liver failure. Liver transplantation: timing and indications.
8. Diagnostic Techniques in Gastroenterology: indications, contraindications, procedural techniques, and complications.

Intended Learning Objectives
Knowledge
- Epidemiology, clinical manifestations, differential diagnosis, treatment, long-term monitoring, and prognosis of the most common gastrointestinal diseases and disorders.
Competencies
- Apply the principles of clinical reasoning to a specific clinical case by identifying the patient's problem and selecting the most appropriate diagnostic and/or monitoring procedures.
- Formulate appropriate therapeutic strategies, recognizing the degree of urgency with which treatment should be initiated.
- Implement appropriate preventive and health-promoting measures aimed at preventing disease and maintaining and improving the health of individuals, families, and communities.
Transferable Skills
- Present a patient's clinical problems in a clear, organized, and structured manner.
- Read, understand, and critically interpret technical material from textbooks, clinical manuals, and point-of-care resources.

To achieve an advanced level of competence, students should demonstrate the ability to:
- Select rational solutions to complex clinical problems by effectively using available educational resources (e.g., UpToDate®).
- Recognize the importance of cost-conscious healthcare, for example by applying the principles of the Choosing Wisely initiative.