Ateneo - UPO

Management of major digestive tract emergencies, with a specific focus on acute gastrointestinal bleeding, fulminant hepatic failure, and related abdominal emergencies.

ESGE (European Society of Gastrointestinal Endoscopy) Guidelines – Management of Non-Variceal Upper Gastrointestinal Hemorrhage.
Aniarti, Nursing in Critical Care, Maggioli Editore.
Chiaranda, Urgencies and Emergencies, McGraw-Hill.
Materiale didattico e articoli scientifici recenti forniti dal docente.

The main objective is to provide the student with the skills to:
Knowledge and understanding: To deepen the pathophysiological and clinical frameworks of the main emergencies of the digestive system, with a specific focus on gastrointestinal bleeding, acute liver failure, and severe pancreatitis.
Applying knowledge and understanding: To acquire technical skills for the management of specific devices (e.g., esophageal tamponade tubes) and for the preparation and assistance during emergency operative endoscopy procedures.
Making judgements: To know how to critically interpret signs of hemodynamic instability and biochemical parameters to establish care priorities and anticipate hemorrhagic or septic complications.
Communication skills: To develop effective technical-scientific language for the transmission of clinical information during handovers between emergency services, endoscopy units, and intensive care units.
Learning skills: To acquire a method for constant updating based on international guidelines (e.g., ESGE, ASGE) and the most recent scientific evidence for the treatment of gastroenterological emergencies.

Knowledge Prerequisites
- Anatomy and physiology of the gastrointestinal tract and liver.
- Pathophysiology of the major gastrointestinal and hepatological diseases.
- Interpretation of vital signs and recognition of clinical deterioration.
- Principles of venous access management, intravenous fluid therapy, and fluid and electrolyte balance.
- Basic knowledge of laboratory diagnostics (complete blood count, liver function tests, coagulation profile, and electrolytes).

Required Competencies
- Ability to assess and monitor vital signs.
- Ability to recognize the early signs of clinical instability.
- Ability to collaborate effectively with the multidisciplinary team in the management of acutely ill patients.

Interactive lectures with analysis of clinical cases drawn from real practice.
Discussion of clinical scenarios regarding emergency diagnostic-therapeutic pathways.
Simulations on the management of specific devices for gastroenterological emergencies.

Students with physical disabilities, Learning Disabilities or Special Education Needs can request specific services and tools via the Staff Sviluppo e Coordinamento Carriere e Servizi alle Studentesse e agli Studenti, consulting the University webpage: https://www.uniupo.it/en/services/servicesstudents-physical-or-learning-disabilities Students with disabilities, learning disabilities or special education needs, once they have contacted the University Staff, can refer to the tutor in charge of the course to define the examination modalities, concerning academic aspects.

The assessment of learning outcomes is conducted in an integrated manner through a single evaluation test, which covers:
1. Advanced nursing care planning in the critically ill patient
2. Guidelines and procedures in the management of the critically ill patient
3. Clinical nutrition in the critically ill patient
4. Time-dependent pathologies in Cardiology
5. Interventional Radiology in Emergency and Urgency
6. Gastroenterological emergencies and urgencies
7. Time-dependent pathologies in Neurology
The assessment consists of a written exam featuring educational/organizational case studies developed by the course instructors. Each case is associated with Multiple Choice Questions (MCQs), featuring 4 response options, only one of which is correct.
The questions are designed to evaluate acquired knowledge, applied understanding, and autonomy of judgment.
The number of questions for each module is proportional to the number of ECTS (CFU) credits assigned, based on the criterion of 4 questions per credit, up to a maximum of 12 questions per module. Consequently, the total number of questions varies according to the number of modules within the integrated course. Specifically, for the Integrated Course in Models and Methodologies for Educational Design, Teaching, Clinical Leadership, and Consultancy, the total number of questions will be 32.
Each question is awarded 1 point. The final result is re-scaled to a range of 0 to 32, where:
18 points represents the minimum passing grade (equivalent to 18/30).
31 or 32 points represents the maximum grade (30/30 cum laude).
The exam will be duration of 50 minutes.

Acute Gastrointestinal Bleeding: Pathophysiology and clinical framework of upper (variceal and non-variceal) and lower gastrointestinal bleeding; management of hemorrhagic shock and protocols according to etiology of bleeding.
Emergency Endoscopy: The nurse's role in assisting with operative endoscopy; management of post-procedural complications.
Liver Failure and Portal Hypertension: Management of hepatic encephalopathy, ascites, coagulopathy; monitoring of patients awaiting urgent liver transplantation.
Non-Surgical Abdominal Emergencies: Severe acute pancreatitis and related multi-organ failure; nutritional and pharmacological management in the critically ill patient.
Emergency Pharmacology: Clinical use of splanchnic vasoactive drugs, high-dose proton pump inhibitors, and management of anticoagulant/antiplatelet therapy during active bleeding.

At the end of the course, students will have acquired:
- Knowledge and understanding: Demonstrate knowledge of the pathophysiological frameworks of gastrointestinal bleeding (upper and lower), severe acute pancreatitis, and related hypovolemic shock.
- Applied knowledge and understanding: Correctly apply fluid resuscitation protocols, manage esophageal tamponade devices (e.g., the Sengstaken–Blakemore tube), and prepare patients for emergency therapeutic endoscopy.
- Making judgements: Establish priorities for intervention based on the patient's hemodynamic stability, critically assessing the severity of gastrointestinal bleeding using validated scoring systems (e.g., the Glasgow-Blatchford Score).
- Communication skills: Develop effective technical communication skills for interdisciplinary handovers among the Emergency Department, the Endoscopy Unit, and the Intensive Care Unit.
- Learning skills: Continuously update professional practice by critically appraising international guidelines (e.g., ESGE and ASGE) and the latest clinical research in emergency gastroenterology.