Gastroenterology – PHAS 310
Instructional Objectives
Upon completion of this course the student will be able to:
1.
Trace the course of the digestive tract from the mouth to the anus, naming each
division and structure and briefly describing the anatomy and function for each
structure.
2.
Describe the tissue layers of the digestive tract.
3.
Discuss the functions of the pancreas and liver in the digestive process. Trace the
anatomical routes of pancreatic and hepatic biliary flow into the digestive tract.
4.
Explain the role of the liver in the metabolism of bilirubin.
5.
Trace the anatomy of the biliary tract. Explain the mechanism of bile formation and
bile release.
6.
Explain the mechanism of swallowing, peristalsis and the function of the lower
esophageal sphincter.
7.
Explain the functions for the following enzymes and hormones:
a.
pepsin
f.
lactase
b.
lipase
g.
secretin
c.
proteolytic enzymes
h.
enterokinase
d.
amylase
i.
cholecystokinin
e.
gastrin
8.
Regarding absorption:
a.
describe the mechanism of absorption from the bowel
b.
list the types and sites of absorption
c.
explain the process of digestion and absorption of:
i.
proteins
ii.
fats
iii.
carbohydrates
iv.
fat-soluble vitamins
v.
water and sodium
vi.
iron
vii.
water soluble vitamins
9.
Explain the cephalic, gastric and intestinal vagal stimulation of digestive function.
10.
Describe the pathophysiology, clinical features, diagnosis and treatment of these
esophageal disorders:
a.
achalasia
d.
Mallory-Weiss tears
b.
reflux esophagitis
e.
Zenker's diverticulum
c.
hiatal hernia
f.
webs and rings
11.
Regarding squamous cell carcinoma of the esophagus
a.
list the predisposing factors
b.
list the clinical features
c.
explain the diagnosis and management
12.
Explain the gastric physiology related to peptic ulcer formation.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Regarding duodenal and gastric ulcers:
a.
discuss the etiology and risk factors
b.
list the clinical features
c.
describe the diagnostic modalities
Regarding peptic ulcer disease, describe the principles of these medical interventions
used in treatment:
a.
antacid therapy
b.
dietary restrictions
c.
anticholinergic agents
d.
H2 (histamine) receptor antagonists
i.
Cimetidine (Tagamet)
ii.
Ranitidine (Zantac)
e.
Carafate
List the complications and describe the surgical procedures for duodenal and gastric
ulcers.
Briefly describe these conditions that may develop after peptic ulcer surgery:
a.
recurrent ulceration
b.
afferent loop syndromes
c.
bile reflux gastritis
d.
dumping syndrome
e.
malabsorption
Describe the pathogenesis, clinical features, diagnosis and management of ZollingerEllison Syndrome.
Regarding gastric carcinoma, describe the epidemiology, risk factors, morphology,
diagnosis and management.
Discuss the differences between erosive, nonerosive and corrosive gastritis.
Explain these following tests used in the diagnosis of malabsorption:
a.
stool fat
b.
xylose absorption
c.
x-ray studies
d.
biopsy
e.
Schilling test
f.
blood tests
Describe the etiology and presentations of fat malabsorption, lactose intolerance,
celiac sprue, and regional enteritis.
List the differences between Crohn's disease and ulcerative colitis with regards to:
a.
epidemiology
b.
pathogenesis
c.
morphology
d.
clinical features
e.
diagnostic techniques
f.
differential diagnosis
g.
complications
h.
management
i.
prognosis
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Describe diverticulosis and how it leads to diverticulitis. Explain the differential
diagnosis and management for both.
Discuss irritable bowel syndrome, its clinical features and management.
Explain mesenteric ischemia and ischemic colitis as vascular disorders of the
intestine.
List and describe the types of benign tumors of the small and large intestine
including adenomas, leiomyomas and polyps.
Regarding colorectal carcinoma:
a.
list the etiology and risk factors
b.
describe the morphology and staging with regards to Duke's classification
c.
list the clinical features
d.
discuss the diagnosis and management
e.
explain the complications
Describe the following screening and diagnostic tests for colorectal cancer:
a.
gastric washings and cytologic studies
b.
endoscopy
c.
diagnostic radiology
d.
stool analysis for occult blood (guiaic study)
e.
proctosigmoidoscopy
f.
colonoscopy
g.
carcinoembroyonic antigen level (CEA)
Discuss the clinical signs and symptoms of the following anorectal disorders:
a.
hemorrhoids
b.
infections
c.
dermatologic diseases
d.
anatomic lesions
Regarding the evaluation of gastrointestinal bleeding, describe the similarities and
differences between acute and chronic GI bleeding and how their management
differs.
Regarding the evaluation of diarrhea, identify the various causes of:
a.
acute diarrhea
i.
viruses
ii.
bacteria
iii.
protozoa
iv.
anxiety, stress
b.
chronic diarrhea
i.
protozoa
ii.
inflammation
iii.
drugs
iv.
tumors
v.
malaborsption syndromes
vi.
post-surgical states
Regarding the evaluation of constipation, identify the various causes, to include:
a.
metabolic disturbances
b.
endocrine factors
c.
habitual use of laxative
33.
34.
35.
36.
37.
38.
39.
40.
41.
d.
mechanical obstruction
e.
lesions
f.
drugs
Regarding the evaluation of jaundice, discuss the clinical signs associated with:
a.
unconjugated hyperbilirubinemias
b.
conjugated hyperbiliribuinemias
Discuss the differential diagnosis of jaundice and the use of liver function tests.
When comparing hepatitis A, hepatitis B, and hepatitis C:
a.
discuss their etiology and epidemiology
b.
describe their pathogenesis and morphology
c.
list their clinical and laboratory features
d.
discuss their complications and prognosis
e.
list the differential diagnosis
f.
describe the management of each
Compare chronic persistent, chronic lobular, and chronic active hepatitis with
regards to:
a.
onset
b.
recurrence
c.
prognosis
d.
liver histology
Regarding cirrhosis:
a.
list the various types
b.
describe the pathogenesis and morphology
c.
list the clinical features
d.
describe the diagnosis and management
Regarding major sequelae of cirrhosis, describe the clinical features, diagnosis and
management of:
a.
portal hypertension
b.
variceal bleeding
c.
splenomegaly
d.
ascites
e.
peritonitis
g.
hepatic encephalopathy
List the common drugs associated with hepatic toxicity and describe how they cause
the toxicity.
Describe the epidemiology, etiology, clinical features, diagnosis, course and
management of hepatocellular carcinoma.
Regarding cholelithiasis and cholecystitis:
a.
discuss the pathogenesis of cholesterol and pigment gallstones
b.
describe the diagnosis
c.
discuss the clinical features
d.
describe the medical and surgical management
e.
list the complications
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43.
44.
45.
46.
47.
Describe the complications of choledocholithiasis, to include:
a.
cholangitis
b.
obstructive jaundice
c.
pancreatitis
d.
cirrhosis
Regarding acute pancreatitis:
a.
describe the pathogenesis and etiology
b.
list the clinical features
c.
describe the diagnosis and management
d.
explain the complications
e.
describe the development of phlegmon, abscess and
pseudocyst
Explain the etiology, pathophysiology, clinical features, complications, diagnosis
and management of chronic pancreatitis.
List the elements of Ranson's criteria as it applies to acute pancreatitis and explain its
utilization in the prognosis.
Describe the clinical features, diagnostic procedures, laboratory findings, course and
management of pancreatic cancer.
Briefly explain the role these diagnostic modalities play in the gastrointestinal
system:
a.
endoscopy
b.
endoscopic retrograde cholangiopancreatography (ERCP)
c.
esophagogastroduodenoscopy (EGD)
d.
colonoscopy
e.
barium studies
f.
sigmoidoscopy
g.
cholecystography
h.
cholangiography
i.
ultrasound
j.
CT scan, MRI
k.
radionuclide bleeding scan