Gastrointestinal

Total Contact Hours:

26 hours

Course Director:

Robert L. Koerker, Ph.D., Associate Professor of Pharmacology and Toxicology

Course Description:

The goal of this course is to introduce the common acute and chronic disease states of the gastrointestinal system, their pathophysiologic bases (including genetic and environmental factors), and what are current diagnostic and therapeutic approaches.

Course Objectives & Integration with the Educational Objectives:

By the conclusion of this course, the student will demonstrate an understanding of:

K1 The esophagus, including the ability to:

• Describe its normal structure and function, including its innervation, smooth muscle regulation and motility, upper and lower esophageal sphincters, and three mucosal components.
• Describe the pathogenesis, clinical presentation, and histopathologic features of Plummer-Vinson syndrome, lesions associated with motor dysfunctions, infectious and reflux esophagitis (including therapeutic treatment), Barrett esophagus and esophageal varices, benign and malignant neoplasms, and tumor like lesions
• Demonstrate an understanding of the nonpharmacologic and pharmacologic treatments for gastroesophageal reflux disease and the mechanisms of action, indications and contraindications, common side effects, and potentially catastrophic drug interactions for the following classes of medication:
• Cholinergic agents and prokinetic agents that increase LES tone
• Prokinetic agents that increase gut motility
• Medications that reduce gastric acid secretion

K2 The stomach, including the ability to:

• Describe its normal gross and microscopic features and explain the functional importance of normal gastric motility and emptying, normal gastric secretions, and normal digestion and absorption
• Describe the pathogenesis and pathologic and clinical features of the following non-neoplastic diseases:
• Pyloric stenosis
• Heterotopias
• Diaphragmatic hernia
• Acute gastritis
• Peptic ulcer diseases
• Stress ulcer disease
• Chronic gastritis
• Hypertrophic gastropathies
• Describe the pathogenesis, pathologic features, and prognosis of early and advanced gastric adenocarcinoma, MALToma, and GIST
• Discuss the pharmacological treatments for peptic ulcer disease and the mechanisms of action, indications and contraindications, common side effects, and potentially catastrophic drug interactions of the following classes of medication:
• Sedatives
• anti-cholinergic drugs
• Combination antibiotic therapy used to treat gastric Helicobacter infection
• proton pump inhibitors
• H-2 receptor antagonists
• Sucralfate
• Antacids
• sedatives
• Discuss the non-pharmacological use of rest or vagotomy
• Describe the use of emetics such as syrup of ipecac, gastric lavage, or peritoneal dialysis in the treatment of oral poisonings and the use of anti-emetics to treat nausea and vomiting associated with pregnancy, motion sickness, GI obstruction, PUD, drug toxicity, myocardial infarction, renal failure, hepatitis, or cancer chemotherapy
• Describe the processes involved in the normal absorption of carbohydrates, fats, proteins, and other nutrients, minerals, and vitamins; their physiological function; and nutritional diseases resulting from deficiencies of each of these, including malnutrition; marasmus; kwashiorkor; deficiencies associated with zinc, calcium, magnesium, and selenium; deficiencies of fat-soluble vitamins (A, D, E, and K); and deficiencies of water-soluble vitamins (thiamine, riboflavin, niacin, pyridoxine, vitamin C, and folate)
• Discuss the pandemic of obesity in the Unites states and the limited successful treatment options such as bariatric surgery
• Describe the differences between enteral and parenteral nutritional support, when is it used, how to calculate energy needs, the purpose of preoperative support, how it improves quality of life with different medical conditions, and what ethical considerations need to be discussed before recommending nutritional support to patients with short bowel syndrome or Crohn's disease

K3 The liver, including the ability to:

• Describe its normal gross and microscopic features, its normal blood circulation and physiologic functions, and general pathologic responses to liver injury, including cirrhosis, portal hypertension, hepatic failure, jaundice, and cholestasis
• Compare and contrast hepatitis A, B, and C; define criteria for serologic diagnosis; and describe clinical outcomes of hepatitis B, C, and D infections and suggested therapies
• Define and describe clinical feature of autoimmune hepatitis
• Describe drug and toxin-induced pathologic changes to the liver

K4 The gallbladder and extrahepatic biliary tract, including the ability to:

• Describe the normal histology and physiology of these structures and methods for clinically evaluating the biliary system
• Describe common congenital abnormalities of the biliary system
• Explain the pathophysiology of gallstone formation and methods of removing the stones surgically, with shock wave lithotripsy, or by dissolution with chenodiol or ursodiol
• Describe the pathologic and clinical features of acute and chronic cholecystitis
• Describe pathologic features of non-neoplastic and neoplastic disorders of the biliary tract

K5 The Pancreatic Ductal System, including the ability to:

• Describe its normal and anatomical variants and explain how each correlates with the embryologic development of the pancreas
• Describe the pathogenesis, pathologic features, and clinical signs of acute and chronic pancreatitis
• Recognize the clinical features of pancreatic cysts, pseudocysts, and neoplasms of the exocrine pancreas
• Describe the choice and side effects of pancreatic enzyme replacement products

K6 The large and small intestine, including the ability to:

• Describe the clinical and pathologic features of the intestines in relation to familial adenomatous polyposis coli and related syndromes, colonic adenocarcinomas, carcinoid tumors and the carcinoid syndrome, and pseudomembranous enterocolitis
• Compare enteropathogenic versus enterotoxigenic pathogens and describe accepted therapies (both antimicrobial and non-antimicrobial) used to treat common GI infections
• Describe the normal pattern of bowel movements and the pathophysiologic mechanisms of chronic diarrhea, and differentiate noninflammatory diarrhea from antibiotic-associated diarrhea and colitis from inflammatory enteritides
• Describe the symptomatic treatment of diarrhea using locally acting adsorbents like kaolin, attapulgite, and activated charcoal, and systemically acting drugs like opiates, diphenoxylate, loperamide, and anticholinergic drugs
• Differentiate irritant, stimulant, and saline cathartics and how they differ from bulk or emollient laxatives
• Compare and contrast the clinical and pathologic features of ulcerative colitis, Crohn's Disease, and irritable bowel syndrome and their treatment with sulfasalazine, glucocorticoids, immunosuppressive drugs, and broad spectrum antibiotics for U.C. and C.D. vs. Lotronex for IBS
• Compare and contrast tropical sprue and celiac sprue
• Describe the hemodynamic changes associated with GI bleeding and understand the changes seen with portal hypertension
• Discuss the pathologic and clinical features of acute appendicitis

C1 Interpersonal communication, including the ability to:

• Work effectively in teams to work toward a group consensus and communicate team decisions during the team-based learning exercise
• Communicate personal questions and opinions during lectures and during the two-hour audience participation review of infectious disorders of the GI tract.
• Engage in a discussion with case facilitators of clinical cases on chronic diarrhea, GI bleeding and jaundice, enteral and parenteral nutrition, and short bowel syndrome and Crohn's disease

P1 Professionalism, including the ability to:

• Follow the medical student honor code
• Communicate with peers, staff, faculty, and administrators in a courteous and respectful manner
• Respect ethnic, cultural, gender, and age differences among peers, staff, and faculty
• Realize that faculty have other obligations and commitments and may not be able to respond to all requests and e-mails in a timely manner
• Contribute to a positive learning environment, collaborate with colleagues, and perform self-assessment and self-directed learning
• Come to class prepared for team-based learning exercises and contribute in a positive manner to the GRAT and Application Exercises by sharing ideas and opinions, respecting the opinions of others in the team, and helping to come to a team consensus or offering a reasoned alternate opinion
• Be respectful and constructive when evaluating courses, faculty, and peers

Learning Activities:

Presentations, Team-Based Learning.

Assessment:

One MCQ exam, Team-Based Learning.