MedInTO Medicine and Surgery

Endocrine, Metabolic and Gastroenteric Diseases

Endocrine, Metabolic and Gastroenteric Diseases

Academic year 2019/2020

Sommario del corso

• Course objectives
• Results of learning outcomes
• Course delivery
• Learning assessment methods
• Support activities
• Program
• Suggested textbooks and readings
• Notes
• Teaching tools

Course objectives

The course aims to provide elements of a decision-making process that leads to the diagnosis of the main gastrointestinal, endocrinological and metabolic diseases, as well as to the rational setting of both medical and surgical therapy.

The means proposed for this purpose include:

• the collection of anamnestic data structured by problems
• the patient's physical signs
• the knowledge of the biotechnological and instrumental resources that can be used, and of their predictive value according to the different contexts of use
• the knowledge of the pathophysiological mechanisms involved in the individual diseases
• the critical evaluation and the ability to correlate clinical symptoms, physical signs and functional alterations with pathological lesions, interpreting their production mechanisms and understanding their clinical significance
• the concept of etiopathogenetic therapy

Results of learning outcomes

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Course delivery

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Learning assessment methods

Written test with 100 multiple choice questions (1 correct answer out of 3 or 4 possibilities) divided by discipline:
• Endocrinology: 30
• Gastroenterology: 30
• Internal Medicine: 30 (10 for each module)
• General Surgery: 10

1 point for correct answer, no penalty for wrong answers

With a score equal to or greater than 60 (60% overall) the test will be considered passed and the student will have access to the oral exam. Oral exam has to be taken within the ongoing exam session.

If a student fails the oral exam or does not complete the oral exam within the ongoing exam session, then the written test must be retaken.

In the event that a student reaches or exceeds 60 points overall but with a score <50% in one or more discipline(s), he/she will have to take the oral exam of the discipline(s) in which it was insufficient and pass it, before taking the oral examination of the other disciplines.

During the suspension of any face-to-face academic activities, due to the COVID-19 health emergency, the exams will be held in the form of an oral interrogation via Webex platform.

Support activities

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Program

Endocrinology

• ENDOCRINE SYSTEM: definition, general anatomy and physiology, hormone synthesis and secretion, hormonal action and physiological function.

• HYPOTHALAMUS-PITUITARY AXES: clinical presentation, diagnostic evaluation and treatment of pituitary hormone excess (hyperprolactinemia, acromegaly, Cushing’s disease) and deficiency (hypopituitarism).

• THYROID GLAND: clinical presentation, diagnostic evaluation and treatment of hypo- and hyper-thyroidism, benign and malignant nodules.

• PARATHYROID GLAMDS: clinical presentation, diagnostic evaluation and treatment of primary and secondary hyper-parathyroidism, hypoparathyroidism; metabolic osteopathies (osteoporosis and osteomalacia).

• ADRENAL GLANDS: clinical presentation, diagnostic evaluation and treatment of Cushing’s syndrome, hyperaldosteronism, pheochromocytoma, Addison’s disease and congenital adrenal hyperplasia.

• GONADS: clinical presentation, diagnostic evaluation and treatment of disorders of sexual differentiation, male and female hypogonadism, pathology of the menstrual cycle.

• GROWTH and PUBERTY disorders: low and high stature, delayed and early puberty.

• SIADH: Syndrome of inappropriate antidiuretic hormone secretion.

• MEN and APS: Multiple endocrine neoplasia and autoimmune-polyendocrine-syndromes.

After attending the course students will be expected to:

• know the anatomical and physiological basis of the endocrine system and its modifications across the lifespan

• suspect the presence of the main endocrine disorders

• know the consequences of hormone excess or deficiency

• know advantages and risks of hormonal therapies

• discuss clinical cases focusing on clinical suspicion, diagnostic approach and therapeutic options

Gastroenterology

• OESOPHAGEAL Disease and Motility Disease: Achalasia, Adenocarcinoma

• GASTRIC Diseases: Gastritis, Peptic Ulcer, Reflux Disease, Gastric Cancer

• INTESTINAL Diseases: Celiac disease, Chron Disease, Ulcerative Colitis, Colon cancer

• LIVER Diseases: Acute and Chronic Viral Hepatitis, Steatosis, Autoimmune Hepatitis, Wilson Disease and Hemochromatosis

• PANCREATIC Diseases: Acute & Chronic Pancreatitis

Internal Medicine (Metabolism)

• DIABETES MELLITUS

• Diagnosis, Classification, and Pathophysiology

• Management and Therapies

• Acute and Chronic Complications

• Discussion of the recent guidelines

• DISORDERS OF LIPOPROTEN METABOLISM

• Diagnosis, Classification, and Pathophysiology

• Management and Therapies

• Discussion of the recent guidelines

• ARTERIAL HYPERTENSION

• Approach to the patients with arterial hypertension (excluded phaeochromocytoma and aldosteron producing adenoma)

• Resistant and malignant hypertension

• Management and Therapies

• Discussion of the recent guidelines

• PURINES and PYRIMIDINES metabolism and disorders

• HOMOCYSTEIN metabolism and disorders

• INHERITED METABOLIC DISORDERS: inborn error of metabolism and screening

• ACQUIRED METABOLIC TOPICS: neoplastic cachexia

• IRON and CUPPER metabolism: inherited and acquired disorders (Hemochromatosis, Iron loading anemia, ACD, Wilson disease)

• ALPHA-1 ANTITRYPSIN DEFICIENCY

• PORPHIRIAS: metabolic disorders caused by altered activities of enzymes within the heme biosynthetic pathway

• HYPERBILIRUBINEMIAS

• GAUCHER DISEASE: inborn error of metabolism that affects the recycling of cellular glycolipids

General Surgery Teaching

• OESOPHAGUS: Physiopathology. Gastro-oesophageal reflux disease and its complications. Primary and secondary motility disorders. Traction and drive diverticula. Dysphagia. Achalasia, Pre-neoplastic lesions and carcinomas.

• STOMACH: Physiopathology. Dyspepsia. Peptic ulcer Complicated ulcer disease. Acute and chronic gastritis. Helicobacter Pylori infection. Early gastric cancer. Gastric neoplasias. Acute and chronic upper digestive bleedings.

• GUT: physiopathology and clinical manifestations of gut malabsorption, Coeliac disease. Chronic diarrhea. Meckel’s diverticulum. Obstruction. Mesenteric Ischemia.

• COLON and RECTUM: physiopathology. Complicated diverticular disease,appendicitis. Appendicular mucocele. Obstruction. Constipation. Colon polyps. Inflammatory bowel diseases: Crohn disease and ulcerative colitis. Colon and rectum neoplasias.

• PANCREAS: acute and chronic pancreatitis. Pancreatic cancer.

• LIVER and GALLBLADDER: diagnostic flow-chart of liver diseases. Differential diagnosis of jaundice. Acute hepatitis and their evolution. Symptomatic gallbladder calculosis. Liver cirrhosis. Chronic liver failure (ascites, porto-systemic encephalopathy, olyguric liver failure, portal hypertension, etc.). Primary and secondary liver tumors.

Williams Textbook of Endocrinology - 12th Edition. S. Melmed, K.S. Polonsky, P. Reed Larsen, H.M. Kronenberg, Eds., Elsevier Saunders, Philadelphia; 2011

Harrison's Principles of Internal Medicine, 20e
J. Larry Jameson, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, Joseph Loscalzo. McGraw-Hill Education

Harrison's Manual of Medicine, 20e
J. Larry Jameson, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, Joseph Loscalzo. McGraw-Hill Education

Note

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• Teaching materials
• Exams and finals
• Go to Moodle
• Visit the forums