Al-Balqa Applied University Faculty of Medicine

Transcription

1 Al-Balqa Applied University Faculty of Medicine Course Title: Gastro-Intestinal Tract (GIT) System. Course Code: Credit Hours: 6 Credit Hours Calendar Description: 6 Weeks / Semester 2 / Second Year Teaching Approaches: Integrated System Course Course Coordinator: Dr. Nabil A. Khouri General Objectives: Upon completion of this course students should be able to: Describe the gross structure and applied clinical anatomy of each GIT region and organ. Recognize the microscopic appearance of different parts of the GIT. Describe the normal embryology development of the GIT. Describe the Physiological function of each GIT structure. Explain the neuronal mechanisms and hormones regulation of the GIT, with emphasis on pancreatic, and biliary functions. Describe the major types of nutrients. Explain how proteins, carbohydrate, and fats are digested and absorbed. Identify and describe the major disease processes including mal-absorption conditions and neoplastic conditions affecting different organs of the GIT in terms of pathogenesis, gross and microscopic changes, manifestations, and complications. Identify various bacterial, viral, fungal, and parasitic infections affecting the GIT. Describe the principle manifestations, diagnosis, and prevention of each individual microorganism and parasitic agent affecting the GIT. Describe the mechanisms of action, pharmacokinetics, indications, and adverse effects of commonly used drugs in the treatment of GIT disorders. Describe the essential nutritional requirement, body weight and energy balance, nutritional deficiencies, and disease processes associated with diet. 1

2 Methods of Instruction: 1. Lectures. 2. Practical classes. 3. Departmental handouts. 4. Clinically videos orientation and seminars. Evaluation and Distribution of Marks: Midterm written examination (MCQ) = 30% Practical in course examination = 20%. Final examination in the end of the system (MCQ) = 50%. Recommended Text Books and Atlases: 1. Anatomy: Clinical Anatomy for Medical Students. By R. S. Snell, latest edition. Grants Atlas of Anatomy or any other Atlas of Human Anatomy. Basic Histology. By L. Carlos Junqueira, latest edition. Before we are born. By K. L. Morre and T. V. N. Persaud, latest edition. 2. Physiology: Textbook of Medical physiology. By Guyton and Hall, latest edition. 3. Biochemistry: Biochemistry. By Campbell & Farrell latest edition. Supplementary Departmental Handouts. 4. Pharmacology: Lippincott s Illustrated Reviews Pharmacology, latest edition. 5. Pathology: Basic Pathology. By Kumar, Cotran and Robbins, latest edition. Supplementary Departmental handouts. 6. Microbiology: Medical Microbiology. JAWETZ MELNICK AND ADELBORG S MEDICAL MICROBIOLOGY By : Geo, F. Brooks, Karen C. Carroll, Janet, S. Butel, Stephan, A. Mores, Timothy. A. Mietzner, Latest Edition. 7. Public Health: Supplementary Departmental Handouts. 2

3 SPECIFIC (LEARNING) OBJECTIVES: After studying the material covered in lectures, s, clinical seminars and case presentations of this course, using his/her private self learning time in a productive way, the student is expected to achieve the following specific objectives: A. LECTURES: # LECTURE TITLE LECTURE OBJECTIVES 1 Introductory Case Presentation for GIT System Understand the general outline of the GIT module. Be familiar with the modalities of teaching throughout the course. Acknowledge the important relation between normal and abnormal structure and function (All) 2 The oral cavity Anatomy and histology Part I (Anatomy 1) 3 The oral cavity Anatomy and histology Part II (Anatomy 2) 4 Embryology of the coelomic cavity and peritoneum (Anatomy 3) 5 Salivary glands and teeth (Anatomy 4) 6 The mechanism of Saliva and salivary secretion (Physiology 1) Appreciate the importance of basic sciences in clinical application. Understand the regions and boundaries of the oral cavity. Describe parts of the mouth -The oral cavity proper. Know the major anatomic features of the lips, cheeks, and gingivae. Describe the gross anatomy and histology of the tongue and palate Outline the intrinsic and extrinsic muscles of the tongue and their movements, innervations, and blood supply. Identify tongue papillae and describe their structures. Describe the hard and soft palate and their anatomic features Discuss the embryology of coelomic cavity and peritoneum. List the divisions of the embryonic cavity. Review the development of the diaphragm. Describe the anatomy of various salivary glands (location and ducts). Describe the parotid, sub-mandibular, and sublingual salivary glands including their relations vascular supply and innervations Describe the histology of various salivary glands. Describe the physiology of saliva. List the main mechanisms of controlling salivary formation. Describe the main role of sympathetic and parasympathetic neuronal control of saliva formation. Discuss the effects of aldosterone hormone and flow rate on the composition of saliva. Mention the main compassion of saliva. Physiological mechanisms of chewing. Describe the main effects of chewing reflex and functions. 3

4 7 Anatomy of the pharynx, and esophagus (Anatomy 5) 8 Diseases of the oral cavity (Pathology 1) 9 Esophagus & Swallowing I (Deglutition) (Physiology 2) 10 Esophagus & Swallowing II (Deglutition) (Physiology 3) 11 Embryology of the gut. (Anatomy 6) 12 The abdominal wall and inguinal region (Anatomy 7) Know the muscles of the soft palate, their movements, and their innervations. Outline the vascular supply. Describe the anatomy and histology of various parts of the pharynx. Identify the muscular wall structure of the esophagus and its anatomical relations and sphincters. Describe the nerve and blood supply of the pharynx and esophagus. Give a simplified classification of diseases of oral cavity. Describe the etiology, pathogenesis, and pathology of the main diseases of oral cavity. Classify the diseases of the salivary glands. Provide a list of the of salivary gland tumors and briefly describe their pathology. Discuss the physiological mechanism of swallowing. Emphasize the Main features of voluntary stage of swallowing and the role of the tongue in swallowing. Indicate the main criteria of pharyngeal phase of swallowing. Discuss the main criteria of neural control concentrating on the neural reflex. Discuss the effect of respiration of pharyngeal stage of swallowing. Describe the physiology of esophagus motility Discuss the main criteria of primary peristaltic movements and it role in swallowing. Discuss the main criteria of secondary peristaltic movements and it role in swallowing. Describe the physiological relation of esophageal stage of swallowing and receptive relaxation of stomach. Describe the main features of lower esophageal sphincter. Discuss the physiology of the lower esophageal sphincter in preventing gastric reflex. Describe the meaning of Aero-phagia and sources of GI gases. Describe the esophageal secretion. Discuss the general features of GI secretions. Discuss the patho-physiology of GRED. Describe the development of the midgut, and hindgut. Describe the landmarks and different regions of the anterior abdominal wall. Describe the layers of the anterior abdominal wall including abdominal muscles and rectus sheath. Describe the anatomy of inguinal region. Describe the spermatic cord coverings and contents. Make a comparison between the inguinal, umbilical, and femoral 4

5 13 The abdominal cavity and peritoneum. (Anatomy 8) 14 Diseases of the esophagus (Pathology 2) 15 Anatomy of GIT hollow organs (stomach, duodenum, small intestines). (Anatomy 9) 16 Anatomy of GIT hollow organs (Small and Large intestines, cecum and rectum). (Anatomy 10) 17 Stomach (Motor function of the stomach) (Physiology 4) herniae. Indicate the relations and arrangements of the abdominal organs. Describe the anatomical features of the diaphragm. Describe foldings and ligaments of the peritoneum. Indicate the Intra- and retroperitoneal relations. Describe the lesser and greater omen (sacs) and other related peritoneal fosse and recesses. Describe the anatomy of the mesenteries. Describe the main acquired anatomic disorders of the esophagus with emphasis on hiatal hernia, achalasia and diverticulosis in terms of etiology, pathogenesis and pathologic features. Describe the main pathologic features of the esophagus with emphasis on reflux esophagitis. Mention the cause, pathologic features, and clinical significance of esophageal varices. Indicate the importance of Barrett's esophagus as an example of a premalignant lesion of the esophagus. Describe the main tumors of the esophagus. Indicate the anatomical relationships of the abdominal esophagus. Describe the anatomy of stomach (location, parts, and anatomical relations). Describe the anatomy of the duodenum and small intestine (location, parts, and anatomical relations). Compare the anatomical features of the jejunum and ileum. List parts and describe general features and relations of large intestine. Describe the anatomy of the rectum and anal canal with emphasis on sphincters. Describe the histological structure of the wall and glands of the esophagus. Identify the histological structure of the stomach. Compare the histological features of the small and large intestines. Identify the histological features and characteristics of different transitional areas and sphincters (gastro-esophageal, gastro-duodenal, ilio-ceacal and recto-anal). Describe the physiology of motor function of stomach. Describe the main characteristic of storage function of stomach. Describe the main characteristic of propulsive of food inside the stomach. Describ the main criteria of emptying of food from the stomach. Discuss the meaning of chime. List the main features of hunger contraction. List the main physiological mechanisms to control pyloric pump. List the main physiological factors that promote emptying. List the main physiological of duodenum in inhibiting gastric emptying 5

6 18 Embriology of the solid organs (Anatomy 11) 19 Anatomy of accessory organs of GIT I (Solid organs). (Anatomy 12) 20 Gastric secretion I (Physiology 5) 21 Gastric secretion II (Physiology 6) 22 Diseases of the stomach (gastritis and peptic ulcer disease) (Pathology 3) 23 Pathology of gastric Tumours (Pathology 4) 24 Gastritis and Helicobacter pylori (Microbiology 1) 25 Small intestinal motility & pancreatic secretion including neural and hormonal effects. Describe the development of liver, pancreas. Describe the common congenital abnormalities of the GIT. Describe the peritoneal coverings and ligaments of various organs in the abdomen. Describe the anatomy of the liver (location, parts, relations and vascular supply). Provide general idea of gastric glands types of and their main secretions. Discuss the main functions of hydrochloric acid. Discuss the main role of vagus in controlling hydrochloric acid secretion. Discuss the main role of histamine in controlling hydrochloric acid secretion. Discuss the main role of gastrin in controlling hydrochloric acid secretion. List the main inhibitory physiological functions prostaglandin. List the main inhibitory physiological functions somatostatin. Provide general idea of potentiation effects histamine vagus and gastrin. Discuss the role of stomach to maintain its own secretions. Discuss the role of duodenum to maintain gastric secretion secretions. Discuss the mechanism of secretion of intrinsic factor. Discuss the mechanism of secretion of pepsinogen. Emphasize the pathophysiology of peptic ulcer. Provide a simplified classification of diseases of the stomach. Describe peptic ulcer disease in terms of etiology, pathogenesis, types, and pathology. Provide a simplified classification of gastric tumors. Enumerate the main types of gastric carcinoma and describe their main features. Identify the main types of gastric lymphoma. Understand the role of Helicobacter in gastritis as well as laboratory diagnosis and sensitivity to antibiotics. Describe gastritis and Helicobacter pylori-induced gastritis in terms of pathogenesis, pathologic features, and complications. Understand the small intestinal motility types and the pancreatic secretion with emphasis on the mechanism controlling it. List the main small intestinal motilities focusing on the roe of propulsive and segmental movements as a main types. 6

7 (Physiology 7) 26 Bacterial infections of GIT (Microbiology 2) 27 Bile secretion and gallbladder function (Physiology 8) 28 Drugs used in peptic ulcer disease (Pharmacology 1) 29 Antiemetics and drugs affecting gastric motility (Pharmacology 2) 30 Colon motility & defecation (Physiology 9) Explain of the physiological role of ileocecal valve to prevent chime from returning to small intestine. Discuss the mechanism and the role of high bicarbonate content of pancreatic secretion. List the role of GI hormone in changing the main composition of pancreatic secretions including cholecystokinin and secretin. Describe the role of acetylcholine (vago-vagal reflex) to main composition of pancreatic secretions. Recognize morphology, culture, and the pathogenesis of causative bacteria (Salmonella, Shigella and Campylobacter). Appreciate epidemiology and treatment. Introduce the types of Bile secretion and gallbladder function. List the bile main compassion. Provide an brief idea about the physiological role of gall bladder in storage and concentration of bile. Discuss the mechanical contraction of gall bladder and the mechanism controlling it. Discuss the physiology of bile salts. Discuss the role of bile salts in micelles formation. Explain the entro-hepatic circulation for bile salts. Midterm examination List major drugs or groups of drugs associated with GI ulceration and ways of preventing or reducing this risk. Describe the mechanism of action of drugs or groups of drugs commonly employed in the management of peptic ulcer disease. Explain the rationale behind the use of drug combination in Peptic ulcer disease. List important antimicrobial drugs employed in peptic ulcer disease, and explain the therapeutic basis of their inclusion in the management of peptic ulcer disease. Enumerate the adverse effects of drugs commonly used in peptic ulcer disease. The mechanism of drug-induced vomiting. List drug classes employed as antiemetics and the mechanism of action each class. Explain the clinical implications of drugs affecting gastric emptying. List the types of Colon motility & Physiology of defecation. List the main large intestinal motilities focusing on the roe of mass and segmental movements as a main types focusing on the meaning of haustration. Understand the main role of gastro-colic and duodeno-colic reflexes on maintain the colonic movements. 7

8 31 Liver functions tests (Biochemistry) 32 Digestion of carbohydrate proteins and lipids (Biochemistry) 33 Absorption Carbohydrates & Proteins (Physiology 10) 34 Pancreatic function tests and liver metabolic storage diseases (Biochemistry 3) 35 Diseases of the intestines I (malabsorption) (Pathology 5) 36 Diseases of the intestine II (inflammatory and ischemic bowel diseases) (Pathology 6) Discuss the transit time in small and large intestine and defecation. Explain the role of enteric reflex in controlling defecation. Explain the main function of sympathetic and parasympathetic supply in defecation physiology. Understand the mechanism, causes, and investigations of liver function tests and its uses for clinical investigations. Understand the use, limitation, and interpretation of LFT Roll of digestive enzymes in digestion. Digestion of carbohydrates (Stages of Carbohydrate digestion: In the mouth and In the small intestine). Digestion of proteins In the Stomach and In the Small intestine pancreatic proteases. Digestion of lipids Mouth, stomach and Intestine: Pancreatic lipase: Other Pancreatic enzymes Provide an idea about the role of intestinal bacteria in feces formation and changes. Introduce the physiological role of mucus secretion of small and large intestine. Discuss the main mechanism of absorption of glucose. Discuss the main mechanism of absorption of Galactose and fructose. Discuss the main mechanism of absorption of pentose. Discuss the main mechanism of absorption of di and tri-peptides. Discuss the main mechanism of absorption of mono-peptides. Discuss the main mechanism of digestion and absorption of nucleic acid. Discuss the role of digestive enzymes in the process of digestion: Digestion of carbohydrates. Digestion of proteins. Digestion of lipids. Describe the clinical laboratory investigations of the pancreatic enzymes and their interpretation and significance. Describe malabsorption in terms of causes, clinical significance, and complications. Describe the chronic inflammatory bowel disease in terms of its main types, etiology, clinical, endoscopic, and pathologic features. Discuss briefly the diverticular diseases of the bowel. Describe the types of ischemic bowel diseases in terms of etiology and pathologic features 8

9 37 Diseases of the intestine III (bowel obstruction and tumors) (Pathology 7) 38 Blood supply of GIT and portal circulation (Anatomy 13) 39 Innervations and lymphatic drainage of the GIT (Anatomy 14) 40 Laxative agents (Pharmacology 3) 41 Anti-diarrheal drugs (Pharmacology 4) 42 Viral hepatitis (Microbiology 3) 43 Hepatitis and alcohol liver disease (Pathology 8) 44 Cholestasis and cirrhosis (Pathology 9) Identify the main causes of bowel obstruction. Provide a simplified classification of small and large intestinal tumors. Describe polyps in terms of types and pathological feature Describe the adenoma-carcinoma sequence and the two-hit hypothesis of development of colorectal carcinoma. List the main diseases of appendix. Describe the blood supply of the stomach, liver, pancreas, spleen, duodenum, small and large intestines including rectum and anal canal. Describe the formation, major tributaries, branches, relations, and termination of the portal system. Describe the nerve supply of different parts of the GIT from the mouth to the anus. Describe the innervation of associated digestive organs (liver, gall bladder, pancreases, and spleen). Describe the lymphatic drainage and regional lymph nodes and major trunks of different parts of the GIT and associated abdominal organs. Review the physiological aspects of normal bowel habits. List the major classes of drugs employed as laxatives and describe their mechanism of action. List the major indications and contraindications of laxatives. Indicate the specific adverse effects associated with the commonly used laxative agents. Describe the therapeutic aims of antidiarrheal drugs. List the major classes of antidiarrheal drugs and describe their mechanism of action. Indicate the major adverse effects possibly encountered in patients using antidiarrheal drugs. Recognize the characteristics of various types of viruses affecting the liver (HAV, HBV, HCV and HEV), their modes of infection, laboratory diagnosis, and epidemiology. Identify the different clinical syndromes of hepatitis including neonatal hepatitis, with emphasis on laboratory and pathologic features of each condition. Describe the other non-infectious causes of hepatitis and jaundice. Discuss alcoholic liver disease as a classical example of toxin-induced liver disease in terms of pathogenesis and pathologic manifestations. Identify the causes, types, routes, and pathological features of hepatitis. Describe the role of the liver biopsy in hepatitis. Define cholestasis and list its main causes. List the main causes of hepatic failure and describe the pathogenesis, pathologic features, and complications of this disorder. Define cirrhosis and describe the pathologic features and complications of this condition. 9

10 45 Regulatory Substances in the Gastrointestinal Tract (Physiology 11) 46 Food poisoning Cholera (Microbiology 4) 47 Diarrhea due to viruses (Microbiology 5) 48 Liver tumors and diseases of intra and extra-hepatic biliary tree (Pathology 10) 49 Absorption Lipids & water & minerals & vitamins (Physiology 12) 50 Amoebiasis (Microbiology 6) 51 Diseases of exocrine pancreas (Pathology 11) Describe the regulatory Substances in the Gastrointestinal Tract general outlook on GI hormones. Discuss the main physiological role of gastrin family (gastrin and cholecystokinin). Discuss the main physiological role of secretin family (VIP, GIP, motilin). Discuss the main physiological role of GI paracrine (somatostatin, histamin). Discuss the main physiological role of GI neurocrines (GRP, Enkephalins). Understand the role of E. Coli, Clostridium perfringens, C. botuliunum, Staphylococcus aureus and B. cerius in food poisoning. Aprpreciate their pathogenesis and epidemology. Recognize morphology, culture and pathogenesis of Vibrio cholerae. Idetify the characteristics of Rota viruses and to a lesser extent those of adenoviruses 40 and 41 Norwalk, Coronaviruses and Astroviruses. Describe the infection mechanism, define antibody response. understand epidomiology, laboratory diagnosis, and control. List and describe the major tumors of the liver. Describe the common diseases of the gall bladder and the extrahepatic biliary tree. Describe the pathology of of the major tumors of the biliary tree. Primary biliary cirrhosis primary sclerosing cholangites Introduce the mechanisms of Lipids & water & minerals & vitamins absorption. Discuss the main mechanism of absorption triglycerides. Discuss the main mechanism of absorption water and the role Crypts of Lieberkuhn. Discuss the main mechanism of absorption sodium and chloride. Discuss the main mechanism of absorption potassium bicarbonate. Discuss the main mechanism of absorption calcium and magnesium. Discuss the main mechanism of absorption vitamins (water and lipid soluble). Understand the differences between Entameoba histolytica and other amoeba, laboratory diagnosis, and treatment. Describe both intestinal and extra intestinal infections. List the main congenital anomalies of the pancreas. Define cystic fibrosis and describe its etiology, pathogenesis, and pathologic features. Describe the causes, pathogenesis, and pathologic feature of different forms of pancreatitis. 10

11 52 Diarrhea due to parasites (Microbiology 7) 53 Intestinal infections with parasites I (Microbiology 8) 54 Nutrition and Gastrointestinal system (Comm. Med. 1) 55 Intestinal infections with parasites II (Microbiology 9) 56 Schistosomiasis and Hydatid disease (Microbiology 10) 57 Treatments of some infectuse diseases (Pharmacology 4) 58 Dietary roughage (Dietary fiber) (Comm. Med 2) Describe the morphology, life cycle, pathogenesis, epidemology, and treatment of Giardia lamblia, Strongyloides, Balantidium, and Cryptosporidium parvum. Understand infections arising from Ascaris, Enterobius, Trichuris and Toxocara. Recognize the life cycle, morphology and treatment of each parasite. Recognize the use of nutritional terms, categorizing the nutrients as macro, micro, and essentials. Understand the use of Recommended Daily Allowance (RDA) tables. Describe different preventive strategies to maintain good digestive health. Understand general nutritional recommendations for patients with upper and lower gastrointestinal disorders. Understand infection caused by Taenia, Himenolepis nana, Ancylostoma and Fasciola, their laboratory diagnosis, epidemiology and treatment. Recognize the life-cycle, pathogenesis and the infection caused by Schistosoma mansoni and Echinococcus granulosus. Understand the epidemiology and treatment of Schistosomiasis and Hydatid disease. Discuss the treatment of hepatic viral disease. Discus the chemotherapy of giardiasis. Discus the chemotherapy of trypanosomiasis. Discus the chemotherapy for leishmaniasis. Discus the chemotherapy for toxoplasmosis. List the mechanism by which dietary fibers affect normal functions. Discuss the effect of fiber on nutrient absorption rates. Describe the beneficial effects of dietary fiber in disease prevention and management. 11

12 B. PRACTICAL LABORATORY SESSIONS: # PRACTICLE TITLE 1 First Anatomy 2 Second Anatomy OBJECTIVES Identify main structures of the oral cavity borders and walls Identify the vestibular cavity and the oral cavity proper Describe the tongue parts, position and relation Identify the intrinsic and extrinsic muscles of the tongue Describe tongue papilla Describe the enervation of the tongue Describe the blood supply of the tongue Identify the teeth parts and numbers Identify the pharynx and its parts and main features and relations. Identify and describe the three salivary glands location reactions and ducts Surface anatomy of the above structures Describe the esophagus relations in the neck and in the thoracic Cavity and its relation with the vogues nerve Describe the vascular supply and innervations of the above Identify the layers of the anterior abdominal wall including: Skin. Fascia (superficial and deep). Abdominal wall muscles (origin, insersion and fascial covorings including the rectus sheath). Identify and recognize the inguinal region including: Inguinal ligament formation. Inguinal canal (location, walls and contents). Deep and superficial inguinal canal openings (rings). The spermatic cord and its coverings. 1. Describe and identify the visceral and parietal peritoneal coverings includung peritoneal layers, reflections, foldings mesenteries, omenta, falciform ligament, fossae, pouches, spaces, and gutters. 2. Identify the abdominal esophagus including: location, muscular wall, relations, and vascular supply. 3. Identify and describe the stomach including: a. Parts. b. Surfaces and borders. c. Epiploic foramin, location, borders and relation. d. Vascular supply. Identify and describe the duodenum including: parts and vascular supply. and biliary system including: salivary. 12

13 Pancreatic and biliary system. Idintefy the jejunum and ileum and their distinguished features. 3 Third Anatomy. 4 Forth Anatomy (Histology ) Identify and describe the cecum including: Ileocecal valve. Apendix. Identify and describe the large intestine including: Parts, length, and external structure. Vascular supply. Identify and describe the liver including: Location, lobes, borders, and relations Lliver peritoneal coverings and attachments including tringular, coronary and falciform ligaments. The porta hepatis and vascular supply: portal vein, hepatic artery and the extra-hepatic billiary system. Identify and describe the gall bladder including: Parts, location, borders and relations. Vascular supply. Identify and describe the pancreas including: Parts, location, and relations. The main and accessory pancreatic ducts. Identify and describe the spleen including: Shape, surfaces, and relation. vascular supply Identify and describe: Abdominal aorta and its various mian branches. Inferior vena cava; location and main tributaries. Describe the surface anatomy of all abdominal organs and vessels. Identify and describe the portal system Describe the oral cavity mucosa Describe the salivary glands histological structure Describe the microscopic structure of the small intestine iincluding the stomach, Duodenum, jejunum and ilium. 1. Describe the microscopic structure of the appendix. 2. Describe the microscopic structure of the cecum and large intestine. Describe the microscopic structure of the solid organs including. Describe the microscopic structure of the small intestine including jejunum and ilium. 3. Describe the microscopic structure of the appendix. 4. Describe the microscopic structure of the cecum and large intestine. 5. Describe the microscopic structure of the solid organs including. 13

14 a. Spleen. b. Liver. c. Pancreas. 5 First pathology 6 Second pathology 7 3 rd pathology 8 4 th pathology 1. Describe the morphology of the more common disease of the salivary glands. a. Mucocele. b. Sialolithiasis. c. Sjogren's syndrome. d. Tumors. 2. Describe the morphology of the following esophageal disease. a. Esophagitis (different types). b. Barret's esophagus and adenocarcinoma. c. Esophageal varices. d. Squamous cell carcinoma 3. Describe the morphology of the following gastric disease. a. Gastritis. b. Gastric ulceration. c. Gastric adenocarcinoma 4. Describe the morphology of the following small intestine disorders. Enteritis. Tumors (caroinoid, GIST, adenocarcinoma, lymphoma) Celiac disease and other causes of malabsorption. Describe the morphology of the following large intestinal disorders. a. Colonic polyps and adenomas. b. Colonic adenocarcinoma. Diverticular disease. Describe the morphology of inflammatory bowel disease and other forms of colitis and tutorial on them. a. Ulcerative colitis. b. Crohn's disease. Pseudomembranous colitis c. Describe the morphology of the following liver disorders a. Steatosis. b. Cirrhosis. c. Neoplasmas. d. Hepatitis. e. Metabolic liver disease Describe the morphology of the following gall bladder and 14

15 9 First microbiology biliary disorders a. Chololelithiasis and cholecystitis. b. Carcinoma of the gall bladder. c. Cholestasis. Exocrine pancreas pathology Examin wet preparation for fecal leucocytes and RBCs. Prepare stool culture for Salmonella and Shigella. (Stool examination) 10 Second microbiology Identify the following parasites in slides: Asacaris, Trichuris, Enterobius, Hookworm, Tinea saginata. (Parasite identification) Small Group Discussion: 1) Peptic Ulcer Disease. 2) Irritable Bowel syndrome. Summary of the teaching activities in the GIT System DEPARTMENT # OF LECTURES # OF PRACTICALS Small Group Discussion Anatomy 14 4 (2 Gross & 2 0 Hist.) Physiology Biochemistry Pathology Microbiology Pharmacology Comm. Med Multidisciplinary Total B. PRACTICAL LABORATORY SESSIONS: # PRACTICLE OBJECTIVES 15

16 TITLE 1. First anatomy practical session. (Anterior abdominal wall, inguinal region and upper GIT) 2. Second anatomy (Histology of the GIT I) Identify main structures of the oral cavity and associated salivary glands and ducts. Also identify the pharynx and its parts and main features and relations. Identify the layers of the anterior abdominal wall including: Skin. Fascia (superficial and deep). Abdominal wall muscles (origin, insersion and fascial covoring iincluding the rectus sheath). Identify and recognize the inguinal region including: Inguinal ligament formation. Inguinal canal (location, walls and contents). Deep and superficial inguinal canal openings (rings). The spermatic cord and its coverings. 1. Describe and identify the visceral and parietal peritoneal coverings includung peritoneal layers, reflections, foldings mesenteries, omenta, falciform ligament, fossae, pouches, spaces, and gutters. 2. Identify the abdominal esophagus including: location, muscular wall, relations, and vascular supply. 3. Identify and describe the stomach including: a. Parts. b. Surfaces and borders. c. Epiploic foramin, location, borders and relation. d. Vascular supply. 4. Living anatomy: a. Describe the topographic planes and divisions of the anterior abdominal wall. Identify and palpate iliac crest, costal margin, linea alba, rectus abdominis, subcostal margin, inguinal ligament and canal, deep and superficial inguinal rings. Radiological anatomy including: Plane abdomin X-ray. Barium swallow and meal. Describe and study the microscopic srtucture of the tongue moucusa, muscles and papillae. Describe the microscopic structure of the salivary glands. Describe the microscopic structure of the esophegous. Describe the microscopic structure of the stomach. Describe the microscopic structure of the duodenum Describe the microscopic structure of the small intestine including jejunum and ilium. Describe the microscopic structure of the appendix. Describe the microscopic structure of the cecum and large intestine. Describe the microscopic structure of the solid organs including. d. Spleen. e. Liver. f. Pancreas. 16

17 3. Third anatomy practical sesssion (Lower GIT and abdominal organs) 4. Fourth anatomy practical sesssion (Imaging and Living anatomy of GIT and associated abdominal organs) Identify and describe the duodenum including: parts and vascular supply. Idintefy the jejunum and ileum and their distinguished features. Identify and describe the cecum including: Ileocecal valve. Apendix. Identify and describe the large intestine including: Parts, length, and external structure. Vascular supply. Identify and describe the liver including: Location, lobes, borders, and relations. liver peritoneal coverings and attachments including tringular, coronary and falciform ligaments. The porta hepatis and vascular supply: portal vein, hepatic artery and the extra-hepatic billiary system. Identify and describe the gall bladder including: Parts, location, borders and relations. Vascular supply. Identify and describe the pancreas including: parts, location, and relations. The main and accessory pancreatic ducts. Identify and describe the spleen including: shape, surfaces, and relation. vascular supply Radilogical anatomy including: Barium meal. Barium enema. Cholysystography Identify and describe: abdominal aorta and its various mian branches. Inferior vena cava; location and main tributaries. Describe the surface anatomy of all abdominal organs and vessels. Identify and describe the portal system. Radiological anatomy including: CT scan and MRI. Abdominal angiogaphy. Identify and describe the salivary and biliary system including: salivary glands and ducts. Pancreatic and biliary system. Surface anatomy of the above structures. 5. First pathology 4. Describe the morphology of the more common disease of the salivary glands. e. Mucocele. f. Sialolithiasis. g. Sjogren's syndrome. h. Tumors. 17

18 6. Second pathology 7. Third pathology 8. Fourth pathology 9. First microbiology (Stool examination) 10. Second microbiology (Parasite identification) 5. Describe the morphology of the following esophageal disease. e. Esophagitis (different types). f. Barret's esophagus and adenocarcinoma. g. Esophageal varices. h. Squamous cell carcinoma 6. Describe the morphology of the following gastric disease. d. Gastritis. e. Gastric ulceration. f. Gastric adenocarcinoma Describe the morphology of the following small intestine disorders. Enteritis. Tumors (caroinoid, lipoma, adenocarcinoma, lymphoma) Celiac disease and other causes of malabsorption. Describe the morphology of the following large intestinal disorders. d. Colonic polyps and adenomas. e. Colonic adenocarcinoma. f. Diverticular disease. 1. Describe the morphology of inflammatory bowel disease and other forms of colitis and tutorial on them. c. Ulcerative colitis. d. Crohn's disease. e. Pseudomembranous colitis. 1. Describe the morphology of the following liver disorders f. Steatosis. g. Cirrhosis. h. Pigmentory. i. Neoplasmas. j. Hepatitis. 2. Describe the morphology of the following gall bladder and biliary disorders d. Chololelithiasis and cholecystitis. e. Carcinoma of the gall bladder. f. Cholestasis. 3. Describe the diseases of the Exocrine Pancreas a. acute and chronic pancreatitis b. pancreatic tumors 1. Examin wet preparation for fecal leucocytes and RBCs. 2. Prepare stool culture for Salmonella and Shigella. 1. Identify the following parasites in slides: Asacaris, Trichuris, Enterobius, Hookworm, Tinea saginata. 11 First 1. List the enteral routes of drug administration. 18

19 pharmacology (Enteral routes and dosage forms administered orally) 2. Indicate the factors affecting the bioavailability of orally administered drugs. 3. Make comparison between different enteral routes of drug administration with respect to rate and extent of absorption, firstpass-hepatic effect, safety, and patient convenience. 4. Identify dosage forms of drugs suitable for enteral administration. 5. Describe the effect of enteral dosage forms on drug pharmacokinetics. 19