bb gastrointestinal

Gastrointestinal Gastrointestinal System System

Block Book

Faculty of Medicine

Pelita Harapan University

Karawaci – Tangerang

2010/2011

AuthorsBenyamin Lukito dr., SpPD

Daniel Richard Kambey dr.

Gastrointestinal, MEU FK-UPH 1

ContributorsJan Tambayong, dr., PHK

Darti Isbandiati, dr., MS, SpPASuga T. Anggawijaya, dr., SpPA

Kistiandono, dr., SpPAVera Damayanti, dr., SpPACucunawangsih, dr., SpMK

Prof. Wahyuni Atmodjo, dr., PAK, Ph.DDr. Anggraeni Barlian, MSc.Hartono Gunadi, dr., PAK

Bernard Hutabarat, dr., PAKProf. Rondang Soegianto, dra., MSc., Ph.D

Dr.rer.physiol. Septelia Inawati W., dr.Winarsih, dr., MS

V. Sutarmo Setiadji, dr., PFK, Ph.DSisirawaty, dr., SpParK

Danielle Tahitoe, dr., SpParKNicolaski Lumbuun, dr., SpFK

Harun Wijaya, dr., SpAT. Haryanto S., dr., SpPK

Benyamin Sastro, dr., SpPDBenyamin Lukito, dr., SpPDSayuri Suwandi, dr., SpPDAnthony Berlim, dr., SpB

Tondung Simorangkir, dr., SpBSubagia Santosa, dr., SpRad

Deisy Budiono, dr.Daniel Richard Kambey, dr.


OVERVIEW

The Gastrointestinal system studied in weekly program comprises of lectures, practical

and clinical skill laboratory, as well as PBL group discussion is intended to give the students a

sense of interest of thinking process concerning the clinical relevance of human structure.

Lectures on basic medical sciences and medical clinical sciences are designed to

complement to the study of gastrointestinal system. All disciplines in medical sciences are

integrated in this block to equip the students with an understanding of gastrointestinal problems

and it’s therapeutically management.

An integrated laboratory practice 4 hours once a week is implemented to have a three

dimensional aspect of the morphology and arrangement of macroscopic and microscopic structural

components of each organ in the gastrointestinal tract.

The selected clinical cases’ incorporating a multidisciplinary approach is created to trigger

the understanding of different disciplines within the gastrointestinal health problems. This session

is carried out in small group setting discussed three times a week and wrapped up by an expert in

the plenary session.

This block is implemented under the following main region, i.e., Diarrhea, Dyspepsia,

jaundice, abdominal bleeding and abdominal pain.

Lippo Village, December 17, 2010

Coordinator of Gastrointestinal system,

Benyamin Lukito dr., SpPD


LIST OF CONTENT

I. Course info

II. Standard of Medical Competencies

III. Teaching and Learning method

IV. Departments

V. Week objectives of lecture and lab practice

VI. List of disease

VII. References

VIII. Assessment

IX. Timetable

X. Approval


CHAPTER I

COURSE INFO

Block : Gastrointestinal

Semester : IV

Credits : 5 credits

Duration : 5 weeks

Teaching activity : 26 hours/week

Started : January 10, 2011

Ended : February 11, 2011

Coordinator : Benyamin Lukito dr., SpPD


CHAPTER II

COMPETENCIES

Components of Competency

1. Area of effective communication

o Be able to explore and exchange information verbally and non-verbally in the

gastrointestinal health problems.

2. Area of clinical skills

o Collect and record accurate and important information about the patient and

his/her family illness in GI tract

o Conduct clinical procedures based on the patient’s problems and needs, and

the doctor’s accreditation.

o Conduct physical examination based on the patient’s problems and needs in

GI tract disorders.

3. Area of scientific basis of medical knowledge

o Apply the concepts and principles of biomedical, clinical and behavioural

science and public health, appropriate to the delivery of primary health care

o Summarize an appropriate interpretation of the history.

4. Area of management of health problems

o Manage health problems in a person, family, or community comprehensively,

holistically, sustainable, co-ordinately and collaboratively in the context of a

primary health care service

5. Area of management of information

o Use information technology and communication in making a diagnosis

o Use health information productively

6. Area of self-awareness and self development

o Undertake lifelong learning


o Develop new knowledge

7. Area of ethics, morals, medico-legal aspects and professionalism,

and patient safety

o Have a professional attitude

o Behave professionally in cooperating with others

Learning outcomes:

1. Effective communication:

1.1. Establish rapport with the patient and his/her family.

Students should be able to:

a. Summarize the patient’s problem, worries and hopes

b. Always establish and maintain the patient’s dignity, confidentiality and privacy

c. Treat the patient as an equal and ask for his/her agreement in deciding on

therapy and medical procedures

1.2. Collect information


a. Able to use open-ended and closed questions in acquiring information (move

from open to closed questions)

b. Ask for clarification from the patient about any of his/her statements which

cannot be clearly understood

c. Use clinical reasoning in exploring the history of the present illness, family

history, and history of past illness

d. Conduct data exploration logically and efficiently

e. Not give education and explanation prematurely while collecting information

2. Clinical skills

2.1. Collect and record accurate and important information about the patient and

his/her family


a. Explore and record clearly the complaints, present illness, medical, family, and

other relevant history

2.2. Conduct clinical and laboratory procedures



a. Choose clinical and laboratory procedures which are appropriate for the

patient’s problem

b. Conduct clinical and laboratory procedures which are appropriate for the

patient’s problem and the doctor’s accreditation

c. Conduct physical examination in ways which minimise pain and discomfort for

the patient

d. Conduct an appropriate physical examination based on the patient’s problem

e. Identify physical signs and record them clearly and correctly

f. Identify, choose and decide on appropriate laboratory procedures

g. Conduct basic laboratory procedures

h. Complete a request form for more advanced laboratory procedures

i. Identify appropriate disease screening test(s)

j. Choose and perform therapeutic activities and preventive procedures

consistent with the doctor’s accreditation

3. Scientific basis of medical knowledge

3.1. Apply the concepts and principles of biomedical clinical

appropriate to the delivery of primary health care


a. Explain the health problem in terms of the principles of the basic medical

sciences, pathogenesis and pathophysiology

b. Explain the molecular and cellular aspects of the health problem, based on an

understanding of the normal mechanisms of the human body

c. Explain the non-biological factors which influence the health problems

d. Develop an effective strategy to prevent the causes of a disease, based on

pathogenesis and pathophysiology and specific risk factors, and the effect of

the disease

e. Explain the various options for patient management

f. Justify the chosen intervention based on pharmacology, physiology, nutrition,

exercise and behavioural change

g. Explain the possibility of drug interactions and side effects

h. Explain the benefit of dietary therapy in the management of certain diseases

3.2. Summarize an appropriate interpretation of the history,

physical examination, and laboratory tests



a. Explain (using pathophysiologic or other approaches) the

clinical and laboratory data to determine the diagnosis

b. Explain the rationale for the diagnosis by reference to evidence based

medicine

4. Management of health problems

4.1. Manage the patient’s disease, illness, and problem as a

whole individual, as part of a family and a community


a. Interpret clinical data to formulate provisional and differential diagnoses

b. Explain the cause, pathogenesis, and pathophysiology of a disease

c. Identify the various options for management of the patient’s disease

d. Manage the health problem independently and responsibly according to

his/her accreditation

e. Give reasons for the chosen management strategy based on pathophysiology,

pathogenesis, pharmacology, psychology, social and other appropriate factors

f. Write clear, complete, accurate, and legible instructions.

g. Identify the indicators of successful treatment, monitor the progress of

management, revise and change therapy appropriately

h. Predict, monitor, recognize the possibility of drug interactions and side effects,

and revise or change therapy appropriately

i. Implement the principles of family medicine in a holistic, comprehensive,

coordinated, collaborative, and sustainable manner in managing the disease

and the patient’s problem

j. Identify the role of the patient’s family, their occupation, and social

environment as factors that may influence the occurrence of disease and the

choice of therapy


CHAPTER III

TEACHING AND LEARNING MEYHOD

1. Lecture : 8 hours/week

2. Group discussion and Plenary : 7 hours/week

3. Laboratory practice : 4 hours/week

4. Clinical skill : 4 hours/week

5. Doctor, Professionalism,

Ethics, Society : 2 hours/week

6. Clinical Exposure : 3 hours/week

Total teaching activity : 28 hours/week


CHAPTER IV

DEPARTMENTS

1. Department of Anatomy and development

2. Department of Histology

3. Department of Physiology

4. Department of Biochemistry

5. Department of Microbiology

6. Department of Parasitology

7. Department of Pharmacology

8. Department of Pathology Anatomy

9. Department of Clinical Pathology

10. Department of Surgery

11. Department of Internal Medicine

12. Department of Pediatric

13. Department of Radiology


CHAPTER V

WEEK OBJECTIVES

WEEK 1

Week Objectives

To describe, in overview, the embryology and structure of the upper GI tract, indicating its

basic anatomy and histology, autonomic connections, the enteric nervous system (ENS)

and blood supply.

To explain the cellular and physiological basis of the gut endocrine system and its

interaction with the enteric nervous system in the control of motility and secretion in the

upper GI tract.

To describe the coordinated neuromuscular activity of the esophagus and stomach

involved in swallowing, gastric phase of digestion, and the role of esophageal sphincters

and the pylorus.

To describe the pathobiology of selected upper GI tract diseases, including esophageal

motility disorders, gastroesophageal reflux disease, gastritis, peptic ulcer disease and

gastric cancer.

To explain gross and histopathology of gastrointestinal diseases

To discuss and explain the role of psychosocial and environmental factors, such as stress,

alcohol, smoking, obesity and diet in the pathogenesis of upper GI tract diseases.

To explain the concepts of essential dietary nutrients and provide an explanation of

nutrient requirements, and recommendations.

To apply knowledge of the normal functions of the upper GI tract to explain the basis of

symptoms such as heartburn, dysphagia, regurgitation, epigastric pain and vomiting.

To analyze symptoms and physical findings in a patient with an upper GI tract disorder to

arrive at a differential diagnosis.

To describe the role of the various laboratory tests and diagnostic procedures in the

evaluation of patients with upper GI tract disease.

To describe the medical and surgical management of esophagitis and acid-peptic disease,

including pharmacological measures to alter motility, gastric acid secretion and mucosal

defence mechanisms


Lectures:

i. Lecture 1: Jan Tambayong, dr., PHK

Theme: Histological feature of gastrointestinal tract

Duration: 50 minutes

Objectives:

To describe histological organization & functions of 4 layers of GI tract

To know histology & ultrastructure of main epithelial cell types in

esophageal mucosa, gastric mucosa & intestinal mucosa

ii. Lecture 2: Jan Tambayong, dr.,PHK; Darti Isbandiati, MS., SpPA;

Cucunawangsih, dr., SpMK

Theme: Laboratory introduction


Objectives:

To explain the essential laboratory practice in gastrointestinal system

iii. Lecture 3,4 : Dr. Anggraeni Barlian, MSc

Theme: Development of Gastrointestinal Tract (GIT)


Objectives:

1. To explain the general formation of foregut, midgut and hindgut

Induction of endoderm to mesoderm in regionalization of GIT

Development of endoderm becomes epithelial lining GIT

Development of mesenchymal mesoderm becomes peristalsis muscle

2. To describe the development of foregut

Development of stomach

Rotation in stomach formation

Displacement of stomach

3. To describe the formation of intestine

Rotation in intestine regions

Malformation due to false rotation

Small intestine

Large intestine

4. To describe the development of liver and gallbladder

Normal development of liver and gallbladder

Abnormality in liver and gallbladder


5. To describe the development of pancreas

Normal development of pancreas

Abnormality in pancreas

6. To explain the developmental defects in:

Omphalocele

Congenital hypertrophic pyloric stenosis

iv. Lecture 5 : Nicolaski Lumbuun, dr., SpFK

Theme: Pharmacological aspect of upper gastrointestinal diseses


Objectives:

To describe the pharmacological management of Peptic Ulcer Disease

(PUD) and Gastroesophageal Reflux Disease (GERD)

To describe pharmacological prevention of NSAID-induced ulcers.

To define both non-pharmacologic & pharmacologic approaches to the

treatment of GERD

To overview the efficacy, safety, and cost of available agents

To explain the mechanism of action, common uses, side effects and

drug interactions for the following classes of agents:

o Antacids

o Cytoprotectants

o H2-receptor antagonists

o Proton pump inhibitors

o Prostaglandin analogs

o Bismuth subsalicylate, promotility agents (dopamine

antagonists)

v. Lecture 6,7: Sayuri Suwandi, dr., SpPD

Theme: Peptic Ulcer Diseases


Objectives:

To explain the pathophysiology of peptic ulcer disease

To explain the clinical symptoms of peptic ulcer disease

To be able to explain the management of peptic ulcer diseases

vi. Lecture 8:V.Sutarmo Setiadji, dr., PFK, PhDGastrointestinal, MEU FK-UPH 14

Theme: Normal digestive system and hormonal roles in gastrointestinal tract


Objectives:

To explain the process of mastication and the formation of bolus

To describe the two stages of deglutition (swallowing) process

To explain the process of digestion and absorption in each segment of

GI tract

To explain the function of GI tract hormone

Integrated Laboratories:

Departments: Anatomy, Histology, Pathology

Lab assistants:

Anatomy:

Wahyuni Atmodjo dr., PAK, Ph.D

Hartono Gunadi dr., PAK

Bernard Hutabarat dr, PAK

Deisy Budiono dr.

Daniel R. Kambey dr.

Histology:

Jan Tambayong dr., PHK

Ronald Ulaan dr., MS

Neneng Suryadinata dr., MPsi.T

Pathology

Darti Isbandiati dr., SpPA

Suga Trisakti dr., SpPA

Vera Damajanti dr., SpPA

Kistiandono dr., SpPA

Objectives:

At the end of the week, the student will be able to:

To identify the gross anatomical structure of upper gastrointestinal tract


To identify histological sections of lips, esophagus, stomach,

To identify the similarities and differences between gastric mucosa, small

intestinal mucosa and colonic mucosa. .

To identify pathologic features of benign peptic ulcer disease and its precursor

lesions


WEEK 2

Week Objectives:

To explain the normal and abnormal fluid/electrolyte transport in the intestinal

tract.

To explain pathophysiological approach in the differential diagnosis of diarrhea.

To overview of microbiology aspect of diarrhea

To explain the pathology and pathophysiology of enteric infection

To explain the gut-associated immune system in health and disease.

To explain the common nutritional disorders and management of malnutrition.

To explain the epidemiology, pathology, clinical manifestations, complications,

treatment and pathogenesis of chronic inflammatory bowel disease, particularly

when complicated by toxic megacolon.

Lectures

i. Lecture 1,2: Wahyuni L Atmodjo, dr., PAK, PhD

Theme: Anatomy of gastrointestinal tract


Objectives:

To know the compartments of the peritoneal cavity

To explain the gross anatomical features esophagus, stomach and

duodenum

To explain the principles innervations of abdominal viscera.

To describe the blood supply and lymphatic drainage of GI tract

To describe the gross anatomical features of small and large intestine.

To explain the differentiation between small and large intestines.

To describe the blood supply of lower gastrointestinal tract

To describe the innervations of lower gastrointestinal tract

To describe the gross anatomical features of liver

To describe the gross anatomical features of pancreas

ii. Lecture 3: Jan Tambayong, dr., PHK

Theme: Lower gastrointestinal tract histological features


Objectives:

To describe the histological feature of duodenum, jejunum/ileum,

appendix and colon.


To describe the essential histological features of the appendix.

To describe how the recto-anal junction is organized histologically as a

site of transition between GI tract and the outside environment.

To explain how the ultrastructural features of the various epithelial cell

types comprising the gastro-intestinal mucosa reflect their respective

functions

iii. Lecture 4: Nicolaski Lumbuun, dr., SpFK

Theme: Pharmacological options in diarrhea management


Objectives:

To describe the primary goals for the treatment of acute diarrhea

To describe appropriate recommendation of non drug therapy for acute

diarrhea patients

To explain the role of drug therapy in the treatment of

Acute / chronic diarrhea & recommend appropriate products

iv. Lecture 5,6: Cucunawangsih, dr., SpMK

Theme: Microorganism in gastrointestinal tract and food poisoning


Objectives:

To describe the causative organism (Helicobacter pylori)

To discuss the microbiological investigations of the gastritis/peptic ulcer

To explain the mechanism of pathogenesis causative organism

To describe the normal flora in the gastrointestinal tract

To discuss the transmission of water-borne enteric pathogens

To describe the characteristic of enteric Gram-negative rods


To describe the antigenic structure and toxins of causative organisms.

To describe the causative organisms (bacterial and viral) of gastroenteritis

in childhood, infant, and traveler.

To describe the list of gastrointestinal infection caused by enteric

Pathogens.

To describe the clinical features of infections caused by enteric

Pathogens.

To describe the list of causative organisms of food poisoning


To describe the clinical manifestations and pathogenesis of food

Poisoning.

v. Lecture 7 : Sisirawaty, dr., SpParK

Themes: Major features of parasites in human gastrointestinal tract


Objectives:

To describe protozoa parasites which are transmitted by contaminated

food water borne

To explain life cycle of protozoa

To describe each stage of species protozoa parasites

To explain which protozoa cause bloody, watery diarrhea and steatorrhea

vi. Lecture 8 : Harun Wijaya, dr., SpA

Themes: Diarrhea in children


Objectives:

To explain the pathophysiology and pathogenesis of diarrhea in children

To explain the pathophysiology of dehydration

To explain the principles of rehydration in children

Integrated Laboratories

Departments: Histology, Pathology, Biochemistry

Laboratory assistants:

Histology:




Pathology:




Kistiandono dr., SpPAGastrointestinal, MEU FK-UPH 19

Biochemistry:

Prof. Rondang Soegiarto, Ph.D

Dr.rer.physiol. Septelia Inawati W. dr.

Winarsih dr., MS

Objectives:


To identify the characteristic histological appearance of the gastrointestinal tract from the

stomach to the recto-anal junction

To identify histological feature of small and large intestine

To identify the gross anatomical structure of small bowel and large bowel

To identify microorganism that play role in gastrointestinal infection

To identify the biochemical process of digestion


WEEK 3

Week Objectives

To describe the gross and microscopic anatomy of the liver including the vasculature

and bile ducts.

To describe chemical modification of drugs by the liver.

To describe blood tests used clinically to assess hepatocyte injury, cholestasis, and

the biosynthetic/metabolic function of the liver.

To describe the molecular pathogenesis, epidemiology and natural history of chronic

viral hepatitis.

To identify the major histopathologic features that accompanies viral hepatitis.

To describe cirrhosis and explain why this leads to portal hypertension and impaired

liver function.

To explain the pathogenesis of hepatic encephalopathy and ascites.

To explain difference between the symptoms of acute hepatitis with those of biliary

obstruction.

To explain of biliary anatomy to the diagnosis of biliary obstruction and gallbladder

disease.

To describe the key points in the history and physical examination in assessing a

patient with jaundice.

To explain the imaging tests for diagnosis of liver disease.

To describe the epidemiology, pathogenesis, pathology, and clinical consequences of

the most common liver tumors - benign (cavernous hemangioma, nodular hyperplasia,

and adenoma) and malignant (hepatocellular carcinoma and cholangiocarcinoma

Lectures:

i. Lecture 1,2: Sisirawaty, dr., SpParK

Theme: Identification of parasites in human gastrointestinal tract


Objectives:

To describe parasites in the hepatobiliary system

To explain the main clinical manifestation of parasitic infection

To explain the main clinical manifestation of protozoal infection

To explain examination of specimens

ii. Lecture 3: Cucunawangsih, dr., SpMK

Theme: Major microorganism in liver infection



Objectives:

To describe the causative organism of viral hepatitis


To describe the microbiological investigations of the viral hepatitis


iii. Lecture 4: Jan Tambayong, dr., PHK

Theme: The microscopic structure and feature of the liver and biliary tree


Objectives:

To describe histological organization of parenchyma & stroma of liver

and it’s related disorders

To describe the comparison between hepatic lobule and liver acinus

To describe salient LM / EM features of hepatocyte

hepatocyte, ,sinuosoid & canaliculus

To explain the major components of a portal area and indicate their

functions.

To explain he difference between Kupffer cells and fenestrated

endothelial cells in hepatic sinusoids and explain how they function.

To explain how the ultrastructural features of the hepatocyte,

perisinusoidal space of Disse, biliary canaliculus and hepatic sinusoid

reflect their respective functions.

To explain how the histological organization of the gallbladder enables it

to concentrate and deliver bile to the duodenum

iv. Lecture 5: Vera Damayanti, dr., SpPA

Theme: Pathological changes in the liver


Objectives:

To describe the pattern of pathological findings that is referred to as

“acute hepatitis.”

To describe the microscopic features that are characteristic of cirrhosis.

To describe the major etiologic agents of cirrhosis.

To explain the difference between the two gross morphologic variants of

cirrhosis, micronodular and macronodular, and explain why such a

classification scheme can be clinically misleading.


To explain the principal recognized etiologies for this disorder in order of

their likelihood. State the most common factor associated with each

etiology.

v. Lecture 6: T Haryanto, dr., SpPK

Theme: Role of laboratory examination in liver diseases


Objectives:

To explain in detail how the liver metabolizes ammonia and bilirubin

To outline the biochemical pathways used by the liver in maintaining a

normal blood glucose concentration

To describe the major plasma proteins synthesized in the liver and To

Describe their functions

To explain the role of laboratory test in distinguishing hepatitis

To explain liver function test in liver diseases

To explain the role of serology test in liver diseases

vi. Lecture 7,8: Benyamin Sastro, dr., SpPD

Theme: Pathophysiological and clinical correlation in liver diseases


Objectives:

To explain differences between acute and chronic liver disease

To explain the correlation between jaundice and other clinical symptoms

To explain the pathogenesis of cirrhosis.

To explain the major complications of cirrhosis and portal hypertension.

To explain the pathogenesis and pathophysiology of GI bleeding in

chronic liver disease, hepatic encephalopathy, ascites and hepatorenal

syndrome.


Departments: Anatomy. Histology, Pathology, Parasitology

Lab assistants:

Anatomy:




Deisy Budiono dr


Histology:




Parasitology:

Sisirawaty dr., Sp.ParK

Danielle dr., Sp.ParK

Objectives:


To identify the essential histological features of the liver with special reference to the

organization of parenchyma and stroma.

To identify the organization of the bile canaliculus, space of Disse and liver sinusoid,

including Kupffer cells

To identify the histology and vascular relations of a classic hepatic lobule. .

To identify the principals of serologic examination in liver infection diseases

To identify examination of parasitologic specimens

WEEK 4

Week Objectives

To explain current knowledge regarding colonic polyp and colon cancer.

To describe the radiological findings in common intestinal disorders

To describe the pathological changes seen in common intestinal disorders, with

special attention to Diverticulitis, colon cancer and polyp.

Lectures:

i. Lecture 1,2 :Vera Damajanti, dr., SpPA

Theme: Neoplasm in lower gastrointestinal tract


Objectives:


To describe pathological changes occur in polyp, adenoma, and

carcinoma

To explain the correlation between pathological and clinical findings in

gastrointestinal malignancies

ii. Lecture 3: T Haryanto, dr., SpPK

Theme: Acute Abdomen


Objective:

To explain the role of laboratory result in the diagnosis of acute

abdomen

To explain the laboratory diagnostic feature in acute pancreatitis

iii. Lecture 4,5 : Anthony Berlim, dr., SpB

Theme: Role of clinical management in gastrointestinal bleeding and tumor


Objectives:

To explain neoplastic disorder in the Gastrointestinal tract

To explain the causes, pathogenesis and management of

gastrointestinal tract acute bleeding

To explain the differences between polyp, adenoma and colon cancer

iv. Lecture 6,7 : Subagia Santosa, dr., Sp.Rad

Theme: Imaging of gastrointestinal tract


Objectives:

To explain the modalities of imaging in gastrointestinal tract

To explain how to interpret normal abdominal x-ray

To describe differences between obstructive and paralytic ileus

radiologically

To describe radiographic appearance of GI tract perforation

To describe common pathological findings on abdominal x-ray

To describe and interpret barium enema examination

To describe and interpret colon-in-loop examination

To describe the role of sonography in diagnosis of gastrointestinal

disease


To describe the role of CT-scan & MRI in diagnosis of gastrointestinal

disease

v. Lecture 8 : Tondung Simorangkir, dr., SpB

Theme: Herniation from abdominal cavity


Objectives:

To describe types of herniation that can occurs from abdominal cavity

To describe the causes and pathogenesis of gastrointestinal tract

herniation and invagination

To describe the management of gastrointestinal tract herniation

Integrated Laboratories

Departments: Clinical Pathology, Pathology, Physiology

Laboratory assistants:

Clinical Pathology:

T Haryanto, dr, SpPK

Pathology:





Physiology:

V Sutarmo Setiadji, dr., PFK, PhD

Objectives


To identify polyp and adenoma

To identify the macroscopic appearance of gastrointestinal malignancies

To identify the microscopic appearance of gastrointestinal malignancies

To identify laboratory features in diagnosing gastrointestinal bleeding


To identify the pathologic changes that occur in the liver

To identify pathological changes in bowel which occur in enteric infection


WEEK 5

Week Objectives

To explain the normal cellular basis for fluid, enzyme and bicarbonate secretion by

the pancreas, indicating how these processes are controlled by neural and

hormonal factors.

To describe the digestion, absorption, metabolism and excretion of macronutrient,

vitamins and minerals focusing on the aspects of absorption, metabolism and

excretion which are relevant to disease and intervention during clinical nutrition

management

To describe disorders of malabsorption and the pathophysiological basis for the

symptoms and signs associated with malabsorption disorders.

To explain the pathogenesis of infectious, alcoholic and obstructive pancreatitis

To describe the anatomic site and physiologic factors involved with normal nutrient

absorption.

To explain factors involved and etiology and clinical features with the clinical

assessment of the nutritional state.

To describe the use of laboratory and radiological tests in the investigation of

malabsorption.

To describe the etiologies and pathophysiology of acute a chronic pancreatitis.

Lectures

i. Lecture 1: Jan Tambayong, dr., PHK

Theme: Microscopic structure of the pancreatic gland


Objectives:

To describe histology features of the pancreas

To explain the exocrine glands in pancreas in the digestive process

ii. Lecture 2: V Sutarmo Setiadji, dr., PFK, PhD

Theme: Role of pancreas in the normal digestive process


Objectives:

To describe the function of pancreas

To explain the physiology of enzymes formation and secretion which

involved in digestive process


To explain the component and its function of the nervous system involved

in the regulation of GI tract

To explain the comparison and the contrast of neural, hormonal and

immune control of the gastrointestinal tract

iii. Lecture 3,4: Prof. Rondang Soegiarto, PhD

Theme: Biochemical process in the gastrointestinal tract & biochemical feature of

pancreatic juice


Objectives:

To describe chemical nature of dietary carbohydrates

To describe action of salivary enzyme

To describe how dietary proteins are digested

To explain whole body protein turnover

To explain biosynthesis of bile pigment in relation with jaundice

To explain the absorption of vitamin and minerals

To describe he role of pancreatic juice

To describe chemical nature of dietary lipid

To outline the products of action of pancreatic lipase, cholesteryl

hydrolase and phospholipase A2 on dietary lipid

To explain the role of bile salt and phospholipids in micelle formation

and the absorption of lipids in the gut

iv. Lecture 5,6 : Tondung Simorangkir, dr., SpB

Theme: Pathopysiological and clinical aspect of abdominal pain


Objectives:

To explain pathogenesis of Abdominal pain

To explain clinical manisfetation of Abdominal pain

To explain diagnostic procedure of Abdominal pain

To explain basic treatment of Abdominal pain

Lecture 7,8 : Benyamin Sastro, dr., SpPD

Theme: Clinical correlation in pancreatic disorder


Objectives:


To explain the pathophysiology of Pancreatic cancer

To explain the clinical features of pancreatic cancer

To explain the diagnostic procedure and management of pancreatic

cancer


Departments: Anatomy, Histology, Pathology

Lab assistants:

Anatomy:



Deisy Budiono dr


Histology




Pathology





Objectives

At the end of the week, the student will be able to

To identify the gross anatomy of pancreas

To identify the microscopic structure of pancreatic gland

To identify the clinical, etiologic, and pathologic features of carcinoma of the

pancreas


CHAPTER VI

LIST OF DISEASES


List of tutors:

Aldoni Latumahina, dr.

Denny Handoyo, dr.,

Stefanus Sumali, dr.

Darwin F. Salim, dr.

Riny Sari Bachtiar, dr.

Yeremia Tatang, dr.

Eric Setiawan, dr

Chrsita Febby. dr.

Dania Kosim, dr.


CHAPTER VII

REFERENCES

1. Anatomy

Anatomy for students, Gray's 1st edition. Elsevier 2005.

Clinical Anatomy for medical students, Richard Snell. Little

Brown

Clinically Oriented Anatomy 4th ed. Keith L. Moore. William &

Wilkins

Atlas of Human anatomy, Frank Netter. Ciba Geigy

2. Langman’s Medical Embryology, TW Sadler. William & Wilkins

3. Histology

Basic Histology. L.C. Junquira, J. Carneiro, R.O. Kelley, 9th ed., Prentice Hall Int.,

2000

Color Textbook of Histology. L.P. Gardner and J.L. Hiati, 2nd ed., Saunders, 2001

4. Pharmacology

Basic and Clinical Pharmacology, Katzung, 10th ed, 2006


CHAPTER VIII

ASSESSMENT

I. Attendance requirements:

Attendance requirements and eligibility to write examinations:

Problem Based learning is an important and integral component of the UPH curriculum. This

instructional method emphasizes cooperative behavior and small group learning which for many

students, is a new way of learning. Consequently for groups to function successfully, regular full

attendance at tutorials is essential.

Attendance expectations as requirements and prerequisites to sit the examinations:

100% for tutorials

70% attendance at lectures

70% attendance in lab practical sessions

Exemptions permitted with Doctor’s certificate, event of Family crisis, disaster or extraordinary

reason with prior permission from tutor. Further criteria are implemented according to UPH criteria

for exemption.

II. Assessment of Student Performance

The system will include assessment of block learning, mandatory courses, assessment of clinical

skills and a comprehensive “end of year” knowledge based examination. Each component will be

given a relative value in calculating a Cumulative Score.

a. Assessment will be conducted for learning in each block and will

include:

i. Knowledge based MCQ

ii. Objective structured Practical Examination (OSPE)

iii. Tutorial performance

b. Clinical skills learning will be assessed at the end of each semester using the

international standard Objective Structured Clinical Examination (OSCE)

c. A comprehensive knowledge based examination (MCQ) will be conducted at the

year end. This will cover content from all components of the 2 previous semesters.

d. The Cumulative Score calculated based on the components will be the final score

and required for a successful Pass for the YEAR

e. The Cut-off score for Pass will be determined by recognized standard setting

processes.

1. Tutorial performanceGastrointestinal, MEU FK-UPH 35

a. Formative :

Weekly discussions with tutor in the group

- Preparation

- Participation

- Professional Behavior

Mid-block (course) discussions with tutor in the group and written assessment

summary provided to the student.

- Preparation

- Participation


During this encounter, the tutor will identify any issues of concern with the student and

assist in efforts to improve.

b. Summative:

Students will be assessed at the end of the block on the following performance in tutorial

sessions:

- Preparation

- Participation


2. Knowledge assessment

Student’s applied knowledge will be assessed at the end of each block using:

Multiple Choice Questions (MCQ)

Laboratory practical examination (OSPE)

3. Clinical Skills Assessment

Student’s applied clinical skills will be assessed at the end of the year using:

OSCE

4. Clinical Exposure

Student’s applied clinical skills will be assessed at the end of the year incorporate to:


OSCE

MCQ

5. Comprehensive Assessment

Student’s applied knowledge will be assessed at the end of the year using:

MCQ comprehensive of FMS 1, 2, 3, 4

III. Relative values:

At the end of the block, the relative value of the block consists of each component as follows:

Component Percentage

1. PBL tutorials 30 %

2. MCQ 50 %

3. OSPE 20 %

At the end of the year, the relative value of Cumulative Score consists of component as

follows:

Component Percentage

1. MCQ comprehensive (items will cover

knowledge from all blocks within the year) 35 %

2. OSCE (compile value within the year) 20 %

3. Blocks (compile value within the year) 45 %

Passing grade at UPH is 56.00% (C) and will be determined through recognized Standards Setting

processes. Relationship to the Grading system and GPA is as indicated in the table.

GRADE RANGE SCALE


A 90,00 - 100 4,00

A – 80,00 - 89,99 3,70

B + 75,00 - 79,99 3,30

B 68,00 - 74,99 3,00

B – 65,00 - 67,99 2,70

C + 60,00 - 64,99 2,30

C 56,00 - 59,99 2,00 (PASS)

C – 50,00 - 55,99 1,50

D 40,00 - 49,99 1,00

E 00,00 - 39,99 0,00


CHAPTER IX

TIMETABLE

Gastrointestinal Block 2011

Block Chair: Benyamin Lukito, dr., Sp.PD

Week 1 Upper GI Tract Disorder Week chair: Daniel R. Kambey, dr.

10-Jan 11-Jan 12-Jan 13-Jan 14-JanTime Monday Tuesday Wednesday Thursday Friday

07.15 - 08.10 PBL Clinical exposure III, PBL Writing PBL08.10 - 09.05 Discussion 1 Small Group Discussion 2 Liberal Arts Discussion 309.05 - 10.00 Histology, JT Field DPES I Writing Embryology10.00 - 10.55 Lab introduction, JT Liberal Arts Anggraeni Barlian10.55 - 11.50 lunch break lunch break lunch break lunch break Self learning11.50 - 12.45 Integrated Lab Self learning Self learning Clinical Skill III Faith activity12.45 - 13.40 Anatomy Clinical Skill III Pharmacology, NL 13.40 - 14.35 Histology 14.35 - 15.30 Pathology Internal Medicine, Sayuri Physiology, VSS

16.00 - 16.50 (15.00 - 16.40) Plenary, Benyamin L

Week 2 Lower GI Tract Disorder Week chair: Daniel R. Kambey, dr.17-Jan 18-Jan 19-Jan 20-Jan 21-Jan

Time Monday Tuesday Wednesday Thursday Friday07.15 - 08.10 PBL Clinical exposure III, PBL Writing PBL08.10 - 09.05 Discussion 1 Small Group Discussion 2 Liberal Arts Discussion 309.05 - 10.00 Anatomy Field DPES I Writing Self learning10.00 - 10.55 WA Liberal Arts 10.55 - 11.50 lunch break lunch break lunch break lunch break Parasitology, Sisirawaty11.50 - 12.45 Integrated Lab Self learning Self learning Clinical Skill III Faith activity12.45 - 13.40 Histology & Pathology A Clinical Skill III Pharmacology, NL 13.40 - 14.35 & Microbiology, CC Pediatrics, Harun

14.35 - 15.30 Biochemistry B Histology, JT Plenary, Harun

Week 3 Hepatobiliary System Disorder Week chair: Daniel R. Kambey, dr.24-Jan 25-Jan 26-Jan 27-Jan 28-Jan


Time Monday Tuesday Wednesday Thursday Friday07.15 - 08.10 PBL Clinical exposure III, PBL Writing PBL08.10 - 09.05 Discussion 1 Small Group Discussion 2 Liberal Arts Discussion 309.05 - 10.00 Parasitology Field DPES I Writing Clin. Path., THS10.00 - 10.55 Sisirawaty Liberal Arts 10.55 - 11.50 lunch break lunch break lunch break lunch break 11.50 - 12.45 Integrated Lab Self learning Histology, JT Clinical Skill III Faith activity12.45 - 13.40 Anatomy & Histology A Clinical Skill III Pathology, Vera 13.40 - 14.35 & Internal Medicine14.35 - 15.30 Parasitology B Microbiology, CC Benyamin Sastro

15.30 - 16.20 Plenary, Benyamin S

Week 4 Malignancy of GI tract Week chair: Daniel R. Kambey, dr.31-Jan 1-Feb 2-Feb 3-Feb 4-Feb

Time Monday Tuesday Wednesday Thursday Friday07.15 - 08.10 PBL Clinical exposure III, PBL PBL08.10 - 09.05 Discussion 1 Small Group Discussion 2 Discussion 309.05 - 10.00 Pathology Field DPES I Radiology10.00 - 10.55 Vera Subagia10.55 - 11.50 lunch break lunch break lunch break HOLIDAY Self learning11.50 - 12.45 Integrated Lab Self learning Self learning Faith activity12.45 - 13.40 Pathology Clinical Skill III 13.40 - 14.35 Clin. Path. Surgery Surgery, Tondung

14.35 - 15.30 Physiology Clin. Path., THS Berlim Plenary, Tondung

Week 5 Acute Abdomen Week chair: Daniel R. Kambey, dr.7-Feb 8-Feb 9-Feb 10-Feb 11-Feb

Time Monday Tuesday Wednesday Thursday Friday07.15 - 08.10 PBL Clinical exposure III, PBL Writing PBL08.10 - 09.05 Discussion 1 Small Group Discussion 2 Liberal Arts Discussion 309.05 - 10.00 Histology, JT Field DPES I Writing Surgery10.00 - 10.55 Physiology, VSS Liberal Arts Tondung10.55 - 11.50 lunch break lunch break lunch break lunch break Self learning11.50 - 12.45 Integrated Lab Self learning Self learning Clinical Skill III Faith activity12.45 - 13.40 Anatomy Clinical Skill III 13.40 - 14.35 Histology Biochemistry Self learning Internal Medicine14.35 - 15.30 Pathology Prof. Rondang Benyamin Sastro

16.00 - 16.50 Plenary, Benyamin L


CHAPTER X

APPROVAL

Block Book : Gastrointestinal system

No.

Dokumen FK?PRO-11.BB.9.03/REV-02

Date17 December

2010

Pages 1 – 43

Name Position Sign

Written byBenyamin Lukito dr., SpPD Block Coordinator

Daniel R. Kambey, dr. Secretary of the Block

Superviced byAllen Widysanto, dr., SpP

Director

Medical Education Unit

Prof. Dr. Bambang Sutrisna, dr., MHSc Vice Dean I

Approved by Prof. David Fairholm, Neurosurgeon Executive Dean

Legalized byEka J. Wahjoepramono, dr., SpBS Dean


bb gastrointestinal

Documents

gastrointestinal tract

gastrointestinal semester

medical clinical sciences

sppd benyamin lukito

clinical procedures

clinical skill laboratory

area of clinical skills

selected clinical cases