Download - 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.
Gastrointestinal, MEU FK-UPH 2
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
Gastrointestinal, MEU FK-UPH 3
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
Gastrointestinal, MEU FK-UPH 4
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
Gastrointestinal, MEU FK-UPH 5
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
Gastrointestinal, MEU FK-UPH 6
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
Students should be able to:
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
Students should be able to:
a. Explore and record clearly the complaints, present illness, medical, family, and
other relevant history
2.2. Conduct clinical and laboratory procedures
Students should be able to:
Gastrointestinal, MEU FK-UPH 7
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
Students should be able to:
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
Students should be able to:
Gastrointestinal, MEU FK-UPH 8
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
Students should be able to:
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
Gastrointestinal, MEU FK-UPH 9
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
Gastrointestinal, MEU FK-UPH 10
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
Gastrointestinal, MEU FK-UPH 11
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
Gastrointestinal, MEU FK-UPH 12
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
Duration: 50 minutes
Objectives:
To explain the essential laboratory practice in gastrointestinal system
iii. Lecture 3,4 : Dr. Anggraeni Barlian, MSc
Theme: Development of Gastrointestinal Tract (GIT)
Duration: 100 minutes
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
Gastrointestinal, MEU FK-UPH 13
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
Duration: 50 minutes
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
Duration: 100 minutes
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
Duration: 50 minutes
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
Gastrointestinal, MEU FK-UPH 15
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
Gastrointestinal, MEU FK-UPH 16
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
Duration: 100 minutes
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
Duration: 50 minutes
Objectives:
To describe the histological feature of duodenum, jejunum/ileum,
appendix and colon.
Gastrointestinal, MEU FK-UPH 17
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
Duration: 50 minutes
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
Duration: 100 minutes
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 explain the mechanism of pathogenesis causative organism
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
Gastrointestinal, MEU FK-UPH 18
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
Duration: 50 minutes
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
Duration: 50 minutes
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:
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., SpPAGastrointestinal, MEU FK-UPH 19
Biochemistry:
Prof. Rondang Soegiarto, Ph.D
Dr.rer.physiol. Septelia Inawati W. dr.
Winarsih dr., MS
Objectives:
At the end of the week, the student will be able to:
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
Gastrointestinal, MEU FK-UPH 20
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
Duration: 100 minutes
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
Duration: 50 minutes
Gastrointestinal, MEU FK-UPH 21
Objectives:
To describe the causative organism of viral hepatitis
To explain the mechanism of pathogenesis causative organism
To describe the microbiological investigations of the viral hepatitis
To explain the mechanism of pathogenesis causative organism
iii. Lecture 4: Jan Tambayong, dr., PHK
Theme: The microscopic structure and feature of the liver and biliary tree
Duration: 50 minutes
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
Duration: 50 minutes
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.
Gastrointestinal, MEU FK-UPH 22
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
Duration: 50 minutes
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
Duration: 100 minutes
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.
Integrated Laboratories:
Departments: Anatomy. Histology, Pathology, Parasitology
Lab assistants:
Anatomy:
Gastrointestinal, MEU FK-UPH 23
Wahyuni Atmodjo dr., PAK, Ph.D
Hartono Gunadi dr., PAK
Deisy Budiono dr
Daniel R. Kambey dr.
Histology:
Jan Tambayong dr., PHK
Ronald Ulaan dr., MS
Neneng Suryadinata dr., MPsi.T
Parasitology:
Sisirawaty dr., Sp.ParK
Danielle dr., Sp.ParK
Objectives:
At the end of the week, the student will be able to:
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
Duration: 100 minutes
Objectives:
Gastrointestinal, MEU FK-UPH 24
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
Duration: 50 minutes
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
Duration: 100 minutes
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
Duration: 100 minutes
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
Gastrointestinal, MEU FK-UPH 25
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
Duration: 50 minutes
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:
Darti Isbandiati dr., SpPA
Suga Trisakti dr., SpPA
Vera Damajanti dr., SpPA
Kistiandono dr., SpPA
Physiology:
V Sutarmo Setiadji, dr., PFK, PhD
Objectives
At the end of the week, the student will be able to:
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
Gastrointestinal, MEU FK-UPH 26
To identify the pathologic changes that occur in the liver
To identify pathological changes in bowel which occur in enteric infection
Gastrointestinal, MEU FK-UPH 27
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
Duration: 50 minutes
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
Duration: 50 minutes
Objectives:
To describe the function of pancreas
To explain the physiology of enzymes formation and secretion which
involved in digestive process
Gastrointestinal, MEU FK-UPH 28
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
Duration: 100 minutes
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
Duration: 100 minutes
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
Duration: 100 minutes
Objectives:
Gastrointestinal, MEU FK-UPH 29
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
Integrated Laboratories:
Departments: Anatomy, Histology, Pathology
Lab assistants:
Anatomy:
Wahyuni Atmodjo dr., PAK, Ph.D
Hartono Gunadi 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
Vera Damajanti dr., SpPA
Suga Trisakti dr., SpPA
Kistiandono dr., SpPA
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
Gastrointestinal, MEU FK-UPH 30
CHAPTER VI
LIST OF DISEASES
Gastrointestinal, MEU FK-UPH 31
Gastrointestinal, MEU FK-UPH 32
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.
Gastrointestinal, MEU FK-UPH 33
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
Gastrointestinal, MEU FK-UPH 34
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
- Professional Behavior
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
- Professional Behavior
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:
Gastrointestinal, MEU FK-UPH 36
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
Gastrointestinal, MEU FK-UPH 37
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
Gastrointestinal, MEU FK-UPH 38
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
Gastrointestinal, MEU FK-UPH 39
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
Gastrointestinal, MEU FK-UPH 40
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
Gastrointestinal, MEU FK-UPH 41