curric

GI System

Course Description

 

Introduction


Welcome to the GI/Liver Block Course. Members of the course faculty are looking forward to spending the next three weeks with you. Teaching this course are faculty and fellows from the Division of Digestive Diseases and Nutrition and the Department of Pathology and Laboratory Medicine.

This course is as much about clinical reasoning and clinico-pathologic correlation as it is about clinical gastroenterology. Much of this reasoning is taught in the lectures and small groups, and is difficult to acquire by independent study alone. We strongly advise you to attend lectures and small group sessions.

Rationale


A physician needs to know, in some detail, the normal function and the diseases of the gastrointestinal system. The impact of digestive diseases is great in terms of economic impact on society, total days of illness in adults, admissions to hospitals and in numbers of surgical procedures performed. The prevalence and significance of gastrointestinal illness is illustrated by the following facts:

  1. Each year 62 million Americans are diagnosed with a digestive disorder.
  2. Gastrointestinal disease accounts for 8% of deaths, 10 - 15% of hospital admissions, 25 - 35% of major operations.
  3. Cancer of the colon-rectum is the second leading cause of cancer mortality in men and the 3rd in women while pancreatic cancer ranks 3rd in terms of cancer mortality in men and 4th in women.
  4. 25% of the US population has some form of chronic gastrointestinal disease.
  5. For every 100 employed persons in the United States, 15 workdays are lost for acute GI disease and 30 workdays for chronic GI disease each year. The estimated yearly economic cost of gastrointestinal disease is 7.4 billion dollars.
  6. The estimated yearly fatality (1995) from diarrheal disease in young children of Asia, Africa, and Latin America is 5 - 20 million.

 

Organization of the Subject Matter


Subject matter is presented either as organ-based lectures or as lectures dealing with common presenting problems involving multiple parts of the GI tract. Where possible, common GI/Liver diseases will be organized according to the widely used clinical mnemonic: VINDICATE

  1. Vascular
  2. Infectious
  3. Neoplastic
  4. Drug
  5. Inflammatory
  6. Congenital
  7. Allergic/Autoimmune
  8. Trauma/Physical
  9. Endocrine/Metabolic

These 9 categories of etiologies cover virtually every disease process affecting an organ-system and make it easier to methodically structure your learning and knowledge retrieval.

The small group sessions consist of clinical cases designed to illustrate and emphasize the points made in the lecture segments. The content of the lab sections generally lags the content of the lectures by one or two sessions to allow you to have familiarity with the subject matter. Although the regions of the GI tract are broken down into individual units, it is important to keep in mind throughout the course that the gastrointestinal system functions as an integrated whole.

The resources page provides access to a series of short (~1 minute each) QuickTime pathology movies highlighting the salient gross and histopathologic features of diseases covered in the GI/liver block. An understanding of the pathology of these diseases is critical because:

  1. Pathology provides the framework for understanding these diseases.
  2. Clinical work-up and treatment of these diseases will change markedly during the course of your medical career; pathology will change little and will always provide a stable base for understanding changes in therapy.
  3. Pathologic images (both gross and histopathologic) are information rich. The morphologic appearance of each disease replaces many pages of less easily remembered descriptive text.
  4. Finally, pathologic images will accompany case-based exam questions

 

Objectives and Goals


At the end of the course each student should understand:

  1. Know the normal structure and function of GI tract and hepatobiliary system
  2. Understand the major diseases affecting the GI tract and hepatobiliary system, their clinical presentations and pathologic features
  3. Understand how these diseases affect the GI system and the entire body
  4. Be familiar with the procedures used to make diagnoses