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  1. Medicine and Surgery
  2. Single Cycle Master Degree (6 years)
  3. Medicine and Surgery [H4104D - H4102D]
  4. Courses
  5. A.A. 2024-2025
  6. 5th year
  1. Clerkship 9
  2. Summary
Insegnamento con unità didattiche Course full name
Clerkship 9
Course ID number
2425-5-H4102D060
Course summary SYLLABUS

Blocks

Skip Teaching units

Teaching units

Course full name Gastroenterology and Hepatology I Course ID number 2425-5-H4102D060-H4102D156M
Course summary SYLLABUS
Course full name Gastroenterology and Hepatology II Course ID number 2425-5-H4102D060-H4102D157M
Course summary SYLLABUS
Course full name Abdominal Surgery Course ID number 2425-5-H4102D060-H4102D160M
Course summary SYLLABUS
Course full name Craniofacial Diseases Course ID number 2425-5-H4102D060-H4102D186M
Course summary SYLLABUS
Course full name Gastroenterology and Hepatology III Course ID number 2425-5-H4102D060-H4102D199M
Course summary SYLLABUS
Course full name Gastroenterology and Hepatology IV Course ID number 2425-5-H4102D060-H4102D200M
Course summary SYLLABUS

Course Syllabus

  • Italiano ‎(it)‎
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Obiettivi

Gli obiettivi della Clerckship 9 (suddivisa in 6 sezioni: Gastroenterology & Hepatology I, II (Clinical Gastroenterology and Hepatology), Gastroenterology & Hepatology III (clinical Radiology of the digestive system), Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2), Abdominal Surgery (surgical aspects of the digestive system part 1) and Craniofacial diseases sono:

per Gastroenterology & Hepatology I, II (Clinical Gastroenterology and Hepatology):
A) Integrare le conoscenze relative all'apparato digerente (Fegato, pancreas e tratto intestinale) completando ed approfondendo gli argomenti presentati durante le lezioni frontali

  1. fornire le conoscenze di base relative al sistema digerente in salute e malattia. fornire le conoscenze adeguate relativamente ad eziologia, epidemiologia, fisiopatologia, clinica, diagnosi e gestione nelle malattie dell'apparato digerente.
  2. comprendere ed applicare le corrette indicazioni per i test diagnostici, bioumorali, endoscopici, radiologici. Fornire le conoscenze teorico-pratiche per l'interpretazione dei test diagnostici.
  3. comprendere i principi del trattamento medico delle malattie dell'apparato digerente ed i concetti di prevenzione e dell'adozione di corretti stili di vita
    B) acquisire competenze semeiologiche, diagnostiche, terapeutiche e gestionali relativamente alle malattie del tratto digerente

competenze pratiche da acquisire:

capacità di raccogliere la storia clinica, gestire diario clinico e cartella clinica ed ambulatoriale del paziente con patologie del tratto digerente
Semeiologia clinica dei pazienti con malattie del tratto digerente
Criteri prescrittivi e Interpretazione dei test bioumorali e sierologici del tratto digerente
Criteri prescrittivi e Interpretazione della diagnostica radiologica del tratto digerente
Criteri prescrittivi e Interpretazione delle procedure endoscopiche del tratto digerente
Principi di terapia medica delle malattie del tratto digerente
Comunicazione con i pazienti e Attitudini relazionali con colleghi e personale sanitario

per Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
ntegrare gli aspetti clinici del sistema digestivo presentati a lezione con una più specifica conoscenza riguardante la diagnosi per immagini attraverso esami radiologici:

  1. Fornire le conoscenze di base sulle metodiche di imaging disponibili per lo studio del fegato, del pancreas e del sistema gastrointestinale.
  2. Comprendere le indicazioni all'uso di specifiche modalità di imaging maturando la consapevolezza dei maggiori punti di forza e di debolezza dei singoli strumenti radiologici con alcuni suggerimenti sulla miglior selezione del paziente.
  3. Vedere da vicino le differenti modalità di imaging in differnti scenari clinici
  4. Accrescere l'interesse verso la diagnosi non- o mini-invasiva delle malattie gastrointestinali ed
    epatobiliopancreatiche.

per Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
Il corso si propone di fornire agli studenti gli strumenti e le conoscenze necessarie per effettuare una corretta
diagnosi clinica delle diverse patologie di interesse chirurgico legate al tratto gastrointestinale, formulando
un'adeguata diagnosi differenziale tra le varie patologie e individuando la corretta indicazione chirurgica e la
procedura chirurgica. Le conoscenze fornite durante il corso daranno allo studente gli strumenti necessari a
comprendere le patologie chirurgiche, anche attraverso l'esame obiettivo, l'anamnesi e lo studio di casi clinici
complessi.
Il tirocinio clinico permetterà agli studenti di comprendere l'algoritmo di trattamento delle principali patologie
chirurgiche e la gestione multidisciplinare dei pazienti.

per Abdominal Surgery (surgical aspects of the digestive system part 1

per Craniofacial diseases
Scopo del modulo di Craniofacial Diseases è conoscere ed approfondire le patologie del distretto testa-collo
mediante la valutazione clinica del paziente (raccolta anamnestica, esame obiettivo, accertamenti strumentali ORL)
e l’interpretazione dei dati strumentali (imaging TC e RM), al fine di formulare un’adeguata proposta terapeutica
per il paziente, sia essa medica o chirurgica. Particolare importanza verrà data all’attività chirurgica specialistica
del distretto testa-collo mediante la presenza costante in sala operatoria dei discenti

Contenuti sintetici

per Gastroenterology & Hepatology I, II (Clinical Gastroenterology and Hepatology):
la descrizione di malattie del fegato, pancreas e tratto digerente: eziologia, epidemiologia, fisiopatologia, clinica, diagnosi e gestione, integrate dalla acquisizione di competenze pratiche nella gestione dei pazienti con malattie dell'apparato digerente

per Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
Approfondimento sulle tecniche di diagnositca per immagini applicate allo studio del fegato, delle vie biliari, del pancreas e del tratto gastrointestinale. Valutazione dell'utilità delle stesse in differenti scenari clinici d'elezione o d'urgenza

per Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
Principi di diagnosi e trattamento delle patologie benigne e maligne di esofago, prime vie digestive, pancreas,
basse vie digestive.

per Abdominal Surgery (surgical aspects of the digestive system part 1
Principali analisi e comprensione degli aspetti chirurgici e della gestione delle patologie gastrointestinali

per Craniofacial disorders
Il modulo di Craniofacial Diseases tratterà i seguenti topics:
• Patologie dell’orecchio
• Patologie del cavo orale
• Patologie del faringe
• Patologie della laringe
• Patologie del collo
• Patologie del naso e dei seni paranasali
• Patologie della base cranica

Programma esteso

per Gastroenterology & Hepatology I, (Clinical Hepatology):

  • Chronic hepatitis: Virali, Autoimmuni, Colestatiche, Alcoliche, da accumulo; da farmaci (DILI) metabolica (NAFLD/MAFLD/DAFLD)
  • Cirrosi e Malattia epatica acuta su cronica (ACLF): sistemi di stadiazione; Ipertensione portale (Ascite, Circoli collaterali, Encefalopatia epatica, Ittero, Infezioni
  • Insufficienza epatica acuta: fisiopatologia, diagnosi, clinica e gestione
  • Carcinoma Epatocellulare (HCC) e colangiocarcinoma: epidemiologia, Patologia, Clinica, Radiologia diagnostica ed interventistica, Terapia medica e Chirurgica
  • Trapianto di Fegato: Indicazioni/Complicanze

per Gastroenterology & Hepatology II (Clinical Gastroenterology):
Sanguinamenti del tratto digerente: epidemiologia, clinica, diagnosi e gestione
Tratto digestivo superiore: Disordini esofagei; disordini funzionali; MRGE; NERD; Peptic disorders
Neoplasie e Neoplasie neuroendocrine del tratto digerente: Epidemiologia, fisiopatologia, Patologia, Diagnostica,
Clinica, Terapia medica e Chirurgica; Endoscopia
Malattie infiammatorie intestinali: IBD: Epidemiologia, fisiopatologia, Patologia, Diagnostica, Clinica, Terapia medica e Chirurgica; Endoscopia
Malattia celiaca: Epidemiologia, fisiopatologia, Patologia, Diagnostica, Clinica, Terapia medica; Endoscopia
Addome Acuto: Clinica, diagnosi e gestione
Pancreas: pancreatiti Acute & Croniche, neoplasie pancreatiche

per Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
-Fegato:
Ecografia, TC e RM - Mezzi di contrasto - Indicazioni cliniche
Lesioni epatiche benigne
Tumori epatici maligni
-Vie biliari:
Ecografia, TC e RM - Mezzi di contrasto - Indicazioni cliniche
Anomalie congenite
Infezioni
Disordini infiammatori autoimmuni
Colangiocarcinoma
-Pancreas:
Ecografia, TC e RM - Mezzi di contrasto - Indicazioni cliniche
Pancreatite acuta e cronica
Pancreatite autoimmune
Lesioni pancreatiche benigne
Tumori cistici e lesioni premaligne - classificazione e follow up
Adenocarcinoma del pancreas
Tumori neuroendocrini - classificazione e implicazioni cliniche
-GI:
Ecografia, TC e RM - Mezzi di contrasto - Indicazioni cliniche
Anomalie congenite
Disordini funzionali
Malattie infiammatorie intestinali
Cancro esofageo, gastrico e colorettale
Tumori neuroendocrini

per Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
PATOLOGIA ESOFAGEA
Valutare la corretta tecnica diagnostica: esofagoscopia, esofagografia, manometria esofagea, pHmetria esofagogastrica,
ecoendoscopia, TC.
Riconoscere i quadri clinici, fornire indicazioni al trattamento chirurgico e descrivere gli aspetti generali dei
principali interventi chirurgici e delle loro complicanze in relazione alle seguenti patologie: Ernia iatale ed esofagite
peptica; Acalasia esofagea (e DMA); lesione esofagea caustica; diverticoli esofagei (Zenker, mediotoracico ed
epifrenico); neoplasie esofagee (benigne e maligne).
PATOLOGIA DELLE PRIME VIE DIGESTIVE
Valutare la corretta tecnica diagnostica: gastroduodenoscopia, radiografia dell'apparato digerente, ecoendoscopia,
ecografia, scintigrafia, TC. Riconoscere i quadri clinici e le complicanze, fornire indicazioni al trattamento chirurgico
e descrivere gli aspetti generali dei principali interventi chirurgici in relazione alle seguenti patologie: ulcera
gastrica; ulcera duodenale; gastrite erosiva acuta; condizioni precancerose gastriche; neoplasie gastriche (benigne
e maligne)
PATOLOGIE DI BASSE VIE DIGESTIVE
Individuare la corretta tecnica diagnostica: rettoscopia, rettosigmoidoscopia, colonscopia, radiografia dell'apparato
digerente, clisma con mezzo di contrasto, defecografia, tempo di transito intestinale, manometria anorettale,
endoscopia, ecografia, TC, RM. Riconoscere i quadri clinici e le complicanze, fornire indicazioni al trattamento
chirurgico e descrivere gli aspetti generali dei principali interventi chirurgici in relazione alle seguenti patologie:
malattia di Crohn e IBD; diverticolosi intestinale; neoplasie del colon, del retto, dell'ano; poliposi; prolasso rettale;
patologia ano-rettale benigna (fistole anali, emorroidi, ragadi, cisti pilonidali)
PATOLOGIA DEL PANCREAS
Valutare la corretta modalità diagnostica: endoscopia, ecografia, ecoendoscopia, colangiografia, TC, RM.
Riconoscere i quadri clinici e le complicanze, fornire indicazioni al trattamento chirurgico e descrivere gli aspetti
generali dei principali interventi chirurgici in relazione alle seguenti patologie: neoplasie pancreatiche; cisti
pancreatiche; tumori neuroendocrini del pancreas.

per Craniofacial diseases
Verranno affrontate le seguenti principali patologie del distretto testa-collo: patologie dell’orecchio esterno, medio
ed interno (otiti, labirintiti, ipoacusie, otosclerosi); patologie del cavo orale e dell’orofaringe (tonsilliti, faringiti,
OSAS); patologie della laringe (disfonie, laringiti, paralisi laringee); patologie delle ghiandole salivari maggiori
(scialoadeniti, scialolitiasi, neoplasie delle ghiandole salivari); patologie del naso e dei seni paranasali (riniti, rinosinusiti, epistassi, poliposi nasosinusale); patologie oncologiche del distretto testa-collo (carcinoma del cavo
orale, carcinoma faringeo, carcinoma laringeo, tumefazioni e metastasi laterocervicali); patologie della base cranica
anteriore e laterale (neoplasie nasosinusali, neoplasie dell’angolo ponto-cerebellare come il neurinoma acustico e
il meningioma, paragangliomi timpanici e timpano-giugulari).

Prerequisiti

Conoscenza dei corsi propedeutici come indicati nel regolamento del corso di laurea in Medicina e Chirurgia.
Conoscenze propedeutiche e conoscenza avanzata in anatomia, semeiotica, biologia e biologia molecolare
Anatomy and histology
Physiology
Pharmacology
General Pathology

Modalità didattica

le sessioni di clerckship 9 sono suddivise in differenti modalità di insegnamento, alternando frequenza nelle unità operative cliniche con lezioni interattive , come segue:

per Gastroenterology & Hepatology I, (Clinical Hepatology) & II (Gastrointestinal clinic):
Lezioni frontali con presentazione interattiva e discussioni collegiali.
Sessioni PBL
Discussione di casi multidisciplinari
frequenza delle seguenti attività pratiche:
attività in regime di degenza ospedaliera e attività ambulatoriale:

  • raccolta di anamnesi del paziente (attività supervisionata)
  • acquisizione/interpretazione referti di laboratorio , microbiologici e strumentali (attività supervisionata)
  • esame obiettivo del paziente (attività supervisionata)
    Attività ecografica addominale (osservazione e apprendimento rudimenti di base per ecografia addominale)
    Attività endoscopica (osservazione procedure endoscopie gastrointestinali)
    il rapporto Studente - Tutor è 1:1 (or maximum 1:3)

per Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
Alternanza di sessioni pratiche in reparto e attività interattive come di seguito riportato:
Lezioni frontali con presentazioni e discussioni interattive.
Sessioni PBL
Discussione multidisciplinare di casi
Attività su base ambulatoriale e in degenza:
Ecografia, Tomografia computerizzata e Risonanza Magnetica - frequenza durante l'esecuzione degli esami

for Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
Lezioni frontali, lezioni multidisciplinari in presenza e si terranno in lingua inglese

for Craniofacial disorders
Gli studenti saranno divisi in gruppi di 5 – 6 studenti che ruoteranno nei diversi ambiti clinici: reparto di degenza
ordinaria, ambulatorio generale ORL, sala operatoria. Gli studenti saranno affiancati dal tutor con una modalità 1:2
o 1:3.
In reparto e in ambulatorio gli studenti affiancheranno ed assisteranno il tutor nella raccolta anamnestica e
nell’esecuzione dell’esame obiettivo, nonché nella valutazione e nell’interpretazione degli esami strumentali.
Insieme al tutor si discuteranno le ipotesi diagnostiche e l’indicazione agli esami da prescrivere, fino a giungere
alla formulazione di una proposta terapeutica. Nel caso specifico del reparto di degenza si discuterà insieme al
tutor la prosecuzione dell’iter del ricovero del paziente.
Gli studenti, nel rispetto della privacy, assisteranno ai momenti di comunicazione con il paziente durante i quali
vengono condivise le ipotesi diagnostiche, gli esami prescritti e la terapia, e raccolti i consensi informati
In sala operatoria gli studenti assisteranno alle procedure chirurgiche programmate nelle varie sedute operatorie
(disponibilità di 2 sale operatorie tutti i giorni); l’atto operatorio sarà occasione di confronto con i tutor per quanto
riguarda l’approfondimento dell’anatomia specialistica dei vari distretti (naso e seni paranasali, orecchio medio ed
interno, collo, cavo orale, orofaringe, laringe, base cranica) e per quanto concerne la condivisione in tempo reale
dei vari passaggi degli interventi chirurgici del distretto testa-collo

In caso di recrudescenza pandemica, le lezioni saranno effettuate via webinar

Materiale didattico

Gastroenterology & Hepatology I, (Clinical Hepatology) & II (Gastrointestinal clinic):

  • Harrison's Principles of Internal Medicine: The 20th edition of the book, edited by Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson and Joseph Loscalzo, (17 August 2018). The 21st edition of the book to be released on 28 March 2022
  • Zakim and Boyer's Hepatology. A Textbook of Liver Disease. Seventh Edition (2018) (Edited by: Arun J. Sanyal, Thomas D. Boyer, Norah A. Terrault, and Keith D. Lindor)
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease- 2 Volume Set Pathophysiology, Diagnosis, Management. 11th Edition - June 9, 2020. Authors: Mark Feldman, Lawrence Friedman, Lawrence Brandt
  • Clinical Gastrointestinal Endoscopy: A Comprehensive Atlas. (2018) Ed. Hoon Jai Chun, Suk-Kyun Yang, Myung-Gyu Choi
  • Malattie Dell’apparato Digerente 2019-2022: Unigastro (Editrice Gastroenterologica Italiana)

per Gastroenterology & Hepatology III (clinical Radiology of the digestive system):

  • Review e articoli didattici disponibili su https://pubs.rsna.org/journal/radiographics e altre risorse accessibili tramite https://pubmed.ncbi.nlm.nih.gov

per Abdominal Surgery (surgical aspects of the digestive system part 1 (Shared with the General Surgery part of the GI Track)

  • Review eand articles available on https://pubs.rsna.org/journal/radiographics and other resources available through: https://pubmed.ncbi.nlm.nih.gov
  • Lessons on power point slides with references to national and international guidelines
  • Sabiston. Textbook of Surgery. Saunders
  • F. Minni. Chirurgia Generale. Zanichelli
  • F. D’Amico. Manuale di Chirurgia Generale. Piccin
  • References available on the scientific biomedical resource Pubmed

for Craniofacial disorders
Practical Otorhinolaryngology - Head and Neck Surgery
Diagnosis and treatment - Zhonglin Mu, Jugao Fang - Springer, 2021

Periodo di erogazione dell'insegnamento

Secondo semestre

Modalità di verifica del profitto e valutazione

L'esame verrà svolto in maniera integrata secondo la modalità prevista dal vertical track del tratto digerente che si svolgerà attraverso:
Valutazione di fine Clerckship che prevede: >70% di frequenza, conferma da parte del tutor dell'acquisizione delle skill pratiche previste secondo una scheda di valutazione predefinita
questi requisiti consentirannoi l'accesso a:

  • Test a scelta multipla (45 domande)
    Tutte le prove saranno svolte in lingua inglese
    la valutazione sulla clerckship 9 sarà: Idoneo o Non Idoneo (propedeutica al sostenere l'esame generale del vertical tract di malattie del tratto digerente: Colloquio orale sugli argomenti svolti a lezione, nei seminari, nei tirocini e nelle sessioni PBL

in caso di recrudesecenza di evento pandemico le prove d'esame potranno essere svolte in modo telematico. in tal caso verrà utilizzata la piattaforma WebEx e nella pagina e-learning sarà presente un link attraverso il quale eventuali spettatori potranno accedere ed assistere alla prova

per for Gastroenterology & Hepatology I, II (Clinical Gastroenterology & Hepatology)
per Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
per Abdominal Surgery (surgical aspects of the digestive system part 1

  • RAPPORTO MEDICO PAZIENTE Mette in atto le buone pratiche del rapporto medico-paziente (colloquio, relazione, informazione, chiarezza, acquisizione del consenso)
    Relationship with collegues and health personell
  • ANAMNESI Raccogliere anamnesi familiare, fisiologica, patologica remota e prossima
    Diary & chart management
  • MISURAZIONE PARAMETRI Misurare la frequenza cardiaca centrale e periferica
    Misurare la frequenza respiratoria e rilevare le caratteristiche del respiro
    Misurare la pressione arteriosa in situazioni diverse
    Rilevare il polso centrale ed i polsi periferici e descriverne le caratteristiche
    Interpretare una curva termica
  • SKILLS: INIEZIONI Posizionare ago canula venosa
    Effettuare infusioni endovenose
    Effettuare iniezioni intramuscolari
    Effettuare iniezioni intradermiche/sottocutanee
  • O2 Applicare l'O2 terapia
    Effettuare saturimetria
  • ECG Eseguire un ECG
    Interpretare i principali quadri elettrocardiografici
  • ASPETTI AMMINISTTRATIVI Compilare una cartella, stendere una epicrisi, una relazione clinica e SDO
    Richiedere un consenso informato
    Compilare una ricetta medica o una richiesta di analisi sulla modulistica del SSN
  • CONTAGIO E PREVENZIONE Applicare le misure di protezione del paziente rispetto al contagio di malattie
    Saper indicare azioni di prevenzione e di educazione sanitaria
  • ESAME OBIETTIVO Examination of the abdomen
    State of conscousness - Hepatic Hencephalopathy
    Diuresis, Bowel alterations Diarrhea and constipation (stool exam)
    Pruritus, skin alterations-pigmentation- Jaundice/Skin disorders /Infectious exanthemas
    Gastrointestinal bleeding
    Nutritional Status /Idratation/ Unintentional weight loss/Thirst / Hunger
    Edemas
  • Nutrizione Calcolare il bilancio idrico
    Rilevare i segni obiettivi di disidratazione
  • ESAMI SPECIALISTICI Interpretare i referti radiologici relativi alle principali patologie Gastro-Epatologiche
    Interpretare i referti di laboratorio relativi alle principali patologie Gastro-epatologiche
    indications and Interpretation of the endoscopic procedures of the GI Tract
    Formulazione delle ipotesi diagnostiche e dell’iter terapeutico
    Liver biopsy (principles)
  • TERAPIA Impostazione della terapia medica in Epato-Gastroenterologia
  • AMBULATORI Assistere a visita ambulatoriale Epatologica, Trapiantologica, Gastroenterologica
    Simulare una visita ambulatoriale Epatologica, Trapiantologica, Gastroenterologica
  • RAGIONAMENTO CLINICO Capacità di inquadrare il motivo del ricovero nel complesso delle eventuali cronicità, altre criticità e fragilità dei pazienti
    Conosce e sa applicare il ragionamento clinico: la capacità di individuare i problemi prioritari o urgenti e quelli secondari e la capacità di proporre ipotesi diagnostiche e di individuare gli accertamenti diagnostici dotati di maggiore sensibilità e specificità per confermare o meno le ipotesi

per Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
L'esame verrà svolto in maniera integrata secondo la modalità prevista dal vertical track del tratto digerente che si svolgerà attraverso:
Valutazione di fine Clerckship che prevede: >70% di frequenza, conferma da parte del tutor dell'acquisizione delle skill pratiche previste
questi requisiti consentirannoi l'accesso a:
Test a scelta multipla (15 domande) + Domande aperte (3 domande)
Tutte le prove saranno svolte in lingua inglese
la valutazione sulla clerckship 9 sarà: Idoneo o Non Idoneo (propedeutica al sostenere l'esame generale del
vertical tract di malattie del tratto digerente: Colloquio orale sugli argomenti svolti a lezione, nei seminari, nei tirocini e nelle sessioni PBL

per Craniofacial Disorders:
• Valutazione su scheda delle skills

Orario di ricevimento

I docenti riceveranno gli studenti su appuntamento concordato via e-mail

per for Gastroenterology & Hepatology I, II (Clinical Gastroenterology & Hepatology): stefano.fagiuoli@unimib.it

for Gastroenterology & Hepatology III (clinical Radiology of the digestive system): pmarra@asst-pg23-it

per Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2: : mpisano@asst-pg23.it

for Abdominal Surgery (surgical aspects of the digestive system part 1: fneri@asst-pg23.it -

for Craniofacial Disorders: : Prof. G. Danesi (gdanesi@asst-pg23.it) -- Tutors: Dr. A. Pusateri (ampusateri@asst-pg23.it); Dr. G. Giourgos (ggiourgos@asst-pg23.it)

Sustainable Development Goals

SALUTE E BENESSERE | ISTRUZIONE DI QUALITÁ | PARITÁ DI GENERE
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Aims

The aim of the Clerckship 9 (subdivided in 6 sections: Gastroenterology & Hepatology I, II (Clinical Gastroenterology and Hepatology), Gastroenterology & Hepatology III (clinical Radiology of the digestive system), Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2), Abdominal Surgery (surgical aspects of the digestive system part 1) and Craniofacial disorders :
are:
for Gastroenterology & Hepatology I, II (Clinical Gastroenterology and Hepatology):
A) To integrate the knowledge of the digestive tract (liver, pancreas & intestine) completing and elaborating on the argument presented during the frontal lessons through:

  1. Providing the basic knowledge the digestive system in health and disease. Provide the necessary knowledge of the aetiology, pathophysiology, diagnosis, differential diagnosis of the digestive systems.
  2. To understand the indications for the diagnostic testing, and the role of endoscopy and of imaging. To provide the theoretical and practical knowledge for the correct prescription of diagnostic imaging based on the clinical question, and for correct interpretation of first level diagnostic imaging.
  3. To understand the principle of medical treatment of digestive system diseases and the concepts of prevention and the relevant life-style measures.
    B) to acquire skills on semeiology, diagnosis, treatment and management of the digestive disease tract

practical skills to be acquired:

  • History taking and diary & chart management
  • physical examination of the patients (digestive tract diseases)
  • Interpretation of biochemical and serological tests to be utilized in evaluating the GI tract
  • interpretation of imaging techniques related to the GI tract
  • indications and Interpretation of the endoscopic procedures of the GI Tract
  • medical therapies of the GI Tract
  • physician-patient communication
  • relationship with collegues and health personell

for Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
To integrate the clinical aspects of the digestive tract presented during the frontal lessons with more specific
knowledge about imaging diagnosis by radiological assessment:

  1. To provide the basic knowledge of the available imaging modalities for the study of the liver, pancreas and
    GI system.
  2. To understand the indications for the specific imaging modality with awareness of the major strenghts and
    limits of each radiological tool with some tricks for better patient's selection.
  3. To see closely how the different imaging modalities work in different clinical scenarios
  4. To increase the interest towords non- o mini-invasive diagnosis of gastrointestinal and hepatobiliopancreatic
    diseases.

for Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2):
The course aims to provide students the tools and the necessary knowledge for performing a correct clinical
diagnosis of the various pathologies of surgical interest, formulating an adequate differential diagnosis between the various pathologies, and identifying the proper surgical indication and surgical procedure. The knowledge and skills provided during the course will give the student the skills to understand the surgical pathologies, also by means of the physical examination, history-taking and the study of challenge clinical cases.
The clinical internship will gradually provides the student the skills to perform invasive and practical procedures in the basic management of the surgical patient.

for Abdominal Surgery (surgical aspects of the digestive system part 1)
A) To integrate the knowledge on the surgical management of the disorders of the digestive tract (Esophagus, stomach, intestine, liver pancreas, spleen, portal system, abdominal wall) completing and elaborating on the arguments presented during the frontal lessons by:

  1. providing the basic knowledge on surgical management, including physiopathology of the surgical trauma response, surgical nutrition, surgical infections, perioperative medicine
  2. providing the necessary knowledge on the surgical aspects of the disorders of the digestive system and the abdominal wall
  3. providing the knowledge on the surgical indications, contraindications, preoperative evaluation (including appropriate tests), surgical techniques and outcomes for the aforementioned disorders
  4. providing familiarity with the surgical process, including history taking and diary & chart management physical examination of the patients, surgically oriented Interpretation of laboratory test, endoscopy and imaging, medical management of the surgical patient, basic surgical maneuvers
  5. providing familiarity with the skills of communication with patient and relatives
  6. providing familiarity with the the relationship with collegues and health persone

for Craniofacial disorders
The aim of the Craniofacial diseases module is to provide elements to understand the head and neck disorders,
through the clinical evaluation of the patient (obtain an adequate anamnesis, perform a complete ENT evaluation
and instrumental ENT examinations such as audiometric tests and upper respiratory tract endoscopy) and the
interpretation of imaging studies (CT and MRI) in order to formulate an etiological diagnosis and establish the
appropriate surgical or medical therapy with attention to the risk/benefit balance of the proposed therapeutic
choices. Particular attention will also be given to the surgical activity in the ORs, with the constant presence of the
students during ENT surgical procedures

Contents

For Gastroenterology & Hepatology I, II (Clinical Gastroenterology and Hepatology):
Main desctiption of Liver, Pancreas & Digestive disease tract diseases: epidemiology, pathophysiology, clinical presentation, diagnosis & management, integrated by the acquisition of practical skillsthe management of patients with digestive tract diseases

Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
Deepening on imaging techniques applied to the study of the liver, biliary tract, pancreas and gastrointestinal tract.
Evaluation of the usefulness of various radiological modalities in different clinical scenarios.

  • for Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
    Principle of diagnosis and treatment of benign and malignant pathologies of oesophagus, upper GI, pancreas,
    extrahepatic biliary tract and gallbladder, lower GI and proctology

  • for Abdominal Surgery (surgical aspects of the digestive system part 1
    Main analysis and understanding of the surgical aspects and management of the GI disorders

  • For Craniofacial disorders
    The module of Craniofacial Diseases will be focused on the following topics:
    • Ear diseases
    • Oral cavity diseases
    • Pharingeal diseases
    • Laryngeal diseases
    • Neck masses
    • Nasal and paranasal sinuses diseases
    • Skull base

Detailed program

for Gastroenterology & Hepatology I, (Clinical Hepatology):Hepatology:
Chronic hepatitis (Pathology & Diagnostic Clinical Hepatology): Viral Hepatitis, Storage diseases, Acute &
Chronic alcoholic hepatitis; Cholestatic liver diseases;
Autoimmune liver disease, Drug Induced Liver disease (DILI; Non-alcoholic Fatty liver disease (NAFLD/MAFLD/DAFLD)
Cirrhosis: Staging systems; Portal hypertension (Ascites, Collateral circles, Hepatic encephalopathy)
Acute on Chronic Liver Failure (ACLF): Physiopathology, Clinic & Management
Acute Liver Failure: Physiopathology, Clinic & Management
Hepatocellular Carcinoma (HCC): Pathology & Diagnostic Clinical Hepatology; Interventional Radiology;
Surgery
Cholangiocarcinoma: Pathology & Diagnostic; Clinical Gastroenterology; Endoscopy; Surgery
Liver transplant: Indications/Complications

for Gastroenterology & Hepatology II (Clinical Gastroenterology):
• GI Bleeding: Clinic, diagnosis & management
• Upper GI: Oesophageal disorders; Functional disorders MRGE (and NERD); Peptic disorders
• GI tract Tumours: Pathology & Diagnostic; Clinical Gastroenterology; Endoscopy; Surgery
• IBD: Pathology & Diagnostic; Clinical Gastroenterology; Endoscopy; Surgery
• Coeliac disease: Pathology & Diagnostic; Clinical Gastroenterology; Endoscopy
• NET tumours
• Acute abdomen: Clinic, diagnosis and management
• Pancreas: pancreatitis (Acute & Chronic), Pancreatic tumours

for Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
-Liver:
Ultrasound, CT, MR - contrast agents - clinical indications
Benign liver lesions
Malignant liver tumors
-Biliary tree:
Ultrasound, CT, MR - contrast agents - clinical indications
Congenital anomalies
Infections
Autoimmune inflammatory diseases
Biliary cancer
-Pancreas:
Ultrasound, CT, MR - contrast agents - clinical indication
Acute and chronic pancreatitis
Autoimmune pancreatitis
Benign pancreatic lesions
Cystic tumors and premalignant lesions - classification and follow up
Pancreatic cancer
Neuroendocrine tumors - classification and clinical implications
-GI:
Ultrasound, CT, MR - contrast agents - clinical indications
Congenital anomalies
Functional disorders
Inflammatory bowel diseases
Esophageal, gastric and colorectal cancer
Neuroendocrine tumors

for Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:

  1. OESOPHAGEAL PATHOLOGY
    Evaluate the different investigative studies and identify the proper diagnostic technique: esophagoscopy, esophagography, esophageal manometry, esophagus-gastric pHmetry, echo-endoscopy, CT.
    Recognize the clinical pictures and complications, provide indications for surgical treatment and describe the general aspects of the main surgical interventions in relation to the following pathologies: Hiatal hernia and peptic esophagitis; Esophageal achalasia (and DMA); caustic esophageal injury; esophageal diverticula (Zenker, mediothoracic and epiphrenic); esophageal neoplasms (benign and malignant).
  2. UPPER GI PATHOLOGY
    Evaluate the different investigative studies and identify the proper diagnostic technique: gastroduodenoscopy, digestive tract x-ray, echo-endoscopy, ultrasound, scintigraphy, CT. Recognize the
    clinical pictures and complications, provide indications for surgical treatment and describe the general aspects of the main surgical interventions in relation to the following pathologies: gastric ulcer; duodenal ulcer; acute erosive gastritis; gastric precancerous conditions; gastric neoplasms (benign and malignant).
  3. SMALL BOWEL, COLON AND RECTUM-ANUS
    Evaluate the different investigative studies and identify the proper diagnostic technique: rectoscopy, rectosigmoidoscopy, colonoscopy, x-ray digestive tract, contrast enema, defecography, intestinal transit time, anorectal manometry, endoscopy, ultrasound, CT, MRI. Recognize the clinical pictures and complications, provide indications for surgical treatment and describe the general aspects of the main surgical interventions in relation to the following pathologies: enteritis; Crohn's disease and IBD; intestinal diverticulosis; neoplasms of the colon, rectum, anus; polyposis; rectal prolapse; benign anorectal pathology (anal fistulas, hemorrhoids, fissures, pilonidal cysts).
  4. BILIARY TRACT AND PANCREAS PATHOLOGY
    Evaluate the different investigative studies and identify the proper diagnostic technique: endoscopy, ultrasound, echo-endoscopy; cholangiography, CT, MRI.
    Recognize the clinical pictures and complications, provide indications for surgical treatment and describe the general aspects of the main surgical interventions in relation to the following pathologies: Cholelithiasis; choledocholithiasis; Vater papilla stenosis; pancreatic neoplasms; pancreatic cysts; neuroendocrine tumors of the pancreas.

per Abdominal Surgery (surgical aspects of the digestive system part 1 (Shared with the General Surgery part of the GI Track)
General aspects of perioperative medicine:
• physiopathology of the response to surgical trauma
• surgical infections
• nutrition in surgery
• the concept of ERAS (Enhanced Recovery After Surgery)
Surgical management of the following digestive and abdominal disorders: Indications, techniques, results
• benign disorders of the esophagus: Diverticula, Achalasia Gastroesophageal reflux
• malignant neoplasms of the esophagus
• benign disorders of the stomach: volvulus, foreign bodies, benign neoplasms
• malignant neoplasms of the stomach
• benign disorders of the small and large bowel , benign neoplasms, IBD , volvulus, intestinal occlusion
• malignant neoplasms of the small and large bowel
• disorders of the anus: Fissures, Hemorroids, fistula, neoplasms, condylomata
• benign disorders of the liver: cysts, angiomas, adenomas , nodal focal hyperplasia
• malignant neoplasms of the liver: primary and metastatic
• liver transplantation
• portal hypertension
• benign disorders of the bile ducts: lithiasis of the gallbladder, and of the intra- and extrahepatic ducts
• malignant neoplasms of the bile ducts
• benign disorders of the pancreas: acute and chronic pancreatitis, cysts and pseudocysts
• endocrine neoplasms of the pancreas
• malignant neoplasms of the pancreas
• disorders of the spleen
Anatomy, physiopathology, natural history and surgical repair of abdominal hernias: hiatal and other diaphragmatic hernias, inguinal and crural, hernias, incisional hernias, general aspects of less common hernias (epigastric, lateral ventral, ischiatic, obturator hernias)
Acute abdomen: peritonitis, intestinal occlusion, hemoperitoneum: Clinical features, assessment and surgical management.
Transplantation of the the lung, the pancreas, the small bowel the kidneys

for Craniofacial disorders
The following main pathologies of the head and neck district will be addressed: external, middle and inner ear
disorders (otitis, labyrintitis, hypoacusia, otosclerosis); oral and oropharyngeal disorders (tonsillitis, pharyngitis, OSAS), laryngeal disorders (laryngitis, laryngeal palsy); salivary gland disorders (sialoadenitis, sialolithiasis, tumors of the salivary glands); paranasal sinus disorders (rhinitis, rhinosinusitis, epistaxis, sinonasal polyposis); tumors of the head and neck (oral carcinoma, pharyngeal carcinoma, laryngeal carcinioma, neck lymph nodes metastasis);
anterior and lateral skull base diseases (sinonasal tumors, cerebellopontine tumors such as acoustic neuromas and
meningiomas, paragangliomas)

Prerequisites

Propaedeutic skills & Advanced knowledge in anatomy, semeiology, biology and molecular biology.

Teaching form

the clerckship sessione are subdivided in the following teaching modality, alternating prasctical sessions in the medical units and interactive activities as follows:

Gastroenterology & Hepatology I, (Clinical Hepatology) & II (Gastrointestinal clinic):
Lectures with interactive presentation and discussion.
PBL sessions
Multidisciplinary cases discussions
attendance of the following activities:
Inpatients & Outpatients:

  • patient History (supervised activity)
  • acquisition/interpretation of biochemical, microbiological, instrumental reports ( supervised activity)
  • physical examination of the patient (supervised activity)
    US Scan (observation & acquisition of basic theoretical Skills)
    Endoscopy (observation & acquisition of basic theoretical Skills)
    the ratio Student/Tutor is 1:1 or maximum 1:3

for Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
Alternating practical sessions in the medical units and interactive activities as follows:
Lectures with interactive presentation and discussion.
PBL sessions
Multidisciplinary cases discussions
Inpatients & Outpatients activities:
Ultrasound, Computed Tomography and Magnetic Resonance - attendance during exam execution.

for Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
Frontal lessons, mutidisciplinary lessons in presence and will be held in english

per Abdominal Surgery (surgical aspects of the digestive system part 1
L'insegnamento alternerà sessioni pratiche (nei reparti chirurgici, in ambulatorio e in sala operatoria) e attività
interattive come segue: Lezioni frontali con presentazione e discussione interattiva.
Sessioni PBL (integrate con lo staff gastroenterologico)
Discussioni di casi multidisciplinari
In caso di recrudescenza della pandemia le lezioni si svolgeranno tramite webinar

for Craniofacial disorders

In case of pandemic resurgence the lessons will be through webinar.

Textbook and teaching resource

Gastroenterology & Hepatology I, (Clinical Hepatology) & II (Gastrointestinal clinic):

  • Harrison's Principles of Internal Medicine: The 20th edition of the book, edited by Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson and Joseph Loscalzo, (17 August 2018). The 21st edition of the book to be released on 28 March 2022
  • Zakim and Boyer's Hepatology. A Textbook of Liver Disease. Seventh Edition (2018) (Edited by: Arun J. Sanyal, Thomas D. Boyer, Norah A. Terrault, and Keith D. Lindor)
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease- 2 Volume Set Pathophysiology, Diagnosis, Management. 11th Edition - June 9, 2020. Authors: Mark Feldman, Lawrence Friedman, Lawrence Brandt
  • Clinical Gastrointestinal Endoscopy: A Comprehensive Atlas. (2018) Ed. Hoon Jai Chun, Suk-Kyun Yang, Myung-Gyu Choi
  • Malattie Dell’apparato Digerente 2019-2022: Unigastro (Editrice Gastroenterologica Italiana)
  • Reviews

surgery

  • Lessons on power point slides with references to national and international guidelines
  • Sabiston. Textbook of Surgery. Saunders
  • F. Minni. Chirurgia Generale. Zanichelli
  • F. D’Amico. Manuale di Chirurgia Generale. Piccin
  • References available on the scientific biomedical resource Pubmed

per Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
Review eand articles available on https://pubs.rsna.org/journal/radiographics and other resources available through: https://pubmed.ncbi.nlm.nih.gov

for Craniofacial disorders
Practical Otorhinolaryngology - Head and Neck Surgery
Diagnosis and treatment - Zhonglin Mu, Jugao Fang - Springer, 2021

Semester

Second semester

Assessment method

The exam will be carried out in an integrated manner according to the modality envised by the digestive disease vertical track which is based on:
End of Clerckship evaluation, which includes: >70% attendance and confirmation by the tutor of the required practical skills
these requirements shall allow the access to:
• Multiple Choice Test (45 questions)
All assessments will be done in English language
The evaluation of clerckship 9 shall be: Idoneous or Non Idoneous (and is considered propedeutic to the general exam of the Digestive disease Tract exam (Oral exam on the topics covered during the lectures, discussion on clinical problem solving and clinical case analysis)

• In the event of pandemic emergency period, only telematics exams may be available. They will be carried out using the WebEx platform and on the e-learning page there will be displayed a public link where possible virtual spectators may get access and assist to the examination

per for Gastroenterology & Hepatology I, II (Clinical Gastroenterology & Hepatology)
per Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
per Abdominal Surgery (surgical aspects of the digestive system part 1

  • PATIENT-PHYSICIAN RELATIOSHIP: practical implementation of the good clinical practices of patient-phyisician relationship: listening, dialogue, information, clearness, consent acquisition.
    Relationship with collegues and health personell
  • MEDICAL HISTORY: family, social, physiological, pathological, current problems
  • Diary & chart management
  • PARAMETERS assessment: central & peripheral hearth rate, Respiratory rate, features of breathing, Blood arterial pressure in clino & ortho, centeal & peripheral pulses, interpretation of a thermic courve
  • SKILLS: INJCTIONS: venous catheter placement, ev. infusiuons, arterial infusions, i.m. injections, s.c injections
  • O2: principlkes of O2 therapy - Saturimetry
  • ECG: to execute an ECG . Interpretations of the main ECG pictutes
  • ADMINISTRATIVE ISSUES: How to fill a medica chart (written & electronical), built a discharge letter & SDO
    how to request informed consent
    Compile a medical prescription or a biochemical & imaging test request
  • CONTAGION & PREVENTION: Knowledge & application of protection measures from infection.
    Knowing the actions of prevention and health education
  • PHYSICAL EXAMINATION Examination of the abdomen
    State of conscousness - Hepatic Hencephalopathy
    Diuresis, Bowel alterations Diarrhea and constipation (stool exam)
    Pruritus, skin alterations-pigmentation- Jaundice/Skin disorders /Infectious exanthemas
    Gastrointestinal bleeding
    Nutritional Status /Idratation/ Unintentional weight loss/Thirst / Hunger
    Edemas
    Nutrition - fluid balance
    Identifications of objective signs od dehydration
  • SPECIALISTIC TESTING:
    imaging interpretation of the main Hepato & GI pathologies
    Interpretation of biochemical tests
    Indication to & interpretation of the endoscopic procedures of the GI Tract
    Diagnostic hypothesis formulation & therapeutical plam design
    Principles of Liver biopsy
  • THERAPY principles of medical therapy in Hepat-Gastroenterology
  • OUTPATIENT CARE: Assisting to Hepatologic, Trapiantologic, Gastroenterologic outpatient visit
    Simulation of an Hepatologic, Trapiantologic, Gastroenterologic outpatient visit
  • CLINICA REASONING: Capability of framing the reason for admission within the contesx of complex chronicity conditions of the patient. concepts of Frailty
    To show knowledge and application of clinical reasonment: capability of identifying priority & urgent issues. proposing diagnostic hypothesis and to plan diagnostic algorithms

for Gastroenterology & Hepatology III (clinical Radiology of the digestive system):
The exam will be carried out in an integrated manner according to the modality envised by the digestive disease vertical track which is based on:
End of Clerckship evaluation, which includes: >70% attendance and confirmation by the tutor of the required practical skills. These requirements shall allow the access to:
• Multiple Choice Test (15 questions) + Open questions (3 questions)
All assessments will be done in English language

for Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2:
The evaluation shall be: Idoneous or Non Idoneous (and is considered propedeutical to the general exam of the Digestive disease Tract)

for Abdominal Surgery (surgical aspects of the digestive system part 1
The evaluation shall be: Idoneous or Non Idoneous (and is considered propedeutical to the general exam of the Digestive disease Tract)

for Craniofacial Disorders:
Evaluation based upon skill form

Office hours

The professors shall receive by appointment upon agreement by e-mail

per for Gastroenterology & Hepatology I, II (Clinical Gastroenterology & Hepatology): stefano.fagiuoli@unimib.it

for Gastroenterology & Hepatology III (clinical Radiology of the digestive system): pmarra@asst-pg23-it

per Gastroenterology & Hepatology IV (surgical aspects of the digestive system part2: : mpisano@asst-pg23.it

for Abdominal Surgery (surgical aspects of the digestive system part 1: fneri@asst-pg23.it -

for Craniofacial Disorders: : Prof. G. Danesi (gdanesi@asst-pg23.it) -- Tutors: Dr. A. Pusateri (ampusateri@asst-pg23.it); Dr. G. Giourgos (ggiourgos@asst-pg23.it)

Sustainable Development Goals

GOOD HEALTH AND WELL-BEING | QUALITY EDUCATION | GENDER EQUALITY
Enter

Key information

ECTS
10
Term
Second semester
Activity type
Mandatory
Course Length (Hours)
80
Degree Course Type
6-year single cycle Master Degree
Language
English

Students' opinion

View previous A.Y. opinion

Bibliography

Find the books for this course in the Library

Enrolment methods

Manual enrolments
Guest access

Sustainable Development Goals

GOOD HEALTH AND WELL-BEING - Ensure healthy lives and promote well-being for all at all ages
GOOD HEALTH AND WELL-BEING
QUALITY EDUCATION - Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
QUALITY EDUCATION
GENDER EQUALITY - Achieve gender equality and empower all women and girls
GENDER EQUALITY

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