Gastrointestinal/Nutrition (GIN): Path TBL

Objectives:
At the conclusion of the required readings, students will be able to:

1. Characterize anatomical and functional histologic features of the upper and lower digestive segments, and digestive glands (salivary glands, liver, pancreas and biliary tract/gallbladder).
2. Discuss cellular physiology and multiple metabolic roles of the main cell types in the upper and lower digestive segments, and digestive glands (salivary glands, liver, pancreas and biliary tract/gallbladder). 
3. Compare the different segments of the digestive tract from a physiological point of view. 
4. Outline the innervation (sympathetic and parasympathetic) and vascular supply of the upper and lower digestive tract.
5. Explain the location and function of the diffuse neuroendocrine system in the GI tract and associated glands.
6. Analyze the immunological role of the GI tract and associated glands. 

Pre-Class Assignments

Chapters:

Rx Bricks:

Foundational Objectives:

1. Discuss the pathologic classification of intestinal polyps. 
2. Describe the main polyposis syndromes based on their histopathology and molecular abnormalities.  
3. Recognize the main categories of neoplastic polyps and their malignant potential. 
4. Compare the gross pathology and histopathology of ulcerative colitis and Crohn disease.
5. Correlate clinical and pathologic features of ulcerative colitis and Crohn disease.
6. Explain potential complications of Crohn disease and ulcerative colitis.

Integrative Objectives:

1. Determine how newer therapies intervene in the pathogenetic sequence of IBD.
2. Outline the genetic mutations associated with familial and sporadic colorectal neoplasia.  
3. Assess the functional roles of the mutated genes in oncogenesis and the adenoma-carcinoma sequence.  
4. Interpret the pathogenetic factors of IBD. 

Pre-Class Assignments

Chapters:

Rx Bricks:

Foundational Objectives:

1. Describe the pathogenesis and etiology of esophageal ulcers (infectious, chemical, etc). 
2. Discuss the pathogenesis of gastroesophageal reflux disease (GERD).
3. Explain the pathogenesis of Barrett esophagus and its relationship to GERD. 
4. Outline the histologic sequence and molecular events responsible for progression of glandular metaplasia to esophageal adenocarcinoma in Barrett esophagus. 
5. Correlate the unique biology of Helicobacter pylori and its role in the pathogenesis of peptic ulcers. 
6. Summarize advantages and disadvantages of tests available for diagnosis of H. pylori infections. 

Integrative Objectives:

1. Contrast histopathology, etiology, pathogenesis, and clinical features of chronic gastritis due to H. pylori and autoimmune gastritis.  
2. Classify anemias based on mean cell volume (MCV) of red blood cells. 
3. Explain the role of cellular and humoral immunity in the development of autoimmune gastritis. 
4. Depict the biochemical events responsible for megaloblastic anemias. 
5. Predict neoplastic complications of autoimmune gastritis based on its pathogenesis.  

Pre-Class Assignments

Chapters:

Rx Bricks:

Foundational Objectives:

1. Discuss the gross appearance and histopathology of cirrhosis. 
2. Contrast the different hepatotropic viruses (A, B, C, D, E) regarding their pathogenesis and clinical presentation.  
3. Differentiate autoimmune hepatitides, cholestatic syndromes and metabolic disorders regarding pathogenesis, histopathology and clinical presentation. 
4. Correlate the histopathology metabolic alterations of cirrhosis with its clinical presentation and complications.   
5. Discuss the different diagnostic alternatives for cirrhosis, viral hepatitides, autoimmune hepatitides, cholestatic syndromes and metabolic diseases affecting the liver.

Integrative Objectives:

1. Illustrate the natural history of chronic hepatitis C infection.
2. Identify the main clinical features and laboratory findings of chronic hepatitis C infection.
3.  Explain the histopathologic progression of hepatitis C infection and its implications for treatment.
4. Identify the main complications arising from chronic hepatitis C infection and their possible pathogenetic mechanisms.
5. Analyze molecular targets of antiviral medications used for chronic hepatitis C infection.

Infectious Enterocolitides , Malabsorption, and Diarrhea

Pre-Class Assignments:

Chapters:

Rx Bricks:

Suggested Readings:

• Histology and histopathology resources on the GIN website
• Boards and Beyond videos on GIN website

Objectives:

1. List four major categories of diarrhea based on pathogenesis.
2. Analyze the four phases of nutrient absorption and how they relate to different etiologies of malabsorption syndromes.
3. Differentiate agents of infectious enterocolitides based on etiology, pathogenesis, and histopathology.
4. Discuss diagnostic methods for infectious enterocolitides.

Integrative Objectives:

1. Summarize laboratory tests useful in the diagnosis of celiac disease.
2. Explain laboratory tests that help distinguish malabsorption syndromes due to pancreatic insufficiency and intestinal mucosal abnormalities. 
3. Outline basic statistical principles of laboratory tests: sensitivity, specificity, positive predictive value, negative predictive value.
4. Correlate the pathogenesis and clinical features of celiac disease with characteristic histopathologic changes in the small intestine and laboratory diagnostics 
5. Delineate the role of the innate and adaptive immune responses in the pathogenesis of celiac disease.
6. Outline the most important short- and long- term and complications of celiac disease.  
7. Categorize malabsorption syndromes based on etiological factors.

Pre-Class Assignments

Chapters:

Rx Bricks:

Suggested Readings:

• Histology and histopathology resources on the GIN site
• Board and Beyond videos on the GIN site.

Foundational Objectives:

1. Discuss the pathogenesis and etiology of acute and chronic pancreatitis.
2. Contrast the main diagnostic features of acute and chronic pancreatitis.
3. Analyze the different forms of hereditary pancreatitis and their underlying genetic mutations .
4. Characterize the main complications of acute and chronic pancreatitis.

Integrative Objectives:

1. Illustrate the molecular events responsible for the pathogenesis of pancreatic adenocarcinoma.  
2. Recognize the different neoplastic lesions of the pancreas and their different clinical behavior. 
3. Summarize the principles of laboratory testing and how clinical laboratory tests are selected for clinical use (sensitivity, specificity, false positive, false negative, Receiver Operating Characteristic curve (ROC). 
4. Define the different types of study design.