Systems and Diseases II

A.Y. 2019/2020
20
Max ECTS
252
Overall hours
SSD
MED/03 MED/08 MED/09 MED/12 MED/13 MED/15 MED/16 MED/18
Language
Italian
Learning objectives
The course represents the synthesis of the notions acquired during the first 3 years and the basis for the subsequent detailed clinical studies the will be carried out during Medical and Specialized Clinics.
The objects are the following:
-to provide the student with the knowledge on the main diseases of Gastrointestinal, Endocrinological, Emathological and Immunoreumathological systems (in particular, etiology, pathophysiology and clinical manifestations)
-to give the main information on the genetics and pathological basis of the above-mentioned diseases
-to provide students with the preparatory tools (language, case history, medical examination) for a correct approach to the patient
-to provide with the main clinical, biochemical, instrumental investigations available to perform a correct diagnosis
Expected learning outcomes
1)To know the pathophysiology of:
DIGESTIVE TRACT
Dysphagia, Dyspepsia, gastroesophageal reflux, chronic gastritis, ulcer
Abdominal distension, Gas, digestion problems, Malabsorption
Intestinale obstruction
Abdominal pain
Jaundice
Hepatic insufficiency, viral and toxic hepatitis, liver diseases such as hemochromatosis and Wilson disease, sclerosant cholangitis
Hepatic encephalopathy
Portal hypertension
Biliary lithiasis
Ascites
Constipation
Diarrhea
Gastrointestinal bleeding
Chronic inflammatory bowel diseases (Crohn disease and ulcerative rectocolitis).

ENDOCRINE - METABOLIC SYSTEM:
Feed-back mechanism and interaction with the other systems
Circadian rithms of hormone secretion. Hormones mechanisms of action
Pathogenetic mechanisms of endocrine disorders and of metabolic diseases: eccess and deficiency
Hormone resistance, bioactivity, alterations of hormone peripheral metabolism
Diseases of thyroid, parathyroids, adrenals, gonads, hypothalamus and pituirary
Metabolic syndrome, insulin resistance
Diabetes type 1&2, gestational diabetes, obesity, hyperuricemia
Monogenic diabetes and obesity
Diabetes complications
Bone metabolism and osteoporosis
Hormones and nutrition

BLOOD:
Differentiation and maturation of blood cells
Role of growth factors
Pathophysiology of the main diseases of blood and lymphohemopoietic organs
Lymphoproliferative and Mieloproliferative diseases
Polycythemia vera and secondary polycythemia
Essential thrombocythemia

IMMUNE SYSTEM:
1) Approach to immunodeficiencies
Approach to autoimmune diseases
Approach to allergic diseases, asthma, rhinitis
Rheumatoid arthritis, Sclerodernia, Sjogren disease
Pathophysiology of joints diseases
Pain in rheumatic diseases
Mineral and uric acid metabolism

2) To know how to define a disease, its epidemiology, etiology and pathophysiology, nosography, signs and symptoms; to interpret the pathophysiological causes of signs and symptoms, the biochemical data, the instrumental investigations. The genetics and pathological basis is also requested for certain diseases.

3) To know the indications and limitations of the main diagnostic approaches
Course syllabus and organization

Linea: Policlinico

Responsible
Prerequisites for admission
Propedeutical courses for Systems and Diseases II include: General Pathology and Physiopathology 3 (compulsory), Human Physiology (compulsory).
For the module of Medical Genetics, the basic knowledge presented in the courses of Biology & Genetics and Systems & Diseases I is expected to be assimilated.
Assessment methods and Criteria
At the end of the course, an oral examination is performed; the test is based on an oral question by at least two teachers responsible for different modules (about 15-20 minutes for each teacher).
During the test, the following elements are evaluated: knowledge of the topics presented during the course, ability of critical reasoning on the study carried out; clarity of the oral presentation and the correct use of specialized lexicon. After collective evaluation of the teachers involved in the exam, the mark is expressed in thirtieths.
Gastroenterologia
Course syllabus
Main manifestations of gastrointestinal diseases (abdominal pain, vomiting, diarrhea, constipation, gastrointestinal overt or occult hemorrhage). Pathophysiology of esophagus, gastroesophageal reflux disease and its consequences, esophageal neoplasia.
Gastric pathophysiology, gastritis, peptic disesase, gastric neoplasia.
Pathophysiology of digestion and absorption, malabsorption syndromes, celiac disease, small bowel neoplasia.
Pathophysiology of liver and biliary tract, acute and chronic hepatitis, ov various etiology, cirrhosis and its complications , hepatic and biliary neoplasia.
Pathophysiology of pancreas, acute and chronic pancreatitis, pancreatic neoplasia. Neuroendocrine neoplasia.
Inflammatory bowel diseases, diverticular disease, colorectal neoplasia.
Functional syndromes (non organic dyspespia, irritable bowel disease).
Gastrointestinal infections.
Teaching methods
The course will be made of frontal lectures, interdisciplinary seminars related to specific topics of relavance, discussions of significant clinical cases: all these activities will be performed with maximal interactivity. In the course of the clerkships the practical aspects will be particularly focused in a specialized ward, with the collection,, of typical patient's histories as well as of physical findings performed directly by the students under the supervision of tutors.
Teaching Resources
UNIGASTRO - Digestive Diseases 2019-2022 Edition
Harrison's Principle of Internal Medicine - Twentieth Edition
Endocrinologia
Course syllabus
Feed-back mechanism and interaction with the other systems
Circadian rithms of hormone secretion. Hormones mechanisms of action
Pathogenetic mechanisms of endocrine disorders and of metabolic diseases: eccess and deficiency
Hormone resistance, bioactivity, alterations of hormone peripheral metabolism
Diseases of thyroid, parathyroids, adrenals, gonads, hypothalamus and pituirary
Metabolic syndrome, insulin resistance
Diabetes type 1&2, gestational diabetes, obesity
Monogenic diabetes and obesity
Diabetes complications
Bone metabolism and osteoporosis
Hormones and nutrition

Of the different diseases the student will learn:
-how to define the disease, its epidemiology, etiology and pathophysiology, nosography, signs and symptoms; to interpret the pathophysiological causes of signs and symptoms, the biochemical data, the instrumental investigations. The genetics and pathological basis will be discussed for specific diseases.
- the indications and limitations of the main diagnostic approaches
Teaching methods
- "Frontal teaching" - standard methods of lessons supported by visual means
- Group discussion of clinical cases with clinical decision making
- Non-formal teaching or problem-oriented teaching (training medical students to work autonomously, to think
independently and to make their own assessments and decisions in the professional field.
Teaching Resources
Reference textbooks:
FAGLIA G., "Malattie del Sistema Endocrino e del Metabolismo" McGraw-Hill
FAGLIA G. , "Core curriculum" McGraw-Hill
Harrison's Principle of Internal Medicine - Twentieth Edition

Scientific articles from peer-reviewed international journals suggested by teachers
Malattie del sangue
Course syllabus
- Concepts of normal vs. pathological hematopoiesis; laboratory diagnostics
- Pathophysiology and main forms of anemia
- Congenital and acquired defects of hemostasis
- Platelet disorders
- Acute onco-hematological diseases: clinical and laboratory diagnostics
- Acute and chronic leukemias
- Hodgkin and non-Hodgkin lymphomas
- Monoclonal gammopathies
- Characterization of Multiple Myeloma
- Lymphoproliferative diseases
- Concepts of transfusion medicine
- Bone marrow transplant and cell therapies
- Emergencies in Hematology
- Discussion of clinical cases
Teaching methods
- "Frontal teaching" - standard methods of lessons supported by visual means
- Group discussion of clinical cases with clinical decision making
- Non-formal teaching or problem-oriented teaching (training medical students to work autonomously, to think
independently and to make their own assessments and decisions in the professional field.
Teaching Resources
Hematology textbook II edition, Authors: Corradini - Foa' - Boccadoro - Cappellini - Carlo-Stella - Cattaneo - Federici - Gambacorti-Passerini - Lambertenghi Deliliers - Mannucci - Pane - Peyvandi - Pogliani. Minerva medica Edition, II° edition 2015, single volume.
Next III Edition in 2020, single volume

Scientific articles from peer-reviewed international journals suggested by teachers
Reumatologia
Course syllabus
Immunological mechanisms of allergic diseases
Anaphylactic reactions- pathogenesis, clinicaI aspects and diagnosis
Food allergy
Drug allergy
Allergic asthma
Allergic rhinitis and conjunctivitis
Atopic dermatitis
Mastocytosis
Introduction to rheumatology and classification of rheumatic disorders
Rheumatoid arthritis
Ankylosing spondylitis and spondyloenthesoarthritis
Infectious arthritis
Gout and crystal induced arthropathies
Osteoarthritis
Osteoporosis, osteomalacia, Paget's disease
Extraarticular localized and diffuse pain syndromes
Autoimmunity and autoantibodies
Sjogren's syndrome
Systemic lupus eryhematosus and antiphospholipid syndrome
Systemic sclerosis
Inflammatory myopathies
Overlap syndrome and undifferentiated connective tissue disease
Systemic vasculitides and polymyalgia rheumatica
Pediatric rheumatology
Autoinflammatory diseases
Teaching methods
Class lessons
Clinical cases
Interactive clinical cases
Interpretation of laboratory tests
Interpretation of radiological images
Teaching Resources
testo: Reumatologia per studenti e medici di medicina generale, III edizione - UNIREUMA. Ed Idelson Gnocchi
testo: EULAR Textbook on Rheumatic Diseases - Third Edition (2018) Textbook on rheumatic diseases - https://www.eular.org › edu_textbook
Anatomia patologica
Course syllabus
Endocrine pathology

Pituitary gland
Thyroid gland
Parathyroid glands
Adrenal gland
Multiple endocrine neoplasms

Pathology of the gastrointestinal tract

Pathology of the esophagus: GERD, Barrett esophagus, esophageal tumors
Pathology of the stomach: gastritis, peptic ulcer, gastric tumors
Pathology of the bowel: celiac disease, IBDs, benign and malignant tumors
Pathology of the liver: General Features of Liver Disease, infectious disease, Autoimmune Hepatitis, Drug- and Toxin-Induced Liver Injury, Alcoholic Liver Disease, Metabolic Liver Disease, Nodules and Tumors
Pathology of the pancreas: acute and chronic pancreatitis, tumors of the exocrine and endocrine parenchima
Pathology of the appendix and the anal canal

Pathology of the hematopoietic and lymphoid tissues
Lymphoid neoplasia
Myeloid neoplasia
Bone marrow biopsy
Teaching methods
Lectures
Teaching Resources
Robbins and Cotran. PATHOLOGIC BASIS OF DISEASE (9th Edition)
Medicina interna
Course syllabus
Immunological mechanisms of allergic pathologies - - Anaphylactic Reaction : pathogenesis, clinical aspects and diagnosis - Food allergy - Urticaria - Allergy to Drugs - Allergic Rhinitis - Allergic Asthma - Atopic Dermatits - Mastocytosis
Teaching methods
Frontal lessons with the help of slides that will be provided to the students as a trace for exames preparation - Clinical cases will be presented for the application of the information presented
Teaching Resources
HARRISON 'S INTERNAL MEDICINE -Slides - Articles for the students
Chirurgia generale
Course syllabus
· Endocrine diseases of surgical interest
· benign and malignant gastric disorders
Teaching methods
Lectures, exercises, seminars, case reports, live surgery
Teaching Resources
Basi teoriche e Chirurgia generale (vol. 1) - Chirurgia specialistica (vol. 2) di Renzo Dionigi

Sabiston Textbook of Surgery, 18th Edition - Expert Consult Premium Edition: Enhanced Online Features and Print
By Courtney M. Townsend, Jr., MD, R. Daniel Beauchamp, MD, B. Mark Evers, MD and Kenneth L. Mattox, MD

Hardbound, 2384 pages
Published: NOV-2007
ISBN 10: 1-4160-3675-X
ISBN 13: 978-1-4160-3675-3
Imprint: SAUNDERS

Manuale di Chirurgia Generale di D.F. D' Amico
II Edizione Riveduta e Aggiornata
Opera in 2 volumi
Edizioni Piccin
Genetica medica
Course syllabus
Genetic predisposition to cancer I: Most common hereditary tumor forms, Sporadic forms vs hereditary forms of cancer, Oncosuppressants and oncogenes, Breast (and ovarian) carcinoma: BRCA1 and BRCA2 genes, TP53 gene and Li Fraumeni syndrome, Pediatric tumors (Gene Dicer). Presentation of clinical cases
Genetic predisposition to cancer II: Colorectal carcinomas, Lynch syndrome and related genes, Familial adenomatous polyposis and APC gene, Other hereditary colorectal tumors (MUTYH)
Genetic predisposition to cancer III: Multiple Neuroendocrine Syndromes, Medullary thyroid carcinoma and MEN2, MEN2 syndrome and RET gene, MEN1 syndrome and gene, MEN4 syndrome.
Onco-hematological diseases: pathogenetic gene and chromosomal alterations and molecular investigation methods.
Predisposition and genetic basis in Diabetes: Monogenic and complex diseases, association studies, Type 1 Diabetes, Type 2 Diabetes, Hereditary Diabetes and MODY genes. Fetal origin of metabolic diseases
Epigenetic defect diseases: genomic imprinting diseases with single locus and multilocus epigenetic defects. Presentation of clinical cases.
Teaching methods
Frontal lessons
Teaching Resources
"Genetics in Medicine", Thompson & Thompson; publications (articles, reviews) for further information are also suggested during the lessons and on the Ariel website. Finally, the presentations used during the lessons are provided to the students.
Anatomia patologica
MED/08 - PATHOLOGY - University credits: 2
Lessons: 24 hours
Chirurgia generale
MED/18 - GENERAL SURGERY - University credits: 1
Lessons: 12 hours
Endocrinologia
MED/13 - ENDOCRINOLOGY AND METABOLISM - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Shifts:
Gruppo 1
Professor: Mantovani Giovanna
Gruppo 2
Professor: Mantovani Giovanna
Gruppo 3
Professor: Arosio Maura
Gruppo 4
Professor: Arosio Maura
Gastroenterologia
MED/12 - GASTROENTEROLOGY - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Shifts:
Gruppo 1
Professor: Vecchi Maurizio
Gruppo 2
Professor: Penagini Roberto
Gruppo 3
Professor: Lampertico Pietro
Gruppo 4
Professor: Caprioli Flavio Andrea
Genetica medica
MED/03 - MEDICAL GENETICS - University credits: 1
Lessons: 12 hours
Professor: Miozzo Monica Rosa
Malattie del sangue
MED/15 - BLOOD DISEASES - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Medicina interna
MED/09 - INTERNAL MEDICINE - University credits: 1
Lessons: 12 hours
Reumatologia
MED/16 - RHEUMATOLOGY - University credits: 3
Lessons: 36 hours
Professor: Capsoni Franco

Linea: San Donato

Responsible
Anatomia patologica
MED/08 - PATHOLOGY - University credits: 2
Lessons: 24 hours
Professor: Pruneri Giancarlo
Chirurgia generale
MED/18 - GENERAL SURGERY - University credits: 1
Lessons: 12 hours
Professor: Bonavina Luigi
Endocrinologia
MED/13 - ENDOCRINOLOGY AND METABOLISM - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Gastroenterologia
MED/12 - GASTROENTEROLOGY - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Genetica medica
MED/03 - MEDICAL GENETICS - University credits: 1
Lessons: 12 hours
Professor: Ghezzi Daniele
Malattie del sangue
MED/15 - BLOOD DISEASES - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Medicina interna
MED/09 - INTERNAL MEDICINE - University credits: 1
Lessons: 12 hours
Professor: Froldi Marco
Reumatologia
MED/16 - RHEUMATOLOGY - University credits: 3
Lessons: 36 hours

Linea: San Giuseppe

Responsible
Anatomia patologica
MED/08 - PATHOLOGY - University credits: 2
Lessons: 24 hours
Professor: Pelosi Giuseppe
Chirurgia generale
MED/18 - GENERAL SURGERY - University credits: 1
Lessons: 12 hours
Endocrinologia
MED/13 - ENDOCRINOLOGY AND METABOLISM - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Gastroenterologia
MED/12 - GASTROENTEROLOGY - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Genetica medica
MED/03 - MEDICAL GENETICS - University credits: 1
Lessons: 12 hours
Malattie del sangue
MED/15 - BLOOD DISEASES - University credits: 4
Lessons: 36 hours
Informal teaching: 16 hours
Medicina interna
MED/09 - INTERNAL MEDICINE - University credits: 1
Lessons: 12 hours
Reumatologia
MED/16 - RHEUMATOLOGY - University credits: 3
Lessons: 36 hours