Semiotics and pathology of systems 2

A.Y. 2020/2021
18
Max ECTS
216
Overall hours
SSD
MED/03 MED/09 MED/12 MED/13 MED/15 MED/16 MED/18
Language
Italian
Learning objectives
The course aims to teach the epidemiology, the principal pathophysiological mechanisms, the procedures for diagnosis and management of the endocrine, metabolic, gastroenterological, rheumatological and haematological diseases.
Expected learning outcomes
The students should be able to:
i) recognize and classify the clinical manifestations of the endocrine, metabolic, gastroenterological, rheumatological and haematological disorders;
ii) recognize the frequency and the main pathological mechanisms involved in these diseases;
iii) correctly employ in the right sequence the main diagnostic exams (biochemical and molecular) as well as imaging techniques;
iv) recognize the clinical methodologies to prevent and reduce acute and chronic complications of these diseases.
Course syllabus and organization

Single session

Responsible
In the first semester the lectures will take place as concurrent classroms:
·in the classroom with a limited number of students, who have previously booked using the "lezioniUnimi" app with the unimi e-mail account username and password; (https://www.unimi.it/it/studiare/frequentare-un-corso-di-laurea/seguire…) and at the same time through the "Teams platform" for online students ;
· The student must wear a surgical mask for the entire duration of his/her stay in the classroom and to sit using every other free seat
· the lectures will be recorded and made available on the teacher's Ariel website for students with proven difficulties to connect during classes
· the lectures will take place at the San Paolo Hospital on the 3rd floor of Blocco C. Students must access classrooms via Blocco C and exit via the side blocks (students leaving Pauling and Fleming rooms towards Blocco B and students leaving Curie, Golgi and Pasteur rooms towards Blocco A).
Students must enter from the main hall (R floor) of the San Paolo hospital and undergo body temperature measurement by the infrared cameras. It is strongly recommended to use the stairs for classrooms entering and/or leaving.
NB for any further information check the unimi.it website: (Home Studiare Frequentare un corso di laurea Seguire il percorso di studi Orari delle lezioni)
Prerequisites for admission
Mechanisms of hormone action, Biochemistry and synthesis of steroid and thyroid hormones, Anatomy and embryological origin of endocrine system, Menstrual cycle and its alterations, Principles of oncogenesis, Mechanisms underlying the heritable diseases, Anatomy and physiology of the digestive system, mechanism of intestinal absorption, biochemistry and hepatic metabolism of carbohydrates, lipids and proteins, principles of immunology, principles of microbiology and virology
Rheumatology, pathogenesis of inflammation, joints' anatomy, biochemical properties of connective tissues
Assessment methods and Criteria
oral exam
Internal medicine
Course syllabus
- Immunodeficiencies;
- Allergic diseases
- Selective IgA deficiency, common variable immunodeficiency
- Allergic rhinitis and conjunctivitis
- Urticaria and angioedema
- Anaphylactic shock
- Food allergy
- Allergy to drugs.
Teaching methods
Lectures, Clinical cases, Seminars, Grand Rounds, Case studies with interactive discussion and clerckships.
The iconographic material used for the lessons is shared with the students at the end of the lesson or deposited on the Ariel platform.
Teaching Resources
· Harrison's Principles of Internal Medicine, 20th Edition, McGraw Hill, 2018 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
Gastroenterology
Course syllabus
Lecture 1 - Approach to the patient with esophageal, gastric and intestinal symptoms
Lecture 2 -A journey inside the digestive tract
Lecture 3 - Functional diseases of the digestive tract
Lecture 4 - Gastro-esophageal reflux and esophageal motility disorders
Lecture 5 - Dysphagia and esophageal cancer
Lecture 6 Pathology of esophagus
Lecture 7 - Helicobacter Pylori related diseases and gastric cancer
Lecture 8 - Pathology of the stomach
Lecture 9 - Malabsorbtion and coeliac disease
Lecture 10 - Pathology of small bowel
Lecture 11 - Inflammatory bowel diseases : Crohn's disease
Lecture 12 - Inflammatory bowel diseases: Ulcerative Rettocolitis
Lecture 13 - Pathology of Inflammatory bowel diseases
Lecture 14 - Diverticular disease
Lecture 15- Colon Cancer
Lecture 16- Pathology of polyps and colon cancer
Lecture 17- Anorectal diseases
Lecture 18 -Intestinal microbiota and the potential role in the gastrointestinal diseases
Lecture 19 - Acute pancreatitis
Lecture 20- Chronic pancreatitis and pancreatic tumors
Lecture 21- Pathology of pancreas
Lecture 22 - Approach to the patient with Liver disease and interpretation of liver function tests
Lecture 23 - Viral Chronic Hepatitis
Lecture 24 - liver cirrhosis and its complications
Lecture 25 - Non alcoholic fatty liver disease and alcoholic liver disease
Lecture 26 - Drug-induced liver injury
Lecture 27 - Immune mediated Liver diseases
Lecture 28 - Inherited liver diseases
Lecture 29 - Gallbladder disease and other diseases of the biliary tract
Lecture 30 - Pathology of the liver
Lecture 31- Liver transplantation
Interactive clinical case discussions (6 hours)
Teaching methods
Lectures, Clinical cases, Seminars, Grand Rounds, Case studies with interactive discussion and clerckships.
The iconographic material used for the lessons is shared with the students at the end of the lesson or deposited on the Ariel platform.
Teaching Resources
· Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 10th edition
· Unigastro (Coordinamento Nazionale dei Docenti di Gastroenterologia): Malattie dell'Apparato Digerente-Edizione 2019-2022( also available in English version)
Endocrinology
Course syllabus
Lecture 1 - Impact of endocrinology on general health
Lecture 2 - Hypothalamus and Pituitary tumors
Lecture 3 - Hypothalamus and pituitary: hypopituitarism
Lecture 4 - Thyroid function and hypothyroidism
Lecture 5 - Thyroid dysfunction: hyperthyroidism and thyrotoxicosis
Lecture 6 - Diagnostic problems of thyroid conditions and rare thyroid diseases
Workshop 7 - Thyroid goiter, nodules and cancers
Lecture 8 - Obesity, disorders of lipid metabolism and nutrition disorders
Lecture 9 - Diabetes Mellitus type 1 and 2
Lecture 10 - Hypoglycemia and differential diagnosis
Lecture 11 - Diabesity and gouts
Lecture 12 - Urbanization, life-style changes and metabolic diseases
Lecture 13 - Male reproductive endocrinology
Lecture 14 - Female reproductive endocrinology
Lecture 15 - Hypercortisolism and endocrine hypertensions
Lecture 16 - Congenital adrenal hyperplasia and Addison disease
Lecture 17 - Disorders of calcium homeostatsis
Lecture 18 -- Multiple Endocrine Neoplasia and neuroendocrine tumors
Lecture 19 -- Metabolic Bone disorders
Workshop 20 - Adrenal Incidentaloma
Lecture 21 - Diabetes insipidus, hyponatremia
Interactive clinical case discussions (8-10 hours)
Teaching methods
Lectures, Clinical cases, Seminars, Grand Rounds, Case studies with interactive discussion and clerckships.
The iconographic material used for the lessons is shared with the students at the end of the lesson or deposited on the Ariel platform.
Teaching Resources
· Endotext: The best Clinical Endocrinology source in the world, and FREE. (www.endotext.org)
· Endocrinologia Core Curriculum, Ed Faglia e Beck-Peccoz, McGraw Hill
Blood diseases
Course syllabus
Lecture 1 - Pathophysiology of Hematopoiesis
Lecture 2 - Cell Blood Count - Bone Marrow aspirate and biopsy, cell morphology
Lecture 3 - Hemoglobin - Main causes of Anemia
Lecture 4 - Anemia due to Iron deficiency and to chronic inflammation; iron overload
Lecture 5 - Anemia due to Folic Acid or Vitamin B12 deficiency
Lecture 6 - Hemolytic anemia: general issues
Lecture 7 - Thalassemia and other hemoglobinophaties
Lecture 8 - Hereditary hemolytic anemias:
Spherocytosis
Sickle-cell anemia
Red blood cell enzymopathies
Lecture 9 - Extrinsic causes: paroxysmal nocturnal hemoglobinuria
Lecture 10 - Autoimmune hemolytic anemia
Lecture 11 - White Blood Cells: general issues
Lecture 12 - Leukopenia; Aplastic Anemia
Lecture 13 - Chronic Myeloproliferative Neoplasms I.
Lecture 14 - Chronic Myeloproliferative Neoplasms II.
Lecture 15 - Acute Leukemia:
Diagnosis
Classification and molecular features
Management
Lecture 16 - Lymphoproliferative disorders: main aspects
Lecture 17- Hodgkin's Lymphoma
Lecture 18- Non-Hodgkin's Lymphomas
Lecture 19 - Pathological Diagnosis in Hematology I.
Lecture 20 - Pathological Diagnosis in Hematology II.
Lecture 21- Chronic Lymphocytic Leukemia (CLL)
Lecture 22 - Plasma Cell Dyscrasia, MGUS
Lecture 23 - Multiple Myeloma
Lecture 24 - Pathophysiology of Hemostasis
Lecture 25- Thrombocytopenia, thrombocytopathies and thrombocytosis
Lecture 26- Hereditary coagulopathies
Lecture 27 - Abnormal clotting activation:
Disseminated intravascular coagulation (DIC)
Thrombotic thrombocytopenic purpura (TTP)
Lecture 28 - Inherited and acquired thrombophila
Lecture 29 - Anticoagulant therapies
Lecture 30 - Biological therapies in Hematology
Lecture 31 - Novel insights in Immunotherapy
Lecture 32 - Hematopoietic stem cell transplantation I.
Lecture 33 - Hematopoietic stem cell transplantation II.
Lecture 34 - Transfusions
Lecture 35 - Distinct entities in Hematology
Amyloidosis
Cryoglobulinemia
Hypersplenism

Additional 6-8 interactive lessons, with clinical case discussion
Teaching methods
Lectures, Clinical cases, Seminars, Grand Rounds, Case studies with interactive discussion and clerckships.
The iconographic material used for the lessons is shared with the students at the end of the lesson or deposited on the Ariel platform.
Teaching Resources
· Corso di malattie del sangue e degli organi emolinfopoietici. Per gli studenti di medicina e chirurgia, scienze biologiche, biotecnologie (Italiano), Sante Tura - Esculapio Ed.
· Manuale di ematologia Edizioni, P. Corradini e R. Foà - Minerva Medica, Second Edition 2014
Rheumatology
Course syllabus
1- Rheumatology at a glance
2- The laboratory in rheumatology
3- Rheumatoid arthritis
4- Crystal arthropathies
5- Spondyloarthritides
6- Polymyalgia rheumatica and giant cell arteritis
7- Osteoporosis
8- Septic arthritides
9- Vasculitides
10- Other osteometabolic disorders
11- Osteoarthritis
12- Connective tissue diseases - SLE
13- Raynaud's phenomenon and systemic sclerosis
14- Myositis - Sjogren's syndrome
15- Rheumatology in internal medicine
16- Extra-articular rheumatisms
17- Low back pain
18- Imaging in rheumatology
Interactive clinical cases discussion
Question time (4 sessions)
Teaching methods
Lectures, Clinical cases, Seminars, Grand Rounds, Case studies with interactive discussion and clerckships.
The iconographic material used for the lessons is shared with the students at the end of the lesson or deposited on the Ariel platform.
Teaching Resources
· Unireuma - Reumatologia - per studenti e medici di medicina generale. Autore: Valentini - Bombardieri - Cutolo - Ferraccioli - AAVV , Editore: Idelson - Gnocchi, Edizione: II 6/2014, Volume: Unico
· EULAR Textbook on Rheumatic Diseases - Third Edition (2018) (https://ard.bmj.com/pages/eular-textbooks/)
General surgery
Course syllabus
- Hepatobiliary diseases
- Colorectal diseases
- Gastric cancer
- Pancreatic disease
Teaching methods
Lectures, Clinical cases, Seminars, Grand Rounds, Case studies with interactive discussion and clerckships.
The iconographic material used for the lessons is shared with the students at the end of the lesson or deposited on the Ariel platform.
Teaching Resources
1. John Bridgewater, Peter R. Galle, Shahid A. Khan, Josep M. Llovet, Joong-Won Park, Tushar Patel, Timothy M. Pawlik,, Gregory J. Gores Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. EASL, Journal of Hepatology 2014:1-22
2. Forner A, Reig M, Bruix J. Hepatocellular carcinoma, Lancet 2018: 1-14
3. Strobel O, Hank T, Hinz U, Buckler W. Pancreatic cancer surgery. Annals of Surgery, 2017
4. Kempeneers MA1, Issa Y1, Ali UA2, Baron RD3, Besselink MG1, Büchler M4, Erkan M5, Fernandez-Del Castillo C6, Isaji S7, Izbicki J8, Kleeff J9, Laukkarinen J10, Sheel ARG11, Shimosegawa T12, Whitcomb DC13, Windsor J14, Miao Y15, Neoptolemos J4, Boermeester MA16; Working group for the International (IAP - APA - JPS - EPC) Consensus Guidelines for Chronic Pancreatitis. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology 2019: 1-9
Medical genetics
Course syllabus
Cystic fibrosis
Classic and non-classical forms
Genetics: genotype / phenotype correlations, allelic heterogeneity, modifier genes, mutational analysis
Therapeutic perspectives

Genetic factors for male infertility
Chromosomal abnormalities (Klinefelter syndrome, Y chromosome microdeletions)
Monogenic diseases (CFTR, AR)
Mitochondrial DNA alterations

Hereditary cardiomyopathies
Hypertrophic, arrhythmogenic, dilatative, or restrictive cardiomyopathies: genetic bases and pathogenetic mechanisms
Cardiac canalopathies (eg long QT and Brugada syndromes)
Conduction defects
Secondary cardiomyopathies: mitochondrial diseases

Cardiac malformations with a genetic basis (syndromic and non)
Chromosomal syndromes (eg Down and DiGeorge syndromes)
Monogenic syndromes: RASopathies

Renal diseases with a genetic basis
Hereditary renal cystic diseases: Polycystic kidney
Glomerular renal diseases
Congenital nephrotic syndromes
Teaching methods
The program will be carried out through lectures with the help of teaching material (slides and / or videos), and practical hospital activities, in which the student will learn how to collect data hystory and to make a physical examination.
Teaching Resources
G. Neri, M. Genuardi, Genetica umana e medica, Edra Masson Ed.
Thompson & Thompson Genetica in Medicina, EdiSES
Blood diseases
MED/15 - BLOOD DISEASES - University credits: 4
Lessons: 48 hours
Professor: Tarella Corrado
Endocrinology
MED/13 - ENDOCRINOLOGY AND METABOLISM - University credits: 4
Lessons: 48 hours
Gastroenterology
MED/12 - GASTROENTEROLOGY - University credits: 4
Lessons: 48 hours
Professor: Zuin Massimo
General surgery
MED/18 - GENERAL SURGERY - University credits: 1
Lessons: 12 hours
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 1
Lessons: 12 hours
Professor: Podda Gianmarco
Medical genetics
MED/03 - MEDICAL GENETICS - University credits: 1
Lessons: 12 hours
Professor: Alcalay Myriam
Rheumatology
MED/16 - RHEUMATOLOGY - University credits: 3
Lessons: 36 hours
Professor(s)
Reception:
Friday 14-15 (appointment requested)
IRCCS Istituto Auxologico Italiano - Ospedale San Luca (5°piano) - Piazzale Brescia 20 - 20149 Milano