Modules

• Year 1
  • Introduction to Year 1 and Year Outcomes
  • Fundamentals of Medicine
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Human Development 1
  • Medicine in Society 1
  • Clinical Communication Skills
  • Student Selected Component (SSC)
• Year 2
  • Introduction to Year 2 and Year Outcomes
  • Cardiorespiratory 2
  • Metabolism 2
  • Brain and Behaviour 2
  • Human Development 2
  • Human Sciences and Public Health 2
  • Locomotor 2
  • Cancer Week
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
  • Clinical Communication Skills
  • Medicine in Society 2
  • Extended Patient Contact
  • Student Selected Component (SSC)
• Year 3
  • Introduction to Year 3 and Year Outcomes
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Public Health
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Student Selected Component (SSC)
  • Clinical and Communication Skills
• Year 4
  • Introduction and Year 4 Outcomes
  • Obstetrics and Gynaecology
  • Child Health
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Neuroscience
  • Dermatology
  • General Practice and Community Care
  • Psychiatry
  • Ear, Nose and Throat
  • Global Health and Ethics
  • Ophthalmology
  • Clinical & Communication Skills
  • Student Selected Component (SSC)
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Teaching Week 2
  • Anaesthesia & ITU (AN & ITU)
  • Breaking Bad News
  • Clinical Pharmacology & Therapeutics
  • Community Care
  • Doctors as Teachers and Educators (DATE)
  • Emergency Medicine (EMERG MED)
  • General (Internal) Medicine (G(I)M)
  • Immediate Life Support (ILS)
  • Student Assistantship
  • Simulation
  • Surgery
  • Student Selected Component (SSC)
• Year GEP 1
  • Cancer Week
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Ethics
  • Brain and Behaviour
  • Human Development
  • Clinical Communication Skills
  • Medicine in Society (GEP)

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Year GEP 1 GEP/DGM: Digestion, Growth and Metabolism

• Dr David Burleigh
• d.e.burleigh@qmul.ac.uk

Teaching Material for this Module

Introduction

The DMG module brings together elements from the Alimentary and Endocrine systems; it also deals with aspects of biochemistry and Human Nutrition.

The Alimentary (gastrointestinal) system absorbs nutrients, primarily derived from digestion of carbohydrates, proteins and fats. Such nutrients are converted by biochemical processes (metabolism) to provide the energy, growth and repair requirements of the body. Hormones have a marked influence on such processes. Finally, waste products of metabolism, together with water and electrolytes, are excreted by the kidneys. 

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Index

• General Outcomes for Gastrointestinal System
• General Outcomes for Renal and Urinary System
• General Outcomes for Endocrine System
• Disorders of the Hepato-biliary System
• Nutrition and Malnutrition
• Adrenal Disease
• Pituitary Disorders

• General Outcomes for Gastrointestinal System
  • Medical knowledge: ANATOMY (TD 8.1)
    • Abdominal / Gut Anatomy - General
      1. Outline the basic components that make up the wall of the alimentary tract.
      2. Define the acronyms MALT and GALT.
      3. Describe variations in the basic wall plan at particular sites (i.e. junctions, retroperitoneal regions).
      4. Describe the changing nature and function of the mucosae in the alimentary tract.
      5. Explain how the mucosa of the small intestine is adapted to increase its surface area for absorption.
      6. Outline the cellular composition of the epithelia in each part of the alimentary tract.
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Gastrointestinal Physiology - General
      1. Critical role of the intestine in animal/human evolution
      2. Normal gastrointestinal tract
      3. List techniques by which energy expenditure can be measured in the living human.
      4. Small intestine - absorption; immune system, coeliac disease and inflammatory bowel disease
      5. Summary - reasons for gastroenterology being an interesting and important area in which to work
    • Function of the GI Tract
      1. Outline control of gastrointestinal function by the autonomic nervous system.
  • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Metabolism - General
      1. Define inherited metabolic disorders and list common inherited metabolic disorders.
      2. Explain why an understanding of Metabolism is important in terms of normal human physiology and disease states. Explain the links between digestion, catabolic and anabolic pathways.
      3. Outline the metabolic impact of Von Gierke's disease.
      4. Discuss with examples the integration of metabolism in different human organs and different cell compartments.
      5. Discuss with examples the significance of the regulation of metabolism in humans.
      6. Outline the biochemical basis and consequences of galactosaemia.
      7. Outline the biochemical basis and consequences of McArdle's disease
      8. Describe the consequences of a deficiency of liver fructokinase or fructose 1-phosphate aldolase.
      9. Outline the inherited metabolic disorders of amino acid metabolism
      10. Describe the consequences of phenylketonuria.
      11. List the genetic causes of dyslipidaemia.
      12. Describe the consequences of familial hypercholesterolaemia.
    • Energy from Metabolism
      1. Calculate the energy requirements in health. Define resting metabolic rate and the thermogenic effect of food and   physical activity. Note that disease may increase resting metabolism but often reduces activity.
      2. Note that a thermodynamically favourable reaction is driven by a favourable one and that ATP to ADP or ADP to AMP are the common drivers.
      3. ATP is regenerated by the oxidation of (removal of electrons from) food. Oxygen is the final electron acceptor but this is indirect via a number of mitochondrial molecules or   electron carriers based on water soluble vitamins. This reforming of
      4. 1st stage of food oxidation: Large molecules protein, fats,  polysaccharides/starch  broken down to small  molecules - no ATP formed
      5. 2nd stage of food oxidation: Numerous small molecules degraded to a few  central  molecules particularly Acetyl CoA with some generation  of ATP
      6. 3rd stage of food oxidation: Citric acid cycle produces electrons from acetyl CoA and oxidative phosphorylation passes the electrons via the electron acceptors to oxygen to form much more ATP.
      7. Acetyl CoA is another (of several) carrier of a group (acetyl) with a thermodynamically favourable high transfer potential. CoA is based on the B vitamin, pantothenate. Most water soluble vitamins are components of coenzymes.
      8. Most biosynthetic processes require the reduction of precursors (donation of electrons to the precursor).  The electron donor is usually NADPH, another form of a B vitamin.
    • Glucose and Glycogen Metabolism
      1. Outline the role of liver glycogen as a source of blood glucose during a normal feeding cycle.
      2. Describe the structure of glycogen.
      3. Outline the circumstances under which glycogen synthesis and degradation will occur.
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • Gastrointestinal System - General Pathology
      1. Outline the changing nature and function of the epithelial lining of the alimentary tract.
      2. Draw a diagram of the normal small intestinal mucosa and show what changes occur in enteropathy.
      3. Illustrate the structure of the upper small intestinal wall (serosa to mucosa).
      4. Describe common pathologies of the gastrointestinal tract.
• General Outcomes for Renal and Urinary System
  • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • Bladder Dysfunction and Urinary Tract Infection
      1. Distinguish between urge incontinence, stress incontinence, overflow incontinence and leak incontinence
• General Outcomes for Endocrine System
  • Medical knowledge: ANATOMY (TD 8.1)
    • Pituitary Gland
      1. Describe the general organisation of endocrine tissues in the pituitary gland
      2. Describe the blood supply to the pituitary gland and its relevance to anterior pituitary function
    • The Adrenal Glands
      1. Describe the general organisation of endocrine tissues in the adrenal glands
      2. Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system
    • Pancreas
      1. Describe the general organisation of endocrine tissues in the Islets of Langerhans of the pancreas
    • Thyroid and Parathyroid Glands
      1. Describe the general organisation of endocrine tissues in the thyroid and parathyroid glands
    • Epithelia and Glands
      1. Recognise and name the cell types found in these endocrine tissues - pituitary gland, thyroid and parathyroid glands, adrenal glands and pancreas
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Thyroid Gland
      1. Outline the synthesis, storage and release of thyroid hormones
      2. Describe the effects of thyroid stimulating hormone on the thyroid gland
      3. Outline the actions of thyroid hormones
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • General Outcomes for Endocrine Disorders
      1. Recognise and describe specific disease processes that affect the glands of the endocrine system
• Disorders of the Hepato-biliary System
  • Hepato-biliary Disorders - General
    1. Give an overview of the role of the liver in carbohydrate, lipid and protein metabolism
    2. Describe the role of the liver in glucose homeostasis
    3. Describe how the liver acts as an organ of detoxification
    4. Discuss the role of the liver in protein synthesis
    5. Describe the storage functions of the liver
    6. Describe how the liver degrades alcohol &how excess alcohol produces a fatty liver.
    7. Describe the components of the biliary tree (including the sphincter of Oddi)
    8. Outline the formation and functions of bile
    9. Describe the function of the gallbladder and its control
    10. Describe the enterhepatic circulation of bile
    11. Describe the origin, metabolism and excretion of bilirubin
• Nutrition and Malnutrition
  • General Outcomes for Nutrition and Malnutrition
    1. Describe the different methods of nutritional assessment
  • Fasting and Starvation
    1. Describe how to identify those at risk of malnutrition
• Adrenal Disease
  • General Outcomes for Adrenal Disease
    1. Clinical uses of corticosteroids
    2. Clinical uses of corticosteroids
    3. Explain how long-term corticosteroid therapy disrupts endogenous corticosteroid secretion
• Pituitary Disorders
  • General Outcomes for Pituitary Disorders
    1. List the hormones secreted by both the anterior and posterior pituitary and in each case explain the role of the hypothalamus in regulating their secretion
    2. Use the concept of negative feedback to explain the principles underlying clinical tests for pituitary hormone secretion

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