Study Guide Alimentary & Hepatobiliary Systems & Disorders STUDY GUIDE “Alimentary and Hepatobiliary System and Disorders” Semester IV 21 March – 2 May 2017 DEPARTMENT OF MEDICAL EDUCATION FACULTY OF MEDICINE UDAYANA UNIVERSITY DENPASAR 2017 Udayana University Faculty of Medicine, DME, 2017 1 Study Guide Alimentary & Hepatobiliary Systems & Disorders CONTENTS Hal Table of contents ……..………….……………………………………………………………. 1 Curriculum ……………………………………………………………………...……………… 2 SKDI …………………………………………………………………………………………….. 5 Block Team ….……………………………………………………………………................... 9 Facilitators …………………………………………………………...………………………… 11 Time Table English Class ….………………………………………………………………… 12 Time Table Reguler Class ..………………………………………...……………………… 16 Student Project ………..…………………………………………………………………….… 20 BCS ………..……………………………………………………………………………………. 21 Hospital Visit ………….……………………………………………………………………….. 22 Assessment method ………………………………………………………………………….. 23 Learning Program .…………………………………………………………………………….. 24 Abstract …..………………………………………………………………………………….…. 24 Learning Task and Self Assessment ……..…………………………………………………. 50 Reference ..…………………………………………………………………………..………… 72 Assessment Form .……………………………………………………………………………. 73 Curriculum Mapping .………………………………………………………………………….. 76 Udayana University Faculty of Medicine, DME, 2017 2 Study Guide Alimentary & Hepatobiliary Systems & Disorders CURRICULUM Aims 1. Comprehend the biologic function of alimentary and hepatobiliary system to pathological process of alimentary and hepatobiliary system disorders. 2. Apply and interpret physical examination, laboratory, and imaging diagnosis of alimentary and hepatobiliary system disorders 3. Diagnose and manage patient with common alimentary and hepatobiliary system disorders 4. Diagnose and refer special patients with alimentary and hepatobiliary system disorders 5. Plan patient, family, and necessary community education about alimentary and hepatobiliary system disorders Learning Outcomes 1. Describe the functional structure alimentary system and its general clinical implications 2. Describe the functional structure of hepatobilliary system and its general clinical implications 3. Comprehend the pathological basis underlying the symptoms and sign of alimentary and hepatobilliary disorders. 4. Recognize the potential uses of common diagnostic and therapeutic alimentary and hepatobilliary procedures 5. Manage oral cavity disorders: a. Diagnose and manage independently some mouth disorders such as Candidiasis, and mouth ulcers. b. Diagnose, give initial treatment and refer glossitis, caries, gingival disorders, periodintitis, pulpitis, toothache and infection c. Diagnose and refer some mouth disorders such as cleft lip and palate, micrognatia and macrognatia, and leukoplakia 6. Manage esophageal disorders: a. Diagnose, give initial treatment and refer corrosive lesion of esophagus and reflux esophagitis b. Diagnose and refer esophageal atresia, achalasia, esophageal varices and esophageal rupture 7. Manage abdominal wall disorders a. Diagnose, give initial treatment and refer umbilical hernia b. Diagnose and refer inguinal hernia, femoral hernia, ephigastric herhia, incisional hernia, diaphragmatic hernia, and hiatus hernia 8. Manage stomach and duodenum disorders: a. Diagnose and manage independently gastritis and gastroenteritis (refer if needed in pediatric cases, especially with dehydration) Udayana University Faculty of Medicine, DME, 2017 3 Study Guide Alimentary & Hepatobiliary Systems & Disorders b. Diagnose, give initial treatment and refer gastric/duodenal ulcer and gastrointestinal bleeding. c. Diagnose and refer Zollinger-ellison syndrome, and Mallory-weis syndrome 9. Manage jejunum and ileum disorders: a. Diagnose and manage independently enteritis case b. Diagnose and refer intestinal atresia, Meckel’s diverticulum, umbilical fistula, omphalocoele-gastroschisis, and malrotation 10. Manage colon and anal disorders: a. Diagnose, give initial treatment and refer irritable bowel syndrome, necrotizing enterocolitis, diverticulitis, colitis, rectal and anal prolapse, proctitis, and haemorrhoids. b. Diagnose and refer (peri)anal abscess, fistula anal, and anal fissure 11. Manage acute abdomen cases: a. Diagnose, give initial treatment, and refer salphingitis (covered more details in The Genital System and Disorders Block), acute appendicitis, appendicular abscess, and ileus b. Diagnose and refer peritonitis, abscess in pouch of douglass, perforation, and mesenteric lymphadenitis. 12. Manage liver disorders: a. Diagnose and manage independently fatty liver, hepatitis A, uncomplicated hepatitis B, and Amoebic liver abscess. b. Diagnose, give initial treatment and refer active hepatitis C and cirrhosis hepatis c. Diagnose and refer liver failure. 13. Manage gall bladder, bile duct and pancreas disorders: a. Diagnose, give initial treatment and refer acute cholecystitis b. Diagnose and refer chole (docho) lithiasis, hydrops of gall bladder, empyema of gall bladder and pancreatitis. 14. Manage neoplasma of alimentary and hepatobiliary system a. Diagnose and refer neoplasma of Alimentary system, such as benign polyps, squamous cell carcinoma, adenocarcinoma, carcinoid tumor, lymphoma b. Diagnose and refer neoplasma of hepatobiliary system, such as liver cell adenoma, hepatocellular carcinoma, cholangiocarcinoma, and carcinoma of the pancreas 15. Manage special cases of alimentary in pediatric: a. Diagnose and manage independently worm infection (covered more details in The Infection and Infectious Diseases Block), peritonitis tuberculosis, and food allergy (covered more details in The Immune System and Disorders). b. Diagnose, give initial treatment and refer malabsorbtion and food intolerance cases. c. Diagnose and refer pyloric stenosis, intussussception, hirschsprung’s disease, chron’s disease, reye’s syndrome, ulcerative colitis and anal atresia. 16. Write rational and legal prescription for alimentary and hepatobiliary patients 17. Implement patient education in the prevention and early detection of common alimentary and hepatobilliary disorders. Udayana University Faculty of Medicine, DME, 2017 4 Study Guide Alimentary & Hepatobiliary Systems & Disorders Curriculum contents 1. Functional structure of alimentary and hepatobiliary system 2. Pathological basis of alimentary and hepatobiliary disorders 3. Symptom and signs of alimentary and hepatobiliary system disorders a. cavity disorders b. esophageal disorders c. abdominal wall disorders d. stomach and duodenum disorders e. jejunum and ileum disorders f. colon and anal disorders g. acute abdomen h. liver disorders i. gall bladder, bile duct and pancreas disorders j. neoplasma of alimentary and hepatobiliary system k. special cases of alimentary in pediatric 4. Physical examination, laboratory investigation and imaging studies in alimentary and hepatobilliary disorders 5. Rational drug use in alimentary and hepatobiliary disorders 6. Management of alimentary and hepatobiliary disorders 7. Communication and basic principles in the prevention and early detection of alimentary and hepatobiliary disorders Some contents of this Block are covered more details in the other blocks, such as: 1. Salphingitis is covered more details in The Genital System and Disorders Block 2. Worm infection is covered more details in The Infection and Infectious Disesases 3. Food allergy is covered more details in The Immune System and Disorders Udayana University Faculty of Medicine, DME, 2017 5 Study Guide Alimentary & Hepatobiliary Systems & Disorders STANDAR KOMPETENSI DOKTER INDONESIA Sistem Gastrointestinal, Hepatobilier, Pankreas No Daftar Penyakit Tingkat Kemampuan Mulut 1 Sumbing pada bibir dan palatum 2 2 Micrognatia and macrognatia 2 3 Kandidiasis mulut 4A 4 Ulkus mulut (aptosa , herpes) 4A 5 Glositis 3A 6 Leukoplakia 2 7 Angina Ludwig 3A 8 Parotitis 4A 9 Karies gigi 3A Esofagus 10 Atresia esofagus 2 11 Akalasia 2 12 Esofagitis refluks 3A 13 Lesi korosif pada esofagus 3B 14 Varises esofagus 2 15 Ruptur esofagus 1 Dinding, Rongga Abdomen dan Hernia Hernia (inguinalis, femoralis, skrotalis) reponibilis, 16 2 irreponibilis Hernia (inguinalis, femoralis, skrotalis) strangulata, 17 3B inkarserata 18 Hernia (diaframatika, hiatus) 2 19 Hernia umbilikalis 3A 20 Peritonitis 3B 21 Perforasi usus 2 22 Malrotasi traktus gastro-intestinal 2 23 Infeksi pada umbilikus 4A 24 Sindroma Reye 1 Lambung, Duodenum, Jejunum, Ileum 25 Gastritis 4A 26 Gastroenteritis (termasuk kolera, giardiasis) 4A 27 Refluks gastro-esofagus 4A Udayana University Faculty of Medicine, DME, 2017 6 Study Guide Alimentary & Hepatobiliary Systems & Disorders 28 Ulkus (gaster, duodenum) 3A 29 Stenosis pilorik 2 30 Atresia intestinal 2 31 Divertikulum Meckel 2 32 Fistula umbilikal, omphalocoele-gastroschisis 2 33 Apendisitis akut 3B 34 Abses apendiks 3B 35 Demam tifoid 4A 36 Perdarahan gastrointestinal 3B 37 Ileus 2 38 Malabsorbsi 3A 39 Intoleransi makanan 4A 40 Alergi makanan 4A 41 Keracunan makanan 4A 42 Botulisme 3B Infestasi Cacing dan lainnya 43 Penyakit cacing tambang 4A 44 Strongiloidiasis 4A 45 Askariasis 4A 46 Skistosomiasis 4A 47 Taeniasis 4A 48 Pes 1 Hepar 49 Hepatitis A 4A 50 Hepatitis B 3A 51 Hepatitis C 2 52 Abses hepar amoeba 3A 53 Perlemakan hepar 3A 54 Sirosis hepatis 2 55 Gagal hepar 2 56 Neoplasma hepar 2 Kandung Empedu, Saluran Empedu, dan Pankreas 57 Kolesistitis 3B 58 Kole(doko)litiasis 2 59 Empiema dan hidrops kandung empedu 2 60 Atresia biliaris 2 61 Pankreatitis 2 62 Karsinoma pankreas 2 Kolon 63 Divertikulosis/divertikulitis 3A 64 Kolitis 3A 65 Disentri