Veidlapa Nr. M-3 (8)
Study Course Description
Internal Diseases I (Gastroenterology, Nephrology, Endocrinology)
Course Code
ISK_241
Branch of Science
Clinical medicine; Internal medicine
ECTS
10.00
Target Audience
Medicine
LQF
Level 7
Study Type And Form
Full-Time
Study Course Implementer
Course Supervisor
Aija Mača-Kalēja
Structure Unit Manager
Jūlija Zepa
Structural Unit
Department of Internal Diseases
Contacts
Riga, Pilsoņu iela 13, isk@rsu.lv, +371 67042338
About Study Course
Objective
To obtain knowledge about endocrine, digestive and renal diseases, which includes understanding of their pathogenesis, clinical manifestations, laboratory and radiological diagnostics, differential diagnostics, possible complications, therapy, its safety and effectiveness.
To improve skills and competence to apply the acquired knowledge in work with the patient, creating a personalized care plan.
To integrate the acquired knowledge, skills and competences in work with the public in the aspect of health.
Preliminary Knowledge
Anatomy of organ systems, topographical anatomy, physiology and pathological physiology. Knowledge of biology, biochemistry, epidemiology, microbiology, histology, genetics and immunology. Physical examination methods, radiological examination methods, functional examination methods, laboratory examination methods in the context of specific pathologies. Knowledge of the causes and causal relationships of changes in the findings of examination methods. Pharmacology of drugs used in endocrinology, gastroenterology and nephrology. Basic principles of medical communication.
Learning Outcomes
Knowledge
1.Describes epidemiology, main pathogenetical aspects and clinical symptoms of endocrine, digestive and renal diseases.
Individual work and tests
Assessment of learning outcomes during each class • Independent work • Case studies • Multiple-choice tests
2.Describes typical laboratory and radiological findings in endocrine, digestive and renal diseases.
Individual work and tests
Multiple-choice tests • Case studies • Independent work • Assessment of learning outcomes during each class
3.Lists the criteria for classification or combinations of characteristic clinical symptoms, laboratory and radiological findings necessary for diagnosis and exclusion of differential diagnoses for endocrine, digestive and renal diseases.
Individual work and tests
Assessment of learning outcomes during each class • Case studies • Independent work • Multiple-choice tests
4.Formulates the diagnosis, activity or extent of the disease using the appropriate classification/nomenclature.
Individual work and tests
Multiple-choice tests • Independent work • Case studies • Assessment of learning outcomes during each class
5.Describes non-pharmacological and pharmacological treatment options for endocrine, digestive and renal diseases, using internationally developed guidelines and recommendations.
Individual work and tests
Assessment of learning outcomes during each class • Case studies • Independent work • Multiple-choice tests
6.Describes medications used to treat endocrine,digestive and renal diseases and their safety considerations.
Individual work and tests
Multiple-choice tests • Case studies • Independent work • Assessment of learning outcomes during each class
7.List risk factors for endocrine, digestive and renal diseases and their prevention in the context of public health.
Individual work and tests
Assessment of learning outcomes during each class • Independent work • Case studies • Multiple-choice tests
Skills
1.Critically evaluates clinical symptoms of endocrine, digestive and renal diseases, interprets laboratory and radiological examination results and determines diagnosis and differential diagnoses.
Individual work and tests
Multiple-choice tests • Case studies • Independent work • Assessment of learning outcomes during each class
2.Analyzes the activity of the disease, the structural damage and changes in functional capacity caused by the disease.
Individual work and tests
Assessment of learning outcomes during each class • Independent work • Case studies • Multiple-choice tests
3.Establishes a treatment plan for the diagnosed disease, as well as a plan for monitoring the safety and effectiveness of the treatment.
Individual work and tests
Multiple-choice tests • Case studies • Independent work • Assessment of learning outcomes during each class
4.Explains the importance of the non-pharmacological approach to the prevention and treatment of the diagnosed disease.
Individual work and tests
Assessment of learning outcomes during each class • Independent work • Case studies • Multiple-choice tests
5.Educate the patient about the nature of the diagnosed disease, its manifestations, the aim of therapy (cure or remission), treatment options, consequences of non-treatment, monitoring of the safety of therapy, the importance of adherence to therapy in its effectiveness, having previously created a plan for the conversation.
Individual work and tests
Case studies • Assessment of learning outcomes during each class
Competences
1.Rationally and purposefully develops a plan for examining the patient to establish a diagnosis, exclude differential diagnoses, assess the importance of comorbidities and their therapy, including by evaluating the benefits and risks of the procedures performed.
Individual work and tests
Assessment of learning outcomes during each class • Case studies
2.Justifies the diagnosis in a structured and reasoned manner, and exclude differential diagnoses.
Individual work and tests
Case studies • Assessment of learning outcomes during each class
3.Develop a personalized treatment plan for the diagnosed disease, assessing comorbidities, the medications used in their treatment, and a long-term plan for monitoring the safety and effectiveness of treatment.
Individual work and tests
Assessment of learning outcomes during each class • Case studies
4.Develops a personalized treatment plan for the diagnosed disease in the context of specific situations, such as planned or ongoing pregnancy, genetic predisposition, social aspects, etc.
Individual work and tests
Case studies • Assessment of learning outcomes during each class
5.Presents personal justified, structured opinion on the clinical case and discuss the clinical course, prognosis and therapeutic options of the disease, evaluating the benefit-risk ratio.
Individual work and tests
Assessment of learning outcomes during each class • Case studies
Assessment
Individual work
|
Title
|
% from total grade
|
Grade
|
|---|---|---|
|
1.
Independent work |
-
|
-
|
|
Independent work, preparing for classes, getting acquainted with the materials posted in e-studies, self-checking materials. Preparation for lectures and classes by getting acquainted with the materials posted in e-studies. Mandatory class attendance. |
||
|
2.
Case studies |
-
|
10 points
|
|
Case analysis in the class work with patients in the ward, taking a history, performing a physical examination, establishing a diagnostic pathway and developing a treatment plan, with subsequent discussion in the class. Student involvement is graded. |
||
|
3.
Multiple-choice tests |
-
|
-
|
|
Multiple choice tests. Self-assessment tests in e-studies, which the students complete when learning certain topics. Available without time limit during the semester. |
||
|
4.
Providing feedback |
-
|
-
|
|
Providing constructive and meaningful feedback on the course by filling out the course evaluation form. The form is anonymous. |
||
Examination
|
Title
|
% from total grade
|
Grade
|
|---|---|---|
|
1.
Assessment of learning outcomes during each class |
50.00% from total grade
|
10 points
|
|
Active, structured, and well-reasoned participation in discussions during classes, analyzing clinical cases and/or theoretical questions (orally or in a written form). During discussions students demonstrate knowledge of the class topic—that is, a specific disease or diseases (including the definition, epidemiology, pathogenesis, clinical presentation, diagnostic principles, medications used in treatment, their contraindications, and possible adverse side effects), as well as the ability to integrate this knowledge when developing a diagnostic pathway, treatment plan, and safety monitoring plan. Student participation is graded. |
||
|
2.
Examination |
50.00% from total grade
|
10 points
|
|
The exam is written, covering the IV year of studies in gastroenterology, nephrology and endocrinology. The exam questions are available in e-studies. The student randomly draws three questions (one question from each module) in a closed manner and answers them in writing. The duration of the exam is 45 minutes. The total percentage of the evaluation criteria (see below) for each question is converted into a grade. The exam is passed if the answer to each question is assessed with at least "4". If any of the questions is assessed with a score lower than "4", the exam is not passed. The student must retake only the exam part of the module of the question that was not passed. Assessment criteria for each question:
The final exam grade is calculated on a cumulative basis. |
||
|
3.
Final assessment |
-
|
-
|
|
The average of the average grades of practical classes in the study course modules and the grade of the examination. |
||
Study Course Theme Plan
FULL-TIME
Part 1
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Classification of esophageal diseases. Functional esophageal diseases. Esophageal Achalasia. Non-reflux oesophagites, esophageal lesions due to infections, systemic diseases, medications, radiation injuries, esophageal tumors. Gastroesophageal reflux disease. Definition, diagnosis, complications. Typical and atypical presentation. Principles of treatment. Barrett’s esophagus. Mallory-Weiss syndrome. Foreign bodies in the esophagus.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Gastroduodenal Diseases I. Classification. Functional dyspepsia (definition, classification (Rome IV), diagnostic criteria, principles of therapy). The concept of gastropathies. Type of gastrites. Sydney classification of gastritis. Clinical relevance of chronic gastritis (atrophy, metaplasia, OLGA and OLGIM systems, cancer).The concept of duodenitis (peptic, non-peptic). Diagnostic capabilities.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Gastric and duodenal diseases II.
Peptic gastric and duodenal ulcer (aetiology, pathogenesis, diagnostics, principles of treatment, complications). H.pylori infection (diagnosis, clinical relevance, Maastricht / Florence consensus, eradication principles). Non-helicobacter and/or non-NSAIDs associated ulcers.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Liver diseases I. Symptoms and syndromes of liver diseases. Bile acids and its metabolism. Compensated and decompensated liver cirrhosis and its complications. Acute-on-Chronic Liver Failure. Portal hypertension and variceal gastrointestinal bleeding. Ascites and spontaneous bacterial peritonitis. Hepatorenal syndrome. Hepatic encephalopathy. Liver failure. Drug-induced liver injury. Liver transplantation.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Liver Diseases II. Acute and chronic viral hepatites. Hepatic parasitosis. Alcohol and non-alcohol liver damage. Non-alcoholic steatohepatitis. Liver tumors and cysts.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Liver Diseases III.
Congenital hepatic metabolism disorders, rare liver diseases: haemochromatosis, Gilbert's syndrome, Wilson's disease, primary biliary cholangitis, autoimmune hepatitis, primary sclerosing cholangitis, α1-antitrypsin deficiency.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Diseases of the gallbladder and biliary tract.
Gallbladder and sphincter Oddi dysfunction. Bile litogenity clinical manifestations (sludge, gallstone microlithiasis, lithiasis) and therapeutical options. Holangites (clinical signs and principles of treatment). Tumors of biliary tract. Primary sclerosing cholangitis. Endoscopic and radiologic treatment of biliary disease.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Diseases of the pancreas.
Classification of pancreatic diseases. Pancreatic insufficiency (cause, clinic, diagnostics, principles of therapy). Gastroenteropancreatic endocrine system and neuroendocrine tumors. Chronic pancreatitis (classification, diagnostic and treatment). Pancreatic carcinoma risk factors.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Small bowel diseases.
Classification of small bowel diseases. Maldigestion and malabsorption. Microbiota and dysbiosis. Short bowel syndrome. Celiac Disease. Enterocolites: E. coli and its pathogenic strains; other infections, travelers' diarrhea. Intestinal parasites. Lactase deficiency.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Colon Diseases.
Diverticulosis. Diverticulitis. Inflammatory bowel disease (Ulcerative colitis, Crohn's disease). Ischemic colitis. Risk factors of colorectal cancer. Prevention. Irritable Bowel Syndrome.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Nutrition in gastroenterological patients.
Nutritional assessment techniques (incl. MUST, SNAQ, NRS scales). Harris Benedict equation (determination of basal metabolic rate). The main types of feeding. Indications and contraindications for enteral and parenteral nutrition).
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Digestive endoscopy.
METC. Upper gastrointestinal endoscopy (indications for immediate and planned use, contraindications). Colonoscopy (indications, bowel cleansing, contraindications). Endoscopic retrograde holangiopancreatography (options, indications). Echoendoscopy (options, indications). Small intestine endoscopy (intestinoscopy, capsule endoscopy). Recent trends in endoscopy (robotic, computerized). Bleeding from the digestive tract.
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
Off site
|
E-Studies platform
|
2
|
Topics
|
Functional dyspepsia. Gastropathies.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Comprehensive examination of the kidney patient.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Urinary tract infection (cystitis, pyelonephritis, acute urethral syndrome).
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
Off site
|
E-Studies platform
|
2
|
Topics
|
Biological mechanisms of hormone activity in norm and pathology. Diagnostic and therapeutic principles in modern endocrinology.
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
Off site
|
E-Studies platform
|
2
|
Topics
|
Irritable bowel syndrome.
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
Off site
|
E-Studies platform
|
2
|
Topics
|
Examination of kidney patient.
|
-
Lecture
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
Off site
|
E-Studies platform
|
2
|
Topics
|
Chronic renal failure.
|
Total ECTS (Creditpoints):
5.00
Contact hours:
52 Academic Hours
Final Examination:
Test (Semester)
Part 2
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Acute renal failure.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Acute allergic bacterial nephritis, HRS, etc. specific causes of acute renal failure.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Glomerulonephritis with predominantly nephritic syndrome (IgAN, post-infectious GN, MPGN).
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Glomerulonephritis with predominantly nephrotic syndrome (MPG, FSGS, MGN).
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Fast progressive glomerulonephritis.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Chronic tubulointerstitial nephropathy (reflux NP, OU, nephrocalcinosis, toxins).
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Cystic kidney disease (ADNP, ARNP, MCNS), kidney stone disease.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Diabetic nephropathy, amyloidosis, systemic lupus erythematosus (kidney aspects).
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Chronic renal failure – classification (chronic kidney disease), syndromes, cardiovascular risk, staging.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Basics of Kidney Replacement Therapy (HD, PD, Tx).
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Common disorders of water and electrolyte metabolism.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Thrombotic microangiopathy, preeclampsia, a. renal stenosis.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Principal mechanisms and regulation of hormone activity. Hypothalamus – normal physiology of pituitary hormones and basics of pathology. Acromegaly, Diabetes mellitus – pathogenesis, diagnostics and principles of therapy.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Adrenal hormones and major diseases. Concept of endocrine arterial hypertension (diagnosis, differential diagnosis and principles of therapy).
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Basic carbohydrate metabolism. Diagnosis, classification, differential diagnosis of diabetes mellitus. Pathogenesis of type 2 diabetes. Principles of therapy and standards of care. Oral antidiabetic agents.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Pathogenesis of type 1 diabetes. Principles of insulin therapy. Concept of acute (hypoglycaemia, diabetic ketoacidosis) and chronic complications (nephropathy, retinopathy, polyneuropathy) of diabetes mellitus.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Role of thyroid hormones in physiological processes. Struma. Hypothyroidism and hyperthyroidism (diagnosis, principles of therapy). Characterisation of thyroid nodules, malignancy criterion.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Regulation of calcium homeostasis. The concept of hyperparathyroidism and hypoparathyroidism.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Principles of diagnosis and therapy of osteoporosis and bone metabolic diseases.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Adiposity and appetite control. Aspects of reproductive endocrinology.
|
Total ECTS (Creditpoints):
5.00
Contact hours:
60 Academic Hours
Final Examination:
Exam (Written)
Bibliography
Required Reading
1.
Klīniskā medicīna. Prof. A.Lejnieka red. 1-3.grāmata, 2010-2012 (jaunākais izdevums latv. val.)
2.
Goldman-Cecil Medicine. 27th edition. Elsevier, 2024.Suitable for English stream
Additional Reading
1.
Ferri’s Clinical Advisor. Elsevier, 2023Suitable for English stream
Other Information Sources
1.
Zāļu Valsts aģentūra
2.
www.uptodate.comSuitable for English stream
3.
www.medscape.comSuitable for English stream