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Gastro Intestinal Module - Phase I

Faculty of Medical Sciences

University of Sri Jayewardenepura

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Introduction

Welcome to the gastrointestinal module. The principle objective of the

gastrointestinal module is to educate the student on the basic structure,

physiological and biochemical aspects of the gastrointestinal system.

This module is designed emphasizing the essential components and minimizing

the non-essential details. The students will get the opportunity of learning about

different types of gastrointestinal secretions and their contribution to digestion

and absorption. They will also learn about mechanisms of gut motility and

important disorders of gut motility like vomiting.

The goals of the entire system are to convert ingestible food to absorbable

particles and finally absorption. An important area of this module is to teach

how gastrointestinal system is regulated, to achieve the above goal.

In this module student is exposed to common gastrointestinal diseases like

diarrhoea, vomiting and jaundice. This exposure will help them to grasp the

fundamentals of the gastrointestinal diseases and relate them to the clinical

conditions in Phase II. For this purpose several case scenarios has been

included at the beginning of each section.

Furthermore active learning is facilitated by small group discussions, fixed

learning modules rather than didactic lectures.

Tutorials and small group discussions will enhance student’s comprehension,

evaluating capacity and reasoning ability. Students are given free time which

allow them to engage in academic activities as they wish. Activities that can be

carried out in the language lab has been identified including listening activities,

matching terms and definitions, cross words, puzzles, scenarios for role play

and to develop communication skills. Skills lab activities that can be done in

relation to gastrointestinal system are examination of the abdomen, insertion of

Nasogastric tube and digital examination of the rectum in models.

For convenience and practicality the GI module is arranged in an anatomical

manner starting from the mouth going down to the anus. The liver and the

pancreas would be separate sections .In each section the main and the

intermediate objectives would be laid down. The areas that the student should

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know as essential core knowledge would be designated as (A) and good to

know and nice to know is depicted as (B) and (C) respectively.

We hope that at the end of the module the student could appreciate the

importance of GI physiology as a vital part of the human body and understand

how its functions relate to the functioning of the human body as a whole.

Module committee

Prof. P. Hettiarachchi (Chairperson, Department of Physiology)

Dr. E. A. S. T. Edirisinghe (Convener, Department of Anatomy)

Dr M.R.P.H Liyanage (Department of Anatomy)

Dr. H. Dissanayake (Department of Anatomy)

Dr. H.Waidyasekera (Department of Physiology)

Dr. W.A.N.Y. Silva (Department of Physiology)

Prof. S. Suresh (Department of Biochemistry)

Prof. H. Peiris (Department of Biochemistry)

Prof. S. Ekanayake (Department of Biochemistry)

Dr. P.P.R. Perera (Department of Biochemistry)

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General objectives

At the end of the module the students should be able to

1. have a basic knowledge of the structure of gastrointestinal tract.

2. have a basic knowledge on digestion and absorption of nutrients in the

gastrointestinal system.

3. understand how the structure of the gastrointestinal tract is suited to carry

out its function.

4. understand how the gastro intestinal tract function are regulated.

5. understand the basis of anatomical, biochemical and physiological.

derangements in selected diseases of the Gastro intestinal tract.

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Main content areas

Main Content Area Lectures

(Hours)

Practical/Dissections

No. of (3hrs)

sessions

Tutorials/SGD

No. of (2hrs)

sessions

1. Introduction (Physiology) 01 - -

2. Face & Mouth (Anatomy) 03 03 -

3. Salivary glands (Physiology, Anatomy) 01,00 00,01 -

4. Pharynx(Anatomy) 01 01 01

5. Structure & Function of Oesophagus

(Physiology, Anatomy)

02,01 01,02 (1hr sessions) 01,00

6. Abdominal wall (Anatomy) 02 02 (1hr,01 session) 02

7. Abdominal cavity (Anatomy) 01 01 00

8. Function of the Stomach (Physiology, Anatomy) 03,01 00,01 01,00

9. Duodenum (Anatomy) 01 02 -

10. Small intestine (Physiology, Anatomy,

Biochemistry)

01,01,03 - 00,00,01

11. Liver & Gallbladder (Physiology, Anatomy,

Biochemistry)

02,02,04 00,01,00 02,02,02

12. Pancreas (Physiology, Anatomy) 01,00 00,01 -

13. Large intestine (Physiology, Anatomy) 01,01 00,02 01,01

14.Overview (Anatomy) 02 - -

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Real Life situations

Real life situation 1: Vomiting

Real life situation 2: Portal Hypertension

Real life situation 3: Jaundice

Real life situation 4: Diarrhoea

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GIT Module – Phase 1

A- Essential to know B- Good to know C- Nice to know

1. INTRODUCTION

Intermediate objectives Broad Content area Activity Duration Department

Introduction to

gastro intestinal

Physiology

Lecture

1 hr

Physiology

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2. FACE & MOUTH


Identify the structure of the mouth & its functions.

Describe the structure of the tongue.

Vestibule, lips, cheeks, gum,

teeth, mouth. (A)

Palate (roof) – hard palate, soft

palate, muscles (levator palate,

tensor palate, palatoglossus,

palatopharyngeus) (A)

Vessels and nerves. (A)

Floor of the mouth. (A)

Boundaries (A)

Contents (submandibular gland,

submandibular duct, sublingual

gland, lingual nerve,

submandibular ganglion,

hypoglossal nerve) (A)

Structures palpable in the

bimanual examination of the

mouth. (A)

Macroscopy& microscopy (A)

Blood supply (A)

Nerve supply (A)

Lymph drainage (A)

Development.(A)

Will be done during head and

neck in neuroscience module

Lecture

Prosected

specimens/

Dissections

Lecture

Histology

practical 1

1 hr

3 hrs

1 hr

3 hrs

Anatomy

Anatomy

Anatomy

Anatomy

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2. FACE & MOUTH (continued)


Describe the muscles of mastication & their

innervation.

Describe the Tempero-mandibular joint

Describe the development of the face and palate.

Masseter, temporalis, lateral &

medial pterygoid (A)

Articular surfaces (A)

Capsules and ligaments,

sphenomandibular ligament (A)

Articular discs (A)

Movements of the tempero

mandibular joint.(A)

Development of face and palate and

congenital abnormalities.(A)

Will be done during head and neck in

neuroscience module

Prosected

specimens

During self

study time

Lecture

3 hrs

1 hr

1 hr

Anatomy

Anatomy

Anatomy

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3. SALIVARY GLANDS


Outline the constituents and functions of saliva

Describe the control of salivary gland secretion

Microscopic anatomy of the salivary glands and the

duct system

Composition and pH of saliva (B)

Functions of saliva (A)

- Immunity.

- Starch digestion by salivary

amylase.

- Lubrication.

- Speech

Conditioned and inborn reflex (B)

Gross anatomy of the salivary

glands, lymphatic drainage, nerve

supply, blood supply, duct system

(A)

Parotid gland (boundaries, contents,

parotid fascia, position, parts and

related structures) (A)

Submandibular gland ( size and

shape, parts, relations) (A)

Sublingual gland. (A)

Microscopy of salivary glands (A)


neuroscience module

Lecture

Dissections

prosected

specimens

Histology

practical 1

(...continuation)

1 hr

3 hrs

Physiology

Anatomy

Anatomy

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4. PHARYNX

5. OESOPHAGUS


Describe the structure of the pharyngeal wall

Describe the development of pharyngeal arches &

their derivatives

Muscles : external, internal (A)

Nerves, arteries, veins, lymphatics

(A)

Nasopharynx (walls, choanae)

Features: nasopharyngeal tonsils,

opening of auditory tubes, tubal

tonsils, salpingopharyngeal fold,

pharyngeal recess) (A)

Oropharynx( walls,

palatoglossal&palatopharyngeal

arches, features: palatine tonsils,

intratonsilar cleft) (A)

Laryngopharynx( walls, inlet of

larynx, features: medial & lateral

epiglottic folds, epiglottic

valleculae) piriform recess (A)

Waldeyer’s ring (A)

Describe the development of gut

derivatives from pharyngeal arches.

(B)


neuroscience module

Prosected

specimens

SGD (Oral

cavity, pharynx

& salivary

glands)

Lecture

2 hrs

2 hrs

1 hr

Anatomy

Anatomy

Anatomy

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5. OESOPHAGUS (continued)


Describe the macroscopic & microscopic anatomy

and relations of the oesophagus and development.

Describe the phases of deglutition

Development of the oesophagus. (A)

Gross anatomy of the oesophagus

(curvatures, constrictions, relations,

blood supply, venous drainage,

lymphatic drainage, nerve supply.)

(A)

Oesophagoscopy, barium swallow

and oesophageal varices (B)

Microscopy of the esophagus (B)

(Lectures, dissections and assessments

will be done during CVS- module

under posterior mediastinum)

Oral phase (A)

Pharyngeal phase (A)

Oesophageal phase (A)

Lecture

Histology

practical 1

(...continuation)

Lecture

1 hr

1hr

Anatomy

Anatomy

Physiology

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5. OESOPHAGUS (continued)


Describe the lower esophageal sphincter pressure

and the competence of the lower

oesophagealsphinter.

Define dysphagia and explain the pathophysiology

of dysphagia

Abdominal oesophagus. (gross

anatomy) (A)

Factors that increase and decrease

the lower oesophageal sphincter

pressure (A)

Factors contributing to the

competence of the lower

oesophgealsphinter (A)

The factors that prevent

gastroesophageal reflux (A)

The structural basis for the gastro

oesophgeal sphincter (A)

Nasogastric tube insertion (B)

List the causes of dysphagia (A)

- Structural lesion

- Physiological basis of achalasia-

cardia

(Prosected

Specimens +

Models)

/ Lecture

Practical

(Skills lab)

SGD

1 hr

1 hr

2 hrs

Anatomy

Anatomy

Physiology

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Describe the regulation of the gastrointestinal system

Gastrointestinal hormones (A)

Neural regulation (A)

Hormonal regulation (A)

Lecture

1 hr

1 hr

Physiology

Physiology

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6. ABDOMINAL WALL


Describe the surface anatomy bones & landmarks of

the abdomen.

Describe the planes & regions of the abdomen.

Anterior superior iliac spine and

pubic tubercle (A)

Surface markings of inguinal

ligament, mid inguinal point

& McBurney’s point (A)

Lateral border of rectus abdominis

dermatomes of anterior abdominal

wall (A)

Planes (subcostal, inter tubercular

etc…) (A)

Regions ( 9 regions) (A)

Trans pyloric plane (A)

Describe the surgical incisions of the

abdominal wall (A)

Dissections

SGD

Lecture

3 hrs

2 hrs

1 hr

Anatomy

Anatomy

Anatomy

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6. ABDOMINAL WALL (continued)


Describe the anterior abdominal wall

Layers ( skin to parietal

peritoneum) (A)

Superficial fascia. ( fatty layer,

membranous layer) (A)

Muscles (A)

Rectus sheath : layers( ant &pos),

contents, linea alba (A)

Fascia transversalis (A)

Umbilicus : ligaments :

ligamentumteres, median umbilical

ligament (A)

Nerves : lower 5 intercostal,

subcostal, ilioinguinal,

iliohypogastric (A)

Arteries: sup. & inf. epigastric

(anastomosis between subclavian&

ext. iliac) , others ( intercostals,

branches of external iliac

&femoral) (A)

Lecture

1 hr

1 hr

Anatomy

Anatomy

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6. ABDOMINAL WALL (continued)


Describe the anterior abdominal wall (continued)

Describe the anatomical structure of the inguinal

region

Veins: lateral thoracic, tributaries of

great saphenous(communication

between sup. & inf. vena cava) (A)

Lymphatics: superficial(umbilicus

as “watershed” area) (A)

Different types of hernias

(incision hernias, umbilical

hernias…) (A)

Surface marking of superficial

inguinal ring and deep inguinal ring

(A)

Walls of inguinal canal (A)

Coverings and contents of

spermatic cord (A)

Different types of hernias (direct

and indirect…) (A)

Examination of abdomen (B)

Dissections

Practical

(Skills Lab)

3 hrs

1 hr

Anatomy

Anatomy

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7. ABDOMINAL CAVITY


Identify the general structure of the abdominal cavity

& arrangement of the abdominal viscera.

Map the surface markings of the

liver, gall bladder, spleen,

duodenum, pancreas, caecum,

kidneys and abdominal aorta (A)

Peritoneum ( parietal and visceral,

folds of peritoneum : greater

omentum, lesser omentum,

mesentery,mesoappendix,

transverse mesocolon, sigmoid

mesocolon) (A)

Functions of peritoneum (A)

Peritonial cavity (A)

Arrangement of abdominal viscera

in 3 layers (A)

Posterior abdominal wall (A)

Relevant clinical applications (A)

Dissections

Lecture

(Peritoneal

reflections)

AVP

3 hrs

1 hr

1 hr

Anatomy

Anatomy

Anatomy

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8. STOMACH


Describe the macroscopic & microscopic anatomy of

the stomach & development.

List the main functions of the stomach

Demarcate the functionally distinct regions of the

gastric mucosa

Describe the function of gastric mucosal cell

Position, shape & size (A)

External features, subdivisions (A)

Key relations (A)

Peritoneal attachments (A)

Mucosa (A)

Blood supply, nerve supply,

Lymphatic drainage (A)

Microscopy (A)

Development (A)

Secretory, digestive and endocrine

functions (A)

Functionally distinct regions of the

gastric mucosa (A)

Different cell types of the gastric

mucosa and the functions (B)

Dissections

Lecture

Lecture

Histology

practical 1

(...continuation)

3 hrs

1 hr

1 hr

Anatomy

Anatomy

Physiology

Anatomy

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8. STOMACH (continued)


List the constituents of gastric juice and function

Describe the mechanism of secretion of HCl

Describe gastric mucosal barrier and its function

and list the factors which disrupt the barrier

Constituents of gastric juice (A)

- HCl

- Pepsin

- Intrinsic factor

- Mucus

Cell type, the mechanism,

regulation of gastric acid secretion,

factors that affect gastric acid

secretion (A)

Factors that maintain the barrier

and disrupt the barrier leading to

peptic ulcer (A)

The role of Helicobactor pylori and

non steroidal anti inflammatory

drugs in disrupting the barrier (A)

Gastrinoma (A)

Physiological basis of treatment (A)

- Proton pump inhibitors

- H2 inhibitors

- Antacids

- Prostaglandin analogues

Lecture

SGD

1 hr

2 hrs

Physiology

Physiology

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8. STOMACH (continued)


Describe gastric motility and empting and its

regulations

Define vomiting

List the causes, and explain the mechanism and

consequences of vomiting

The events that occur following (A)

- Entry of the food bolus Into

the stomach

- Receptive relaxation

- Peristalsis

The mechanism of gastric empting

(A)

Outline the consequences of

gastrectomy in relation to the

functions of stomach (A)

The causes of vomiting,

- Neural (A)

- Chemical (A)

- Psychic factors (A)

The mechanism and consequences

of vomiting (A)

Fluid and electrolyte imbalance (A)

Lecture

1 hr

Physiology

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9. DUODENUM


Describe the macroscopic and microscopic anatomy

of the duodenum.

Describe the position, parts, key

relations, peritoneal attachments

(A)

Describe the mucosa, nerves and

vessels (A)

Microscopy (A)

Development (B)

Describe the relevant clinical

applications (A)

Duodenal ulcers, surgical

interventions and complications,

radiology (B)

Dissections

Lecture

Histology

practical 2

3 hrs

1 hr

3 hrs

Anatomy

Anatomy

Anatomy

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10. SMALL INTESTINE


Describe the macroscopic & microscopic anatomy

and development of the small intestine.

List the main functions of the small intestine

Describe the structure function relationship of the

digestive epithelium and the circular muscles.

Describe principals of digestion of macromolecules

Jejunum, ileum, duodenal, jejunal

flexure, mesentery, mucosal

features, Meckel’s diverticulum (A)

Vessels and nerves (A)

Microscopy (A)

Development (B)

Digestion of nutrients (A)

Absorption of nutrients and water,

minerals, electrolytes (A)

Structure of the digestive

epithelium (A)

- Structure function relationship

- Constituents of intestinal juice

- Nerve supply.

- Types of intestinal motility and

function

Mechanism of digestion of protein,

carbohydrate and fats (A)

Role of enzymes in protein,

carbohydrate and fats digestion (B)

Histology

practical 2

(...continuation)

Lecture

(Embryo-3)

Lecture

Histology

practical 2

(...continuation)

Lecture

SGD

1 hr

1hr

1 hour

2 hours

Anatomy

Anatomy

Physiology

Anatomy

Biochemistry

Biochemistry

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10. SMALL INTESTINE (continued)


Describe principals of absorption and transport of

macromolecules.

Describe the mechanism of absorption of

micronutrients.

Mechanism of absorption and

transport of protein, carbohydrates

and fat (A)

Water, iron, Na+, K+, other

minerals, vitamins (A)

Lecture

Lecture

1 hr

1 hr

Biochemistry

Biochemistry

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11. LIVER AND GALLBLADDER


List the main functions of the liver and outline the

consequences of derangement of liver function

Describe the determinants of the liver function


of the liver and the biliary system.

Synthetic function-plasma protein,

clotting factors, (A)

- Vitamin B12

- Storage

- Detoxification

- Metabolism-carbohydrate,

protein, lipid (will be done in

endocrine and metabolism

module)

State the fate of the constituents of

the chylomicron in the hepatocyte,

HDL, LDL formation and

metabolism (A)

Abnormalities of liver function test

- Protein-albumin, globulin (A)

- Enzymes –AST, ALT, GGT,

ALP (A)

- Coagulation test- prothombrine

time (A)

Liver – position & parts, fissures,

surfaces and lobes, porta hepatic,

common hepatic ducts, key

relations of diaphragmatic and

visceral surfaces, peritoneal

attachments, bare area, vessels,

physiological lobes) (A)

Lecture

Lecture

SGD

GLS

Lecture

Practical

Dissections

SGD

2 hr

2 hrs

2 hrs

1 hr

1 hr

3 hrs

3 hrs

2 hrs

Physiology

Biochemistry

Physiology

Biochemistry

Biochemistry

Biochemistry

Anatomy

Anatomy

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11. LIVER AND GALLBLADDER (continued)



of the liver and the biliary system.(continuation)

Structure function relationship of the hepatocytes

Gall bladder – position & parts, key

relations, cystic duct & artery

variations, veins, lymphatics,

nerves, gall stones) (A)

Bile duct – origin, course,

termination, sphincter) (A)

Blood supply of the liver (A)

Explain the organization of liver

tissue in relation to its

microcirculation, making correct

use of the terms portal triad, central

vein, sinusoidal capillary,

hepatocytes, lobule, periportal

region and centrilobular region (A)

Histology

practical 2

(...continuation)

Anatomy

Schematic description of the relationship between

hepatocyte and bile canaliculi

Describe the pathophysiological basis of portal

hypertension

Outline the embryological origin of the liver

Relationship of hepatocytes to bile

canaliculi and sinusoidal capillaries

(A)

Collateral circulation of the liver

and the mechanism of development

of portal hypertension (A)

Structural and functional changes in

the liver between the embryonic

period and the post natal period (C)

Lecture

Lecture

(Embryo-4)

1 hr

1 hr

Anatomy

Anatomy

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11. LIVER AND GALLBLADDER (continued)


Describe the formation secretion and transport of

bile

Outline the disorders of bile formation and secretion

Disordered liver function

Physiological, biochemical, and anatomical basis of

jaundice

Constituents of bile, formation of

bile, mechanism of secretion of bile

in hepatocyte, transport and storage

of bile in the duct system and

gallbladder (A)

Mechanism of gallstone formation]

(A) - Super saturation of bile

- Excess bile pigments

Biochemical and physiological

aspects of disordered liver function

(A)

Emphasis on biochemical changes

in jaundice (A)

Types of jaundice and mechanism

of development of jaundice in liver

disorders (A)

Lecture

Lecture

Tutorial

SGD

SGD

Hospital visit

1 hr

1 hr

1 hrs

2 hrs

2 hrs

3 hrs

Biochemistry

Biochemistry

Biochemistry

Physiology

Anatomy

Physiology

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12. PANCREAS


List the functions of exocrine pancreas

Outline the regulation of pancreatic juice secretion

Outline the physiological basis of features of

exocrine pancreatic disorders

Describe the macroscopic &microscopic anatomy of

the pancreas and its development

List the constituents of the

pancreatic juice (A)

Enzymes, HCO3- (A)

Pancreatic enzymes (A)

- Tripsin,

- Chymotrypsin,

- Pancreatic amylase,

- Lipase

Carbohydrate, protein, lipid

digestion with pancreatic enzymes

(A)

CCK-PZ, secretin (A)

Gross anatomy of the pancreas and

the main anatomical relation of the

pancreases (A)

Blood supply lymphatic drainage

(A)

Duct system of the pancreas (A)

Pancreatic acinus (A)

Microscopy (A)

Development (B)

Lecture

Dissections

Histology

practical 2

(...continuation)

1 hr

3 hrs

Physiology

Anatomy

Anatomy

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13. LARGE INTESTINE


Describe the gross anatomy of the large intestine,

with relation to other structures &microscopic

anatomy.

Describe the macroscopic & microscopic anatomy of

the rectum & anal canal.

Describe the anatomical structure

of the caecum & vermiform

appendix (position & variation, key

relations, taenia coli, ileocaecal

valve, meso appendix, vessels and

nerves) (A)

Relevant clinical applications.

(appendicitis, thrombosis of appen-

dicular artery, appendicectomy) (A)

Outline the gross anatomy of colon

and its function. (parts, colic

flexures, transverse mesocolon,

haustra, appendices epiploicae,

vessels, nerves) (A)

Relevant clinical applications (A)

Microscopy (A)

Development (A)

Relations, peritoneal attachments,

sphincters, mucosa (A)

Haemorroids, fistulas, anal fissures

(A)

Development (A)

Microscopy (A)

Will be done with the dissections of

the pelvis.

Dissections

SGD

Dissections

Lecture

Histology

practical 2

(...continuation)

3 hrs

2 hrs

2 hrs

1 hr

Anatomy

Anatomy

Anatomy

Anatomy

Anatomy

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13. LARGE INTESTINE (continued)


Describe the function of the large intestine

Describe the mechanism of defecation

Describe the physiological and biochemical basis of

different types of diarrhoea

Physiological basis of features and consequences of

vomiting/diarrhoea

Storage absorption, of water and

electrolytes motility (A)

Nerve supply of internal and

external anal sphincters (A)

Pathophysiological basis of

Hirshprung disease (A)

Secretory diarrhoea, osmotic

diarrhoea, electrolyte abnormalities

(A)

Basis of treatment with ORS (A)

Lecture

SGD

1 hr

2 hrs

Physiology

Physiology

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14. OVERVIEW


Describe the blood supply and the lymph

drainage of the gastrointestinal tract

Blood supply of the gastrointestinal

tract(A)

Lymph drainage of the

gastrointestinal tract(A)

Lecture

Lecture

1 hr

1 hr

Anatomy

Anatomy

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Real life situation-1

Vomiting

Topic: Vomiting

Scenario:

You and your close friends visited a Dansala on Vesakpoya day and had lunch.

When you came back to the boarding place, your friend had vomited repeatedly

with a large amount of undigested food particles and he looked unwell. Then he

has been taken to the dispensary. On the way you also had vomited 4-5 times.

Doctor examined your friend and checked blood pressure and asked him to

admit to CSTH. The doctor has examined you and he had asked to take some

drugs and Jeevani.

Next day you noticed full recovery of your friend and went to hospital to see

your friend. You noticed that he has been given a Saline drip. Jeevani was also

present in his locker.

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Real life situation -2

Portal Hypertension

Topic: Portal Hypertension

Scenario:

While you were on vacation from University, your school friend called in the

morning & told that his 56 year old uncle was admitted to the hospital following

vomiting dark coloured blood. He also told that his uncle had a swollen

abdomen & was bit confused at the time of admission.

Nimal told that his uncle was a heavy alcoholic, who had consumed a bottle of

arrack per day for the last 25 years. He only stopped taking liquor 1 month back

after he had being advised by the doctor following a similar episode of

vomiting.

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Real life situation -3

Jaundice Topic: Jaundice

Scenario:

Your mother phoned you from your hometown telling that your aunt has been

transferred to Kalubowila Hospital with abdominal discomfort. Your mother

wants you to see your aunts in the evening on the way to your boarding place.

She complained of abdominal discomfort and noticed that she looks tired and

yellow discolouration of eyes. You were lucky enough to see the bed head

ticket since you are a medical student. You notice that doctor has ordered the

following investigations.

Serum bilirubin

Aspartate transaminase

Alanine transaminase

Urobilinogen

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Real life situation – 4

Diarrhoea Topic: Diarrhoea

Scenario:

Your friend in the boarding place developed diarrhea in the evening and you

took her to hospital. Doctor admitted her to Ward 9, Colombo South hospital.

She was given a normal saline drip.

You are interested in finding the reasons of your friend’s diarrhoea and reason

for giving a saline. The following day when you were visiting your friend, she

was feeling better. You want to find out the mechanism of development of

diarrhea, the reason for giving drip at the onset and Oral Rehydration Solution

later.

25/09/2017 Version 2.0

31

Recommended Reading

Note- Students are expected to read the latest edition

Anatomy Clinical Anatomy for Medical Students by Richard S. Snell

Grants Atlas of Anatomy by M.R. Agur

Cunningham’s Manual of Practical Anatomy by G.J. Romanes

Wheater’s Functional Histology by B.Young and J.W.Herath

Human Embryology by Inderbir Singh

Biochemistry Text book of Biochemistry with Clinical Correlations by Thomas M.

Delvin

Harper’s illustrated Biochemistry by Victor W. Rodwell, Peter J.

Kennelly, David A. Bender, Kathleen M. Botham, P. Anthony Weil

Clinical Chemistry by William J Marshall

Physiology

Review of Medical Physiology by William F. Ganong

Pathophysiology of Disease: An Introduction to ClinicalMedicine by

Gary D. Hammer and Stephen J. McPhee

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