GIT & HEPATOBILIARY-II

MODULE
th
4 Year MBBS
KMU (IHPER)- Central Curriculum Committee 1
 Table of Contents

Khyber Medical University (KMU) Vision: .........................................................................3

Khyber Medical University (KMU) Mission: ........................................................................3
Institute of Health Professions Education & Research (IHPER) Mission: .....................................3
Introduction to Module ................................................................................................4
Teaching Hours Allocation ............................................................................................5
General Learning Objectives .........................................................................................6
Specific Learning Objectives .........................................................................................7
Theme-1 (Difficulty in swallowing) ................................................................................7
Theme-2 (Epigastric pain) ........................................................................................ 11
Theme-3 (Pain right upper abdomen) ........................................................................... 22
Theme-4: (Diarrhea and Constipation).......................................................................... 31
Theme- 5 (Bleeding per Rectum) ................................................................................ 39
Practical work ...................................................................................................... 43
Learning Resources ................................................................................................... 46
Assessment Plan – 4th Year MBBS ................................................................................... 47
Assessment Blueprints ............................................................................................... 49

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Khyber Medical University (KMU) Vision:
Khyber Medical University will be the global leader in health sciences academics and
research for efficient and compassionate health care.

Khyber Medical University (KMU) Mission:

Khyber Medical University aims to promote professional competence through
learning and innovation for providing comprehensive quality health care to the nation.

Institute of Health Professions Education & Research (IHPER) Mission:

To produce leaders, innovators and researchers in health professions education who
can apply global knowledge to resolve local issues.

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 Introduction to Module
Gastro-intestinal-II and Hepatobiliary-II Module is designed to provide both basic, clinical knowledge and skills to the
medical students. The modules include sessions on important pathological diseases of gastrointestinal system and
hepatobiliary system. The relevant clinical subjects are also taught under the shared themes with pharmacological
explanation. The medical and surgical management and preventive aspect of the diseases is also addressed.

Table 1: Themes

S. No Themes Duration Weeks

1 Difficulty in swallowing 1

2 Pain epigastrium 1

3 Pain right upper abdomen 2

4 Diarrhea and constipation 3

5 Bleeding Per Rectum 1

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 Teaching Hours Allocation
Table 2: Total hours distribution of each subject

S. No Subject Hours

1 Pathology 49

2 Pharmacology 20

3 Forensic medicine 22

4 Community medicine 23

5 Medicine 13

6 Surgery 14

7 Pediatrics 4

8 Family medicine 3

9 Anatomy 1

10 PRIME 1

11 Research* 16**

Total hours 153

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 General Learning Objectives

By the end of GIT-II Module, 4th year MBBS students will be able to:
1. Describe the etiology, pathogenesis, morphology, clinical features, laboratory diagnosis, medical

and surgical management of diseases of GIT & hepatobiliary system.

2. Interpret the liver function tests in different hepatic diseases.

3. Describe the basic and clinical pharmacology of drugs used in GIT & hepatobiliary diseases.

4. Write prescriptions for common GIT & hepatobiliary disorders.

5. Describe medico legal aspects of abdominal trauma.

6. Describe medico legal aspects of vegetable acid, corrosive and irritants poisoning.

7. Describe the epidemiology and prevention of malnutrition and viral hepatitis.

8. Analyze demographic processes in context of public health care.

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 Specific Learning Objectives
Table 3: Theme wise learning objectives

Theme-1 (Difficulty in swallowing)

Subject Topic Hours S# Learning objective

Pathology Salivary Gland (Inflammation 1 1 Classify the inflammatory and neoplastic diseases
and tumors) of salivary gland.
2 Describe the etiology, morphology and clinical
presentation of inflammatory and neoplastic
diseases of salivary gland.
Esophagus 2 3 Classify esophagitis.
4 Describe the etiology, pathophysiology,
morphology, clinical presentation and
complications of esophagitis
5 Classify esophageal tumors.
6 Describe the etiology, pathogenesis, morphology,
clinical presentation, diagnosis and complications
of esophageal tumors
Medicine Oral Cavity Diseases 1 7 Discuss the etiology of stomatitis and Aphthous
ulcers

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 8 Discuss the clinical features of stomatitis and
Aphthous ulcers
9 Discuss the investigations of stomatitis and
Aphthous ulcers
10 Devise a management plan for stomatitis and
Aphthous ulcers
Esophagus: 1 11 Discuss the causes of esophageal motility
1) Esophageal motility disorders
disorders 12 Discuss the clinical features of esophageal
motility disorders
13 Discuss the relevant investigations of esophageal
motility disorders
14 Devise a management plan of esophageal motility
disorders
2) Esophagitis 1 15 Discuss the etiology of esophagitis
16 Discuss the clinical features of esophagitis
17 Discuss the appropriate diagnostic testing for
esophagitis
18 Devise a management plan for esophagitis
3) Cardia achalasia 1 19 Discuss the etiology, clinical features,
investigations and management of Cardia
achalasia

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 4) Gastro Esophageal 20 Discuss the risk factors, etiology, clinical
reflux disease (GERD) features, investigations, complications and
management of GERD
ENT Cleft lip and palate 1 21 Discuss the etiology, clinical features,
investigations, complications and management of
cleft lip and palate
Pharyngitis and Tonsillitis 1 22 Discuss the etiology, clinical features,
investigations, complications and management of
Pharyngitis and acute Tonsillitis
23 Explain the clinical features, and management of
peritonsillar abscess
24 Discuss the classification, etiology, clinical
features, investigations, and management of
Chronic Tonsillitis
Oropharyngeal cancer 1 25 Discuss the classification, etiology, clinical
features, investigations, and management of
oropharyngeal cancers
Salivary glands 1 26 Classify diseases of the salivary glands
27 Explain the etiology, clinical features,
investigations and management of Mumps, and
Sialadenitis

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 28 Explain the etiology, clinical features,
investigations and management of salivary ducts
stones
Dysphagia 1 29 Explain the types, etiology, clinical features,
investigations and management of a patient with
dysphagia
Surgery Tumors of the esophagus 1 30 Discuss the classification, etiology, clinical
features, investigations, staging and management
of Esophageal cancers
Para-esophageal hiatus 31 Explain the etiology, clinical features,
hernia investigations and management of Para-
esophageal hiatus hernia
PRIME/Medical Social accountability 1 32 Explain the concept of social accountability
Education
33 Differentiate between different social
accountability issues

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 Theme-2 (Epigastric pain)

Pathology Gastritis 1 34 Explain the types, etiology, microscopic

morphology and clinical features of Gastritis
Peptic ulcers 2 35 Discuss the etiology, pathophysiology,
morphology, complications and lab. diagnosis of
peptic ulcer disease
36 Discuss the role of H.Pylori & campylobacter in
the causation of Peptic ulcer disease
37 Discuss the morphology, virulence factors and lab
diagnosis of H. Pylori & campylobacter
Gastric polyps and tumors 1 38 Classify gastric polyps and tumors
39 Describe the pathogenesis, morphology, lab
diagnosis and complications of gastric polyps and
tumors.

Medicine Gastritis 1 40 Explain the types, etiology, clinical features,

investigations, management and complications of
Gastritis
Peptic ulcer disease 2 41 Explain the types, etiology, clinical features,
investigations, management and complications of
Gastritis

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 42 Describe H.pylori eradication therapy protocols in
the treatment of peptic ulcer disease
Upper GI Bleeding 1 43 Explain the etiology, clinical features,
investigations and management of a patient with
upper GI bleeding
44 Describe the indications and procedures of
pharmacological
and endoscopic treatment of variceal bleeding
Pharmacology Anti-emetics 2 45 Classify anti-emetic drugs
46 Describe the mechanism of serotonin antagonists
as anti-emetic agents.
47 Enlist the clinical uses (anti-emetic) and adverse
effects of serotonin antagonists.
48 Describe the pharmacological basis of serotonin
antagonists in chemotherapy induced vomiting
49 Describe the mechanism of H1-antagonists as
anti-emetic agents.
50 Enlist the clinical uses (anti-emetic) of H1-
antagonists.
51 Describe the mechanism of anticholinergic drugs
as anti-emetic agents.

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 52 Enlist the clinical uses (anti-emetic) of
anticholinergic drugs.
53 Describe the pharmacological basis of
scopolamine in motion sickness
54 Describe the anti-emetic mechanism of D2-
receptor blockers (Metoclopramide &
Domperidone).
55 Enlist the clinical uses (anti-emetic) and adverse
effects of D2-receptor blockers.
56 Compare the pharmacological features of
metoclopramide & Domperidone.
57 Describe the drug interaction of metoclopramide
with levodopa.
58 Describe the mechanism of neuroleptics as anti-
emetic agent.
59 Enumerate the clinical uses (anti-emetic) of
neuroleptic drugs.
60 Describe the antiemetic mechanism of
benzodiazepines.
61 Describe the antiemetic mechanism of
glucocorticoids.

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 62 Enumerate the indications (anti-emetic) of
glucocorticoids.
63 List anti-emetic drugs used in morning sickness.
64 List anti-emetic drugs used in chemotherapy
induced vomiting.
Drugs used in the treatment 65 Enlist the drugs used in variceal hemorrhage
of variceal bleeding 66 Describe the mechanism of somatostatin and
octreotide in variceal hemorrhage
67 Describe the mechanism of Vasopressin &
Terlipressin in variceal hemorrhage
68 Describe the mechanism of beta-blockers in
variceal hemorrhage
Drugs used in the treatment 2 69 Classify the drugs used in Peptic ulcer disease
of Peptic ulcer disease and 70 Describe the mechanism of action, indications and
Gastritis adverse effects of proton pump inhibitors (PPIs).
71 Describe the pharmacokinetics of PPIs with
special emphasis on time of administration
72 Describe the drug interaction of Omeprazole & H2
blockers with Sucralfate
73 Describe the drug interaction of Omeprazole with
Clopidogrel

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 74 Describe the mechanism of action, indications and
adverse effects of H-2 blockers.
75 Compare/differentiate H2-blockers in terms of
bioavailability and involvement in drug
interactions
76 Describe the mechanism of action, indications and
adverse effects of Antacids.
77 Enumerate the properties of an ideal antacid.
78 Describe the pharmacokinetics of antacids with
special emphasis on time of administration
79 Describe the drug interactions of antacids with
tetracyclines, iron and fluroquinolones.
80 Describe the mechanism of sucralfate in the
treatment of peptic ulcer
81 List the indicationsof sucralfate.
82 Discuss the drug interaction of sucralfate with
digoxin, ketoconazole and tetracyclines.
83 Describe the pharmacokinetics of sucralfate with
special emphasis on time of administration.
84 Describe the mechanism, indications and adverse
effects of bismuth compounds.

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 85 Describe the role of anticholinergic drugs in
peptic ulcer.
86 List the indications (anti-peptic ulcer) of
anticholinergic drugs.
87 Discuss the pharmacological basis for the use of
prostaglandin analogues (Misoprostol) in the
treatment of peptic ulcer.
88 List the contraindications of misoprostol.
89 Describe triple therapy for the eradication of
H.pylori infection.
90 Describe quadruple therapy for the eradication of
H.pylori infection
Forensic Common house-hold poisons 1 91 Enlist, domestic, medicinal and garden poisons
medicine commonly used
Corrosives/ Mineral acids 92 Enlist different commonly used mineral acids
93 Enumerate physical appearance and uses of
Sulphuric acid
94 Describe mechanism of action, fatal dose & period
of Sulphuric acid
95 Describe clinical features and treatment of
Sulphuric acid burns

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 96 Describe postmortem appearance and forensic
importance of Sulphuric acid burns
97 Enumerate physical appearance and uses of nitric
acid
98 Describe mechanism of action and fatal dose &
period of nitric acid
99 Describe clinical features and postmortem
appearance of nitric acid burns
100 Enumerate physical appearance and uses of
hydrochloric acid
101 Describe clinical features and postmortem
appearance of hydrochloric acid burns
Corrosives/ Alkali 1 102 Enlist different commonly used alkali
103 Enumerate physical appearance and uses of alkali
104 Describe mechanism of action, clinical features
and treatment of alkali burns
105 Describe postmortem appearance and forensic
importance of alkali burns
1 106 Enlist different commonly used organic acids
Corrosive/ organic acid 107 Enumerate physical appearance and uses of
carbolic acid

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 108 Describe mechanism of action, fatal dose & period
of carbolic acid
109 Describe clinical features and treatment of
carbolic acid poisoning
110 Describe postmortem appearance and forensic
importance of carbolic acid poisoning
111 Enumerate physical appearance and uses of oxalic
acid
112 Describe mechanism of action, fatal dose & period
of oxalic acid
113 Describe clinical features and treatment of oxalic
acid poisoning
114 Describe postmortem appearance and forensic
importance of oxalic acid poisoning
Corrosive/ vegetable acid 1 115 Enumerate physical appearance, sources and uses
and cyanides of cyanides
116 Describe mechanism of action, fatal dose & period
of cyanides
117 Describe clinical features and treatment of
cyanide poisoning
118 Describe postmortem appearance and forensic
importance of cyanide acid poisoning

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Surgery Gastric cancer 1 119 Describe the types, etiology, risk factors, lab
diagnosis and management of a patient with
gastric cancer
Gastric outlet obstruction 1 120 Describe the etiology, diagnosis and management
of a patient with gastric outlet obstruction
Community Health system of Pakistan: 2 121 Describe health care system of Pakistan using
medicine and Introduction WHO Health system frame work
public health Primary health care (PHC) 122 Define PHC
123 Describe the history of development of PHC
124 Describe the concepts and components of PHC
125 Describe comprehensive & selective PHC
126 Describe reasons for failure of PHC
127 Describe Health Systems before & after PHC
128 Describe district health care system
129 Enumerate indicators for assessing PHC
Health education 3 130 Define health education
131 Describe objectives and functions of health
education
132 Describe the components of health education
133 Describe the methods of health education

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 134 Describe the communication channel in health
education
135 Describe the constraints in health education
136 Describe classification of theories of health
education
137 Describe the stages in health education
138 Describe the principles of health education
139 Describe the strategies for an effective health
education program
140 Explain the methods of evaluation and
effectiveness of a health education project
Health management 141 Define concept of HMIS
information system (HMIS) 142 Enumerate the components of HMIS
143 Describe its importance in health care delivery
system
144 Enumerate the principles of HMIS
145 Give the causes of failure of HMIS
Hospital administration 1 146 Define health care delivery system
147 Describe the need of a specialized hospital
administration
148 Describe the attributes of a good hospital
administrator

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 149 Describe functions involved in hospital
administration
150 Describe the levels of hospitals and management
levels in a hospital
Health plans - Longitudinal, 1 151 Describe different health plans
horizontal, integrated, 5 152 Describe characteristics of health plans
year, ADP, SAP, Short term,
long term
Health plans – MDGs 1 153 Enumerate MDGS
154 Describe targets & indicators of various health
related MDGs
155 Describe reasons for failure to achieve MDGS
Health plans – SDGs 1 156 Enumerate SDGs related to health
157 Describe targets & indicators of various health
related SDGs
158 Describe Pakistan progress on set targets
Health planning 1 159 Define health planning
160 Describe importance & use of planning in health
161 Explain the reasons for ineffective health
planning in Pakistan
162 Describe health planning cycle
163 Describe the types of health planning

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 Health economics 1 164 Define Health economics
165 Explain the importance of economic studies in
health
166 Describe different tools used in economic
evaluations
Health policy 1 167 Define health policy
168 Describe its role in health system
169 Describe different stages in policy making
170 Describe the different types of policies
171 Describe the constraints in policy making
172 Describe health policy of Pakistan.
Role of international health 1 173 Enumerate international health agencies working
in health sector.
agencies in public health
174 Discuss structure and function of WHO & UNICEF
175 Explain the roles of WHO & UNICEF in Pakistan.

Theme-3 (Pain right upper abdomen)

Anatomy Gross anatomy 1 176 Explain the lobes and segments of the liver
177 Discuss the gross structure of gall bladder and
biliary channels
178 Explain the gross and microscopic structure of the
pancreas
Liver histology 179 Explain the microscopic structure of the liver and
gall bladder

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Pathology Liver Function Tests 1 180 Enumerate the functions of the liver.
Explain the significance of different liver function
tests.
Interpret the Liver function tests in different
diseases.
Mechanisms of liver injury 1 181 Describe the etiology and morphology of liver
and repair injury and repair
Acute Liver failure 182 Describe the etiology, pathogenesis, clinical and
biochemical and other features of acute liver
failure
Chronic Liver disease and 1 183 Describe the etiology,
liver cirrhosis pathogenesis, clinical and biochemical and other
features of chronic liver disease
184 Explain the complications of liver cirrhosis
Portal hypertension 185 Describe the etiology,
pathogenesis, clinical features and complication
of portal hypertension
Viral hepatitis A and E 1 186 Explain the Etiology, pathogenesis, morphology
and clinical features of Acute viral hepatitis A and
E infection

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Viral hepatitis B 2 187 Explain the Etiology, risk factors, pathogenesis,
morphology and clinical features of Acute viral
hepatitis B infection
188 Explain the pathogenesis, morphology and clinical
features of Chronic viral hepatitis B infection
189 Discuss the stages of viral hepatitis B infections
190 Discuss the complications of chronic Hepatitis B
virus infection
191 Discuss the serological markers of hepatitis B
Virus infection
192 Explain the preventive strategies of Hepatitis B
virus infection
Viral Hepatitis C 1 193 Explain the Etiology, risk factors, pathogenesis,
morphology and clinical features of viral hepatitis
C infection
194 Discuss the complications of chronic Hepatitis C
virus infection
Autoimmune hepatitis 1 195 Define autoimmune hepatitis
196 Explain the serological and morphological
features of autoimmune hepatitis
Toxin and Drug induced 197 Explain the etiology and morphological features
hepatitis of toxins and drug induced hepatitis

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Alcoholic liver disease 1 198 Discuss the morphology, pathogenesis and
complications of Alcoholic liver disease
Metabolic liver diseases 1 199 Describe the morphology, clinical features and
• Non-Alcoholic liver complications of NAFLD, Hemochromatosis,
disease (NAFLD) Wilson`s disease and Alpha-1 Anti-Trypsin
• Hemochromatosis deficiency
• Wilson`s disease 200 Describe the etiology, morphology, clinical
• Alpha-1 antitrypsin features and complications of Hemochromatosis
deficiency 201 Describe the etiology, morphology, clinical
features and complications of Wilson`s disease
202 Describe the etiology, morphology, clinical
features and complication of Alpha-1 Anti-Trypsin
deficiency
Liver abscess 1 203 Describe the etiology, pathogenesis, morphology,
clinical presentation, complications and lab
diagnosis of Liver abscess
Tumors of the liver 1 204 Classify liver tumors
205 Explain the benign tumors of the liver
206 Discuss the risk factors, etiology, morphology,
clinical features, staging and complications of
hepatocellular carcinoma

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Gall bladder 1 207 Discuss the types, risk factors, etiology,
• Gall stones morphology, clinical features and complications
of gall stones
• Cholecystitis 208 Discuss the risk factors, etiology, morphology,
clinical features and complications of acute
cholecystitis
209 Discuss the risk factors, etiology, morphology,
clinical features and complications of Chronic
cholecystitis
• Gall bladder cancer 1 210 Discuss the risk factors, etiology, morphology,
clinical features, staging and complications of
carcinoma gall bladder
Pancreas 2 211 Enlist and define the congenital anomalies of
pancreas
212 Discuss the risk factors, etiology, morphology,
clinical features and complications of acute
pancreatitis
213 Discuss the risk factors, etiology, morphology,
clinical features and complications of chronic
pancreatitis
214 Describe the pathogenesis and complications of
pancreatic pseudocyst

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 215 Discuss the risk factors, etiology, morphology,
clinical features, staging and complications of
carcinoma of pancreas
Pediatrics Hereditary 1 216 Classify hereditary hyperbilirubinemias
hyperbilirubinemias 217 Explain the types, clinical features, investigations
and management of different hereditary
hyperbilirubinemias
Acute hepatitis A 1 218 Explain the Etiology, pathogenesis, clinical
features, investigations and treatment of Acute
viral hepatitis A infection
Medicine Hepatitis B virus infection 1 219 Explain the Etiology, pathogenesis, clinical
features, investigations and treatment of Acute
viral hepatitis B infection
220 Explain the Etiology, pathogenesis, clinical
features, investigations and treatment of chronic
viral hepatitis B infection
Hepatitis C virus infection 1 221 Explain the Etiology, pathogenesis, clinical
features, investigations and treatment of chronic
viral hepatitis C infection
222 Explain the clinical features, investigations,
management and complications of liver cirrhosis

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 223 Explain the treatment of a patient with hepatic
encephalopathy
Metabolic liver diseases 1 224 Discuss the management of a patient with
Wilson`s disease
225 Discuss the management of a patient with
Hemochromatosis
226 Discuss the management of a patient with primary
biliary cirrhosis
227 Discuss the management of a patient with
autoimmune hepatitis
Hepatic vein obstruction 228 Discuss the etiology, clinical features,
investigations and management of a patient with
hepatic vein obstruction
Hepatocellular carcinoma 1 229 Explain the etiology, clinical features,
investigations, treatment and complications of
hepatocellular carcinoma
Carcinoma of the pancreas 230 Discuss the risk factors, etiology, clinical
features, staging and complications of carcinoma
of pancreas
Surgery Gall bladder and pancreas 2 231 Explain the etiology, clinical features,
investigations, treatment and complications of
gall stones

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 232 Explain the etiology, clinical features,
investigations, treatment and complications of
acute and chronic cholecystitis
233 Explain the etiology, clinical features,
investigations, treatment and complications of
acute and chronic pancreatitis
Carcinoma of the gall bladder 234 Discuss the risk factors, etiology, clinical
features, staging and complications of carcinoma
of gall bladder
Liver abscess 1 235 Explain the etiology, clinical features,
investigations, treatment and complications of
liver abscesses
Hydatid liver cysts 236 Explain the etiology, clinical features,
investigations, treatment, and complications of
Hydatid liver cysts.
Pharmacology Hepatotoxic drugs 1 237 Describe first pass hepatic metabolism
238 Enlist common hepatotoxic drugs
239 Explain the drug treatment of paracetamol
poisoning.
Drugs used in the treatment 1 240 Classify the drugs for hepatitis B virus infection.
of hepatitis B 241 Describe the duration and adverse effects of drugs
used in the treatment of chronic hepatitis B.
1 242 Classify the drugs for hepatitis C virus infection.

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 Drugs used in the treatment 243 Describe the duration and adverse effects of drugs
of hepatitis C used in the treatment of chronic hepatitis C.
Community Viral Hepatitis 1 244 Describe the epidemiological determinants of
medicine Hepatitis B & C.
245 Describe the prevalence and incidence with
reference to local context.
246 Describe the preventive & control measures for
Hepatitis B & C.
Family Medicine Acute and chronic hepatitis 1 247 Explain the etiology and clinical features of acute
hepatitis.
248 Explain the management strategies of acute
hepatitis in family practice.
249 Explain the etiology, clinical features and
complications of Chronic hepatitis.
250 Explain the management strategies of chronic
hepatitis in family practice.
251 Describe the red flags in a patient with acute and
chronic hepatitis for referral to specialty care.

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 Theme-4: (Diarrhea and Constipation)

Pathology Intestinal obstruction 1 252 Define hernia, adhesions, volvulus, and

intussusception
Ischemic bowel disease 253 Describe the etiology, pathogenesis, morphology,
and complications of small bowel ischemia
Diarrheas 1 254 Define malabsorption syndrome
255 Classify diarrheas
256 Explain the etiology, morphology, clinical
features and complications of Celiac disease
Bacterial enterocolitis 2 257 Explain the etiology, pathogenesis, and clinical
features of bacterial enterocolitis
258 Explain the etiology, pathogenesis, morphology
and clinical features of Salmonellosis
Parasitic enterocolitis 1 259 Classify the parasites invading the small gut
Entamoeba histolytica 1 260 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of Amebiasis
Giardia lamblia 1 261 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of Giardiasis
Hymenolepis nana 4 262 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of H. nana
infestation

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Diphyllobothrium latum 263 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of
Diphyllobothrium latum
Schistosoma hematobium, 264 Enlist physical characteristics of Trematodes
mansoni and japonicum
265 Classify Schistosoma on the basis of organ systems
affected
266 Describe the routes of infection, pathophysiology
life cycle, clinical features and lab diagnosis of
Schistosoma hematobium, mansoni and japoncum
267 Compare the morphological characteristics of
eggs of different species of Schistosoma.
Ascaris lumbricoides 4 268 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of Ascaris
lumbricoides
Strongyloides 269 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of
Strongyloides
Ankylostoma duodenale 270 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of
Ankylostoma duodenale

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 Enterobius vermicularis 271 Discuss the life cycle, morphology, pathogenesis,
clinical features and complications of Enterobius
vermicularis
Medicine Intestinal tuberculosis 1 272 Discuss the etiology, pathogenesis, clinical
features, investigations, treatment and
complications of intestinal tuberculosis
Surgery Acute appendicitis 1 273 Discuss the etiology, risk factors, pathogenesis,
clinical features, differential diagnosis,
investigations, treatment and complications of
acute appendicitis
Intestinal obstruction 1 274 Discuss the etiology, clinical features,
investigations, management and complications of
intestinal obstruction
Pharmacology Antidiarrheal agents 1 275 Define and classify antidiarrheal agents
(Opioids, Colloidal bismuth 276 Describe the mechanism of action of different
compounds, Kaolin & Pectin, antidiarrheal agents
etc
Laxatives (Bulk-forming, 1 277 Define and classify laxative drugs
stool softners, osmotic 278 Describe the mechanism of action of different
laxatives, stimulant laxatives
laxatives, etc.

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Lactulose 279 Describe the pharmacological basis of Lactulose in
the treatment of hepatic encephalopathy
Anti-amoebic drugs 1 280 Classify anti-amoebic drugs
281 Describe mechanism of actions of Metronidazole
& Dialoxanide Furoate
282 Enlist indications and adverse effect of
Metronidazole & Dialoxanide Furoate.
283 Describe the drug interaction of Metronidazole
with Alcohol.
Anthelmintics 1 284 Classify Anti-Helminthic drugs
285 Enumerate clinical use(s), adverse effects and
contraindications of Albendazole, Mebendazole,
Pyrantal Pamoate, Ivermectin, Praziquantel &
Niclosamide
286 Describe mechanism of action of Albendazole,
Mebendazole, Pyrantal Pamoate, Ivermectin,
Praziquantel & Niclosamide
Anti-Salmonellosis drugs 1 287 List the drugs used in enteric fever

288 Describe the basis for selection of antibiotics in

enteric fever based on age, pregnancy and
resistance

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 289 Describe the clinical applications of
fluroquinolones in the treatment of
gastrointestinal disorders
Forensic Irritants 3 290 Classify irritants poisons
medicine Irritants: 291 Enlist common metallic irritant poisons
Metallic poisons 292 Describe physical appearance, uses, mechanism,
fatal dose, fatal period and signs and symptoms of
Copper and Mercury poisons
293 Describe the treatment, postmortem appearance
and medicolegal importance of common Copper
and Mercury poisons
294 Describe the signs and symptoms, treatment,
postmortem appearance and medicolegal
importance of acute and chronic Arsenic
poisoning
295 Describe the signs and symptoms, treatment,
postmortem appearance and medicolegal
importance of acute and chronic Lead poisoning
Irritants /mechanical 1 296 Enlist commonly encountered mechanical poisons
poisons/ powder glass 297 Enumerate symptoms and signs, treatment,
postmortem appearance and forensic importance
of powder glass

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Irritants/ nonmetallic poisons 4 298 Enlist commonly encountered inorganic elements
poisoning
299 Enumerate physical appearance and uses of
phosphorus
300 Describe mechanism of action, fatal dose & period
of phosphorus
301 Describe clinical features and treatment of
phosphorus poisoning
302 Describe postmortem appearance and forensic
importance of phosphorus poisoning
303 Describe physical appearance, uses, mechanism
of action, clinical features, treatment,
postmortem appearance and forensic importance
of aluminum phosphide
304 Describe physical appearance, uses, mechanism
of action, clinical features, treatment,
postmortem appearance and forensic importance
of chlorine
305 Describe physical appearance, uses, mechanism
of action, clinical features, treatment,
postmortem appearance and forensic importance
of iodine

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 Irritants/ vegetable poisons 2 306 Enlist commonly encountered inorganic elements
poisoning.
307 Describe characteristics, active principles, and
clinical features of vegetable poisons.
308 Enumerate uses, fatal dose and fatal periods of
vegetable poisons.
309 Describe treatment, postmortem appearance,
and forensic importance of vegetable poisons.
Irritants/ animal poisons 2 310 Differentiate between poisonous and non-
poisonous snakes
311 Classify snakes on the basis of their venom.
312 Describe the characteristics of snake venoms
313 Classify different snakes venoms
314 Describe steps of management of snake bite
315 Describe post mortem appearance and medico
legal aspects of venomous snake bite
316 Describe sign and symptoms of scorpion bite
Community Overview of common 1 317 Describe the common intestinal worm infestation
medicine intestinal worms’ infestation in our local context
and their control 318 Describe the epidemiological determinants of
common worm infestation with reference to local
context

KMU (IHPER)- Central Curriculum Committee 37

 319 Describe the preventive & control measures for
common worm infestation
Control of dysentery 1 320 Describe the epidemiology of Dysentery.
321 Describe the prevention & control measures of
Dysentery.
Food hygiene 1 322 Describe the term food Hygiene
323 Describe the importance of food hygiene
324 Describe the process of Food hygiene
Family medicine Enteric infections 1 325 Classify enteric infections
326 Describe the etiology, clinical features,
investigations and management of Salmonellosis
327 Describe the red flags in a patient with Salmonella
infections for referral to specialty care.
1 328 Explain the etiology, and management of acute
gastroenteritis.
329 Discuss the primary and secondary prevention of
acute gastroenteritis in a primary healthcare
setting.
330 Describe the red-flags in a patient with acute
gastroenteritis for referral to specialty care.

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Pediatrics Lactase deficiency 1 331 Describe the clinical features, investigations,
complications, and management of Lactase
deficiency.
Infectious diarrhea 332 Describe the etiology, clinical features,
investigations, complications, and management
of infectious diarrheas in children.
Celiac disease 1 333 Describe the etiology, clinical features,
investigations, complications, and management
of Celiac disease.

Theme- 5 (Bleeding per Rectum)

Pathology Inflammatory bowel disease 2 334 Classify IBD
(IBD) 335 Discuss the risk factors and etiology of IBDs
336 Explain the pathogenesis clinical presentation of
IBD
337 Differentiate between Ulcerative colitis and
Crohn`s disease
338 Discuss the investigations and management of
IBDs
339 Explain the intestinal and extra-intestinal
manifestations/complications of IBDs

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 340 Explain the role of surveillance colonoscopy in
patients with Ulcerative colitis
Diverticular disease 1 341 Explain the etiology, pathogenesis, morphology
and clinical features of Colonic diverticulosis
Colonic polyps 1 342 Classify colonic polyps.
343 Describe the pathogenesis, morphology, clinical
presentation, complications and diagnosis of
different types of colonic polyps
Hemorrhoids 344 Define hemorrhoids
345 Explain the morphology, pathogenesis and clinical
features of Hemorrhoids
Colorectal carcinoma 1 346 Describe the adenoma carcinoma sequence
347 Describe the pathogenesis, morphology, clinical
presentation, complications and staging of
colorectal Carcinoma
Surgery Ulcerative colitis 1 348 Explain the etiology, pathogenesis, clinical
features, complications and surgical management
of Ulcerative colitis
Crohn`s disease 1 349 Explain the etiology, pathogenesis, clinical
features, complications and surgical management
of Crohn`s disease

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 Diverticular disease 1 350 Explain the etiology, pathogenesis, clinical
features, complications and management of
Diverticulosis and Diverticulitis
Anal diseases: 1 351 Define perianal fistula and anal fissure
• fistula 352 Explain the risk factors and management of anal
• fissures fistula and anal fissures
• hemorrhoids 353 Explain the risk factors and management of
hemorrhoids
Colorectal cancers 1 354 Classify colorectal cancers
356 Describe the staging of colorectal cancers
357 Explain the pathogenesis, risk factors and clinical
features of colorectal cancers
358 Explain the complications, management and
prognosis of colorectal cancers
Ischemic Colitis 1 359 Explain the etiology, pathogenesis, clinical
features, complications and management of
Ischemic colitis
Medicine Irritable bowel syndrome 1 360 Explain the risk factors, clinical features, and
management of Irritable bowel syndrome
Ulcerative colitis 1 361 Explain the etiology, pathogenesis, clinical
features, complications and surgical management
of Crohn`s disease

KMU (IHPER)- Central Curriculum Committee 41

 Crohn`s disease 1 362 Explain the etiology, pathogenesis, clinical
features, complications and management of
Crohn`s disease
Ano-rectal infections 1 363 Classify anorectal infections
364 Explain the risk factors, clinical features and
management of anorectal infections including
sexually transmitted infections
Pharmacology Drugs used in the treatment 1 365 Enlist the drugs used in IBS
of Irritable Bowel Syndrome 366 Describe the mechanism of action of
(IBS) antispasmodics (anticholinergics), 5-HT receptor
antagonisms (Alosetron) in IBS
Drugs used in the treatment 2 367 Classify the drugs used in IBD
of IBD 360 Describe the mechanism of actions of
aminosalicylates, glucocorticoids, purine
analogues, methotrexate, monoclonal antibodies
and anti-integrin in IBDs
369 Explain the adverse effects of drugs used in the
treatment of IBD
Forensic Abdominal injuries 1 370 Describe injuries to abdominal wall
medicine 371 Describe injuries to esophagus, intestine and
stomach
372 Describe injuries to liver and spleen

KMU (IHPER)- Central Curriculum Committee 42

 Practical work
Pathology Ascaris Lumbricoides 6 373 Identify the important morphological and staining
characteristics of the ova
Enterobius vermicularis 374 Identify the important morphological and staining
characteristics of the ova
Ankylostoma duodenale 375 Identify the important morphological and staining
characteristics of the ova
Liver Function Tests 376 To interpret normal and abnormal liver function
tests in different clinical scenarios
Pharmacology Peptic ulcer disease 5 377 construct prescription for Helicobacter-
associated peptic ulcer disease (Triple therapy &
Quadruple therapy)
Anti-emetics 378 construct prescriptions for motion sickness,
morning sickness, post-operative patient
379 construct prescriptions for cancer chemotherapy-
induced vomiting
380 construct a prescription for a patient suffering
from amoebic dysentery
Enteric fever 381 construct a prescription for a patient suffering
from Enteric fever
382 Write a prescription for a patient suffering from
Ascariasis

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Forensic Poisons 5 383 Identify corrosives
medicine Corosives 384 Case presentation of vitriolage
Irritants 385 identify common irritant poisons
Metallic poisons 386 identify common Metallic and non-metallic
poisons
Vegetable and animal poisons 387 identify common Vegetable and animal poisons
Community Protein calorie malnutrition 1.5 388 Identify the model
medicine 389 Differentiate between the clinical features of 2
models
390 Justify its public health importance
391 Signify the concept of food fortification and food
adulteration
My food plate/ The pyramid 1.5 392 Identify the model
393 Describe different components of the model
Health education 1.5 394 identify a health education message on the
problem/scenario provided
395 Formulate a health education message on the
problem/scenario provided
House fly /arthropods 1.5 396 Identify the model
397 Explain the disease caused by this vector and its
control

KMU (IHPER)- Central Curriculum Committee 44

Aedes Egypti 1.5 398 Identify the model
399 Explain the disease caused by this vector and its
control
Autoclave 1.5 400 Identify the model
401 Explain the types of items for which autoclaves
are used
402 Explain the steps of instruments sterilization

KMU (IHPER)- Central Curriculum Committee 45

 Learning Resources
Table 4: Reference Textbooks
S# Subjects Resources
1. Anatomy A. Gross Anatomy
1. K.L. Moore, Clinically Oriented Anatomy
B. Embryology
1. KeithL. Moore. The Developing Human
2. Langman’s Medical Embryology
2. Community Medicine 1. Community Medicine by Parikh
2. Community Medicine by M Ilyas
3. Basic Statistics for the Health Sciences by Jan W Kuzma
3. OBGYN 1. Obstetrics by Ten Teachers, Louise C. Kenny, Jenny E. Myers
2. Gynaecology by Ten Teachers, Louise Kenny, Helen Bickerstaff
3. Hacker & Moore's Essentials of Obstetrics and Gynecology
4. Textbook of Gynecology, Rashid Latif Khan
5. Fundamentals of Gynaecology, Dr Arshad Chohan
4. Pathology 1. Robbins & Cotran, Pathologic Basis of Disease,9 th edition.
2. Rapid Review Pathology,4 th edition by Edward F. Goljan MD
5. Physiology 1. Textbook Of Medical Physiology by Guyton And Hall
2. Ganong‘s Review of Medical Physiology
3. Human Physiology by Lauralee Sherwood
4. Berne & Levy Physiology
5. Best & Taylor Physiological Basis of Medical Practice
6. Paeds Basis of Pediatrics (8th Edition Pervez Akbar)

KMU (IHPER)- Central Curriculum Committee 46

 Assessment Plan – 4th Year MBBS
The year-4 will be assessed in 4 blocks

1) Block-1 (Neurosciences-2 module) will be assessed in paper-J

2) Block-2 (GIT and hepatobiliary module) will be assessed in paper-K

3) Block-3 (Renal-2, Endocrine & Reproduction-2 module) will be assessed in paper-L

4) Block-4 (ENT and EYE modules) will be assessed in paper-M

5) Each written paper consists of 120 MCQs.

6) Internal assessment will be added to final marks in KMU as shown in below table.

7) In OSPE, each station will be allotted 6 marks, and a total of 120 (+10% marks of

internal assessment) marks are allocated for each OSPE/OSCE examination.

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 4th Year MBBS Modules Assessment Plan
Theory paper Modules Theory Internal OSPE/OSPE Internal assessment Total Marks
marks assessment OSPE/OSPE
theory (10%)
(10%)
Paper J Neurosciences-2 120 13 120 13 266

Paper K GIT & 120 13 120 13 266

Hepatobiliary-2
Paper L Renal-2, Endocrine 120 14 120 13 267
& Reproduction-2

Paper M ENT and EYE 120 13 120 13 266

Research* 20 15 35

Total Marks 480 53 500 67 1100

*Research viva of 20 marks will be conducted in paper-L. However, the rest of 15 marks will be decided by the concerned department internally
for the contribution of the students in research project/thesis.

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 Assessment Blueprints

Table 5: Paper K (GIT & Hepatobiliary – II Module)

Subject Total MCQs
Pharmacology 16
Pathology 41
Forensic medicine 16
Community medicine 18
PRIME 01
Medicine 11
Surgery 12
Pediatrics 03
Family medicine 02
Total 120

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 Table 6: OSPE/OSCE Distribution
Subject Viva stations OSPE/OSCE stations Total

Pharmacology 2 2 4

Pathology 2 2 4

Forensic medicine 2 2 4

Community medicine 2 4 6

Medicine (GIT examination) x 1 1

Surgery (GIT/local x 1 1

examination)

Total 8 12 20

* A minimum of 20 stations will be used in final exams. Total marks will be 120 (6 marks for each station).

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