The course consists of the presentation of clinical cases concerning the main endocrine, metabolic and liver diseases of internal medicine interest in order to acquire the ability to design differential diagnosis paths and to set up appropriate pharmacological and non-pharmacological therapies taking into account the gender differences in the various pathologies.
KNOWLEDGE AND UNDERSTANDING. At the end of the course, students will have to demonstrate knowledge and ability to understand the fundamental concepts and principles on which the differential diagnosis and therapy of the main endocrine, metabolic and liver diseases of internal medicine interest is based.
ABILITY TO APPLY KNOWLEDGE AND UNDERSTANDING. At the end of the course the student must be able to apply the knowledge acquired in the previous point in order to apply the appropriate methodologies for the practical management of the patient's clinical problem. You must also know how to prescribe and appropriately interpret laboratory tests (chemical, microbiological and genetic) and instrumental tests (diagnostic imaging and pathophysiological tests) aimed at differential diagnosis. You must know how to plan the appropriate therapy by evaluating the risk-benefit ratio of drugs and non-pharmacological therapies. At the end of the course, students should be able to manage patients' clinical internal problems.
MAKING JUDGEMENTS. At the end of the course, students will have to demonstrate that they have not only acquired knowledge and concepts, but also that they are able to provide appropriate judgments in relation to the setting of the diagnostic-therapeutic process, patient safety and management of the clinical risk.
COMMUNICATION SKILLS. At the end of the course, students must be able to express themselves and argue appropriately through the specific terminology acquired through the lessons provided, the teaching material and/or the reference text. Students must also be able to communicate with patients and family members in a clear and empathetic way using simple terminology and avoiding technical terms.
LEARNING ABILITY. At the end of the course, students will have to demonstrate that they are able to apply the minimum knowledge, skills and competences described in this Syllabus.

Pathophysiology of endocrine, metabolic and liver diseases and methods of clinical examination. Pharmacology of endocrine, metabolic and liver disease therapies.

Clinical cases concerning the main endocrine, metabolic and liver diseases with analysis of gender differences in various pathologies. Painless jaundice and itching. Jaundice in an acutely ill patients. Abnormal liver enzyme. Abdominal swelling. Unintentional weight loss in a woman with tachicardia and fine resting tremor. Postural hypotension and unintentional weight loss in a woman with hypothyroidism. Hyperprolactinemia in a woman with menstrual irregularities. Glucose control at home. Glucose control in the hospital.

Oxford Handbook of Clinical Medicine. Tenth Edition. Current Medical Diagnosis & Treatment 2024. McGraw Hill LANGE. SIMI HANDBOOK Terapia Medica. Seconda edizione 2022. EDRA Ed.

Clinical cases in endocrine, metabolic and liver diseases. PAINLESS JAUNDICE AND ITCHING. Specific learning objectives: Bilirubin metabolism. Differential diagnosis of jaundice. Posthepatic cholestatic jaundice. Pancreatic carcinoma. Calculosis of the bile ducts. Primary biliary cirrhosis. Primary sclerosing cholangitis. Pre-hepatic jaundice. Hemolysis. Gilbert's syndrome. JAUNDICE IN AN ACUTELY ILL PATIENTS. Specific learning objectives: Cholangitis. Differential diagnosis of acute hepatitis. Serology of viral hepatitis. Treatment of viral hepatitis. Infectious mononucleosis. Drug-induced hepatitis. Acute liver failure. Triggering factors, diagnosis and therapy of hepatic encephalopathy. ABNORMAL LIVER ENZYME. Specific learning objectives: Liver function tests. Differential diagnosis of asymptomatic elevation of transaminases. Non-alcoholic fatty liver disease. Treatment of metabolic syndrome. Alcoholic liver disease. Differential diagnosis of chronic hepatitis. Autoimmune hepatitis. Hemochromatosis. Wilson's disease. ABDOMINAL SWELLING. Specific learning objectives: Ascites: differential diagnosis. Liver cirrhosis: causes, pathophysiology, clinical picture, diagnosis and complications. Portal hypertension. Secondary hyperaldosteronism in edematous syndromes. Compensated and compensated cirrhosis, Child-Pugh staging and MELD. Principles of therapy for ascites and other complications. Precipitating causes of hepatic encephalopathy. Indications for liver transplant. UNINTENTIONAL WEIGHT LOSS IN A WOMAN WITH TACHICARDIA AND FINE RESTING TREMOR.
Recognizing hyperthyroidism. Differential diagnosis of the causes of hyperthyroidism. Principles of therapy for hyperthyroidism. Recognizing hypothyroidism. Thyroid hormone replacement therapy. Recognizing subacute thyroiditis. Differential diagnosis of thyroid nodules. Laboratory and instrumental tests of thyroid function. POSTURAL HYPOTENSION AND UNINTENTIONAL WEIGHT LOSS IN A WOMAN WITH HYPOTHYROIDISM. Recognize acute and chronic adrenocortical insufficiency. Glucocorticoid replacement therapy for adrenocortical insufficiency. Recognize possible associations between endocrine and non-endocrine autoimmune syndromes. HYPERPROLACTINEMIA IN A WOMAN WITH MENSTRUAL IRREGULARITIES. Differential diagnosis of hyperprolactinemia. Recognize primary hypothyroidism and hypothyroidism secondary to pituitary insufficiency. Principles of therapy for hyperprolactinemia. Pituitary adenomas. Cushing's syndrome. Diabetes insipidus. Hypopituitarism. Polycystic ovary syndrome. GLUCOSE CONTROL AT HOME. Epidemiology of type 2 diabetes. Pathophysiology of type 1 and type 2 diabetes. Diagnosis of diabetes mellitus. Mechanism of action of oral antidiabetics. Insulin therapy, with particular attention to "basal-bolus". Goals of antidiabetic therapy. Prevention of type 2 diabetes through treatment of metabolic syndrome.
Chronic macroangiopathic and microangiopathic complications of diabetes. Diabetic retinopathy. Prevention and control of the progression of diabetic nephropathy. Evaluation of albuminuria. Diabetic polyneuropathy. Autonomic neuropathy. Diabetic foot. GLUCOSE CONTROL IN THE HOSPITAL. Hyperglycemia in acute illness. Recognition and prevention of hypoglycemia in diabetes mellitus. Hypoglycemia therapy. Differential diagnosis of hypoglycemia in non-diabetic patients. Acute complications of diabetes. Ketoacidosis. Hyperosmolar coma. Recognize acid-base balance disorders. Differential diagnosis of metabolic acidosis. Anion gap. Ketoacidosis and lactic acidosis. Identify and manage refeeding syndrome in anorexia and alcoholism.

Lectures and clinical case studies on real or simulated patient. Attendance of a two-week internship in an internal medicine department (UCO Clinica Medica, Cattinara Hospital, Trieste, ASUGI) is required. The teaching material is made available to students via the Moodle and MS-Teams platforms.

Any changes to the methods described here will be communicated on the Department, Course of Study and teaching website.
Prof. Gianni Biolo. Department of Medical, Surgical and Health Sciences. University of Trieste. UCO Clinica Medica - Cattinara Hospital – ASUGI. Strada di Fiume 447, 34100 Trieste; e-mail: biolo@units.it; tel. 040-3994432. Consultation is by appointment.

Evaluation of clinical skills through an oral exam, which includes discussion of clinical cases and topics included in the program. Score 29-30 cum laude: the student has an IN-DEPTH knowledge of the subject, has excellent communication skills and masters medical-scientific language. Score 26-28: the student has a GOOD knowledge of the subject and explains the topics clearly using appropriate medical-scientific language; Score 22-25: the student has a DISCRETE knowledge of the subject, even if limited to the main topics and explains the topics quite clearly with a reasonable command of language; Score 18-21: the student has the MINIMUM knowledge of the subject and explains the topics clearly enough although the language skills are poorly developed; Exam not passed: the student DOES NOT HAVE THE MINIMUM KNOWLEDGE required of the main contents of the course. The ability to use specific language is very poor or non-existent and he is unable to apply the knowledge acquired independently.