Serice Id XL

Study Programme Medicine
MODULE
Nutrients uptake and metabolism
Second year
Spring semester
Faculty of Medicine
LUHS
2014-2015
1. General information
Prior your studies of this and other modules you have to get acquainted with the main
document of study process at LUHS. This is The Regulation of Studies issued on June20, 2014
by LUHS Senate order Nr. 47-05.
The booklet of the module is also available on www.personalas.ktu.lt/~julivan/PBL-II and III
year. On this web site you can also find information related with the module.
The main source of flexible information is provided by module organizers and contributors at
Intranet of LUHS – FC.
Supervisor of the module: prof. L.Ivanovienė (laima.ivanoviene@lsmuni.lt)

Coordinator of the module: prof. R. Morkūnienė (ramune.morkuniene@lsmuni.lt)
Departments
Institute of Human anatomy
Environmental and occupational medicine
Biochemistry
Institute of Physiology and Pharmacology
Human Histology and Embryology
Pathological anatomy
Internal Diseases
Subjects and teachers in charge:

Human anatomy (assoc. prof. V. Gedrimas; 327238; dr. I.Saburkina, tedeinga@yahoo.com)
Biochemistry (prof. L.Ivanovienė, 327323, laima.ivanoviene@lsmuni.lt; prof. V.Borutaite;
vilmante.borutaite@lsmuni.lt )
Pharmacology (lecturer, dr. R. Jankūnas, 327242)
Physiology (lecturer I. Korotkich, 327285, igor.korotkich@lsmuni.lt)
Human Histology and Embryology (prof. A. Valančiūtė, 327210, angelija.valanciute@lsmuni.lt, doc.
K.Lasiene ,327235, krislasi@itc.kmu.lt )
Pathological physiology (dr.D.Akramienė, 327285)
Pathological anatomy (Identified in the progress of the module)
Environmental and occupational medicine (assoc. prof. D. Lukšienė, 327360, dalia.luksiene@lsmuni.lt)
Essentials of medical diagnosis (doc. dr. E. Mašanauskienė, 306093)
2. General content of the module
In the module „Nutrients uptake and metabolism“, students study fundamental subjects, which are
essential to understand and know pathogenesis mechanisms, morphological aspects of pathology and to
have notion about common death causes. Analyzing the problems of this module the students gain new
knowledge and apply it to the following domains:
• Anatomic and histological structure of digestive system
• Mechanisms of digestion and uptake of nutrients
• Regulation of metabolism
• Relationship between metabolism and tissue function
• Relationship between disorders of metabolism and pathological processes
• Metabolic disorder-caused changes of digestive system morphology, the most common death
causes
• Clinical evaluation of metabolic disorders
• Prevalence and social aspects of most frequent metabolic disorders.
3. Aim of the Module
The student after have studied this module should know how to define, analyze, explain and relate
phenomena to the cases analyzed in the module. Attaining this aim, students must gain knowledge
about:
• Anatomic and histological structure, function and embryogenesis of the digestive system
• Mechanisms, regulation and disorders of nutrients digestion and uptake
• Changes in morphology of digestive system caused by diseases of digestive system, metabolic
disorders, endoinfections and pancreatitis; causes of death in aforementioned conditions.
• Bile secretion, origin of bile pigments, enterohepatic circulation
• Cholestasis: ethiopathogenesis and impact to human health
• Mechanisms, regulation and disorders of synthesis, storage and breakdown of reserve
compounds (lipids)
• Epidemiology, ethiopathogenesis and principles of obesity treatment
• Integration of carbohydrate, lipid and protein metabolism in cells; disorders of integration
• Blood lipid metabolism and disorders; molecular causes of disorders, laboratory and clinical
diagnostics, principles of treatment
• Ethiopathogenesis and molecular mechanisms of atherosclerotic lesions; principles of
diagnostics and treatment
• Synthesis and regulation of pancreatic hormone secreation; mechanism of insulin action, tissue
and whole organism responses to insuline; causes of insuline hyposecretion and hypofunction
• Regulation of glucose metabolism and blood glucose concentration, disorders of glucose uptake
in tissues; diabetes mellitus: diagnostics, multiple lesions of organs and tissues, changes in
metabolism and ketogenesis, principles of patient observation and treatment
• Metabolism of nitrogenous compounds and it‘s regulation. Importance of imbalance of
synthesis and degradation of nucleotides in pathogenesis. Excretion of final products of
nucleotide degradation.
• Role of liver in detoxification of toxic metabolites and in xenobiotic metabolism. Liver damage:
morphological aspects and influence on the physiological and biochemical function.
Relationship between liver damage and functions of other organs.
• Principles of pancreas and digestive system clinical investigation
4. Tutorials
4.1. Case 1. Yellow lady
A 40-year-old woman was healthy. Suddenly she felt very strong pain in the bottom of the navel and
her back. The pain had been continuing for 12 hours. She called for a doctor. The patient complained
about acute pain below navel during the last two days. Color of her excrements was whitish, color of
urine was brown. The woman complained of itchy skin. Her skin and eyes obtained yellow color. The
patient was obese, had a slight fever.
During physical examination it was observed: during palpation woman felt pain in the area of
epigastrium and below right rib arch. The blood tests were performed: level of hemoglobin was normal;
concentration of total bilirubin 290 µmol/l (normal 17 µmol/l); concentration of conjugated bilirubin
150 µmol/l (normal 5 µmol/l); activity of blood amylase 800 U/l (normal 70-235 U/l); activity of blood
lipase 1000 U/l (normal 0-200 U/l).
What do these alterations indicate?

How did these alterations appear?
Do these symptoms and patient‘s complains match?
Concept of problem: Relationship between disorders of metabolism and formation of bile stones and
outcome of this process.
Clinical symptoms: pains of abdomen, jaundice
Aim
To study mechanisms of bile and pancreas juice secretion, the structure of bile and pancreas ducts,
origin of bile components, degradation mechanisms of hemoproteins as main precursors of bile
pigments, role of bile in digestion, causes and clinical outcomes of obstruction of bile ducts.
Learning objectives and contents

To complete an analysis of this problem the students must know:
• Anatomy of digestive system components (digestive tract, major digestive glands). Anatomic
structure of major digestive glands - pancreas and liver; anatomic structure and topography of
bile ducts and gall bladder, to be able to recognize preparations of these organs.
Subject – Anatomy
Institute of Anatomy
References:
Supplementary readings:
1. Gray‘s anatomy, 39 ed., Elsevier, Churchill - Lvingstone, 2005.
• Features of histology of digestive system and liver

Subject – Human Histology and Embryology
Department of Histology and Embryology
References:
Jungeira LC. et al. Basic Histology, 2010, p.p.281 – 339
Langman’s Medical Embryology,2006,p.p.203-226
Moore Persaud. Before we are born, 2003,p.p.201 - 227
• Main classes of nutrients and their digestion in different parts of digestive tract
Subject – Biochemistry
Department of Biochemistry
References:
1. Mark’s Basic medical biochemistry 2nd edition, 2005, p. 3-24, 493-503, 583-586, 687-690.
2. Harper’s biochemistry 23 edition, 1993, p. 599-614.
3. J.W.Baynes, M.H.Dominiczak Medical Biochemistry. 4th ed. Saunders, 2014, p.111-125.
4. Lippincott's Illustrated Reviews: Biochemistry, 3 edition, 2005, p. 83-88, 171-178, 243-246.
• Transport of digestion products through intestinal mucosa. Composition and role of gastric
juice in degradation of nutrients.
References:
1. Mark’s Basic medical biochemistry 2nd edition, 2005, p. 503-510, 586-593, 690-691.
2. Harper’s biochemistry 23 edition, 1993, p. 609-610, 614-620.
3. Lippincott's Illustrated Reviews: Biochemistry, 3 edition, 2005, p. 86, 247.
4. 3. J.W.Baynes, M.H.Dominiczak Medical Biochemistry. 4th ed. Saunders, 2014, p.111-125.
• Composition and role of bile. Mechanisms and regulation of bile acid synthesis; mechanisms
of gallstones formation.
References:
1. Mark’s Basic medical biochemistry 2nd edition, 2005, p. 585-587, 627-631,
3. Lippincott's Illustrated Reviews: Biochemistry, 3 edition, 2005, p. 222-224.
• Regulation of the secretion of pancreatic juice and bile. Role of gastrointestinal hormones.
Subject – Physiology
References:
1. Ganong WF. Review of medical physiology. 23nd ed. New York: Lange Medical Books /
McGraw-Hill; 2010, p. 435-436, 443-449, 485-486.
2. Ganong WF. Review of medical physiology. 22nd ed. New York: Lange Medical Books /
McGraw-Hill; 2005, p. 482-488, 497-498, 503.
• Pathological physiology of digestion. Jaundice; etiology, types and changes of body functions.
Subject – Pathological Physiology
References:
Copstead L. E., Banasik J. L. Pathophysiology, Elsevier Saunders. 2013. p. 756 – 759.
McCance K., Huether S. E. Pathophysiology, Elsevier Mosby. 2010. p. 1485-1487.
• Characteristics and catabolic pathway of hemoproteins

References:
1. Mark’s Basic medical biochemistry 2nd edition, 2005, p. 812-815.
2. Harper’s biochemistry 23 edition, 1993, p. 337-338, 345-346.
• Bilirubin formation pathways. Transport of bilirubin to liver and bile. Urobilin formation in
intestine; diagnostic importance of heme catabolites.
References:
1. Mark’s Basic medical biochemistry 2nd edition, 2005, p. 812-815.
3. Lippincott's Illustrated Reviews: Biochemistry, 3 edition, 2005, p. 280-283.
• To understand clinical investigation of gall bladder and bile ducts, to understand cholestasis.
Subject – Essentials of Medical Diagnostics
Clinic of Internal Diseases
References:
1. Epstein O, Perkin G.D., Cookson J. Clinical Examination edition 2008, 2012 p.186-221.
2. Kumar & Clark : Clinical Medicine, 2010, p.347- 419.
4.2. Case 2. Weak muscles.
The sixteen-year-old boy sought medical help for progressive muscle weakness. He experienced
painful muscle cramps on severe exercise but he could tolerate moderate exercise normally. The
exercise test was done and blood and urine was analysed biochemicaly. Results show, that severe
exercise was followed by dramatically elevated serum levels of lactate dehydrogenase, ceratine kinase
and aldolase. Myoglobinuria was also present. The blood glucose level was normal and could be
elevated by treatment with glucagon. Serum lactate concentration before exercise was 1,1 mM (normal
0,5-1,8 mM), after 5 min of severe exercise increased to 1,5 mM (normal 6,0-12,1 mM). It was decided
to do a muscle biopsy. The results of the biopsy analysis: the glycogen deposited in increased amounts
had a normal structure, concentration of glucose-6-phosphate was increased and fructose-1,6-phosphate
was decreased if compare to normal values.
What is the significance of his serum enzyme levels and the myoglobinuria after severe exercise test?
Why is there an increased deposition of muscle glycogen?
Why is patient able to tolerate moderate, but not severe, exercise?
What do the results of treating patient with glucagon indicate about his condition?
Concept of the problem. The supply of energy during muscle contraction
Clinical symptoms. Muscle cramps, myoglobinuria, intolerance of severe exercise
Aim
To understand the main mechanisms of nutrients utilization and storage in muscle cells, the
principles of energy metabolism regulation, to relate processes of energy formation and transmission to
muscle contraction-relaxation, to evaluate the state of muscle and to interpret biochemical analysis data
for characterisation of pathological process.
Learning objectives and contents:

To complete an analysis of this problem the student must know:
• Histological features of digestive system implicated in digestion of carbohydrates
Subject – Histology
References:
Jungeira LC. et al. Basic Histology, 2010, p.p.281 – 339
Langman’s Medical Embryology,2006,p.p.203-226
• Principles, regulation, energy yield and biological importance of degradation of carbohydrates
(the main muscle energy substrate) in a cell under metabolism in anaerobic and aerobic
conditions
Unit - Department of Biochemistry
References:
1. CM Smith, A Marks, MA Lieberman. Marks' Basic Medical Biochemistry. A Clinical Approach. 2d
ed. Lippinkott Williams&Wilkins, 2005, p. 337-339, 341-358, 360-378, 380-389, 390-395, 399-416.
2. PC Champe, RA Harvey, DR Ferrier. Lippincott's Illustrated Reviews: Biochemistry. Ed.3. 2005, p.
69-114.
3. R.K.Muray, D.K. Granner, P.A. Mayes, V.W.Rodwell. Harper’s Biochemistry. 24th ed. A lange
medical book. Prentice-Hall International. 1996, p. 119-130, 164-171, 172-180.
1. Devlin M.D. Textbook of Biochemistry with Clinical Correlations. Wiley-liss, 6th ed., 2006.
• Structure of carbohydrates glycogen and glucose, principles, regulation and biological

importance of synthesis of glycogen and glucose
References:
ed. Lippinkott Williams&Wilkins, 2005, p. 58-63, 511-525, 556-577.
83-85, 115-134.
medical book. Prentice-Hall International. 1996, p. 131-141, 181-189, 190-200.
• To relate processes of energy formation and transmission to muscle contraction-relaxation

References:
ed. Lippinkott Williams&Wilkins, 2005, p. 862-876
323-324
medical book. Prentice-Hall International. 1996, p. 647-664.
• Repeat! Muscle contraction physiology from the module Locomotion.

4.3. Case 3. Obesity
A 48 years old man for several years has been willing to slim down. He was consulted by many
therapists, and various diets were recommended for him. Unfortunately nothing helped out. And
several days ago he decided to start starving and to get rid of several kilos. Therefore he consulted to
his doctor about the new diet, which lacks carbohydrates but is rich in fat.
It has turned out that this man has been having overweight since he was 15 or 16 years old. As he grew
up he always had not less than 100 kilograms. His father and his brother were also obese. At the
moment this man weighs 108 kilograms, and is 178 cm tall. The majority of fat are allocated in the
belly area. The concentration of blood glucose is at the normal level.
What mechanisms are responsible for the overweight of this man?

Is it an important problem?
What could you propose for this man?
Concept of the problem: the mechanisms of reserved fat accumulation and use.
Clinical symptoms: overweight
Aim
To investigate the structural features and transport, the mechanisms of accumulation and
assimilation of lipids and their components in tissues.

By the time the students have solved this problem they will have been showing knowledge on or
known the following:
• The mechanisms of hydrolysis and synthesis of depot fats, and the regulation of these processes.
References:
1. Harper‘s Biochemistry, 23rd edition. R.K. Murray, D.K. Granner, P.A. Mayes, V.W. Rodwell.
Appleton and Lange, Norwalk, Connecticut, 1993, p. 142-153, 241-265.
• The biosynthesis of fatty acids in human body.

References:
1. Harper‘s Biochemistry, 23rd edition. R.K. Murray, D.K. Granner, P.A. Mayes, V.W. Rodwell.
Appleton and Lange, Norwalk, Connecticut, 1993, p. 212-219.
• The mechanisms of obesity resulting in the disproportion of accumulation and hydrolysis of fats
and the body-mass regulation principals.
References:
Harper‘s Biochemistry, 23 edition. R.K. Murray, D.K. Granner, P.A. Mayes, V.W. Rodwell.
Appleton and Lange, Norwalk, Connecticut, 1993, p. 258-260, 603.
Additional readings:
1. Lippincott‘s Illustrated Reviews: Biochemistry, 3rd edition. P.C. Champe, R.A. Harvey, D.R.
Ferrier. Lippincott Williams and Wilkins, 2005, p. 347-370.
2. Marks‘ Basic Medical Biochemistry: A Clinical Approach, 2nd edition. C. Smith, A.D.
Marks, M. Lieberman, 2005.
• Causes, morphology aspects and the most common death causes of obesity
Subject – Pathological Anatomy
Subdivision - Clinic of Pathological Anatomy
References:
I.L. Robbins and R.S. Cotran. Pathologic basis of disease, 7th ed., 2005, p. 461-465, 1207-1209.
• Clinical evaluation of obesity
Subject – Essentials of Medical Diagnosis
Subdivision – Clinic of Internal Diseases
References:
1. Lynn S. Bickley. Guide to physical examination and history taking. Lippincott Williams and
Wilkins, 2007, p. 90-96.
2. Parveen Kumar and Michael Clark. Clinical medicine. W.B. Saunders Company, 2005, p.
229-264.
• Prevention of obesity and evaluation of dietary on a caloric basis

Subject – Environmental and Occupational Medicine
Subdivision – Department of Environmental and Occupational Medicine
References:
1. Ustinavičienė R, Lukšienė DI. Human nutrition: [electronic book]. Kaunas: Lithuanian University
of Health Sciences, Lithuanian Academic e. library (eLABa), 20130522 , 2012. 65 p.
2. Caballero B. The global epidemic of obesity: an overview. Epidemiol Rev. 2007;29:1-5.
• Histological features of white and brown adipose tissue.
Subject - Histology
Subdivision – Department of Histology and embriology
4.4. Case 4. Worried about heart attack
A 38-year-old self-employer businessman, Brian C., went to his physician concerned about his
health. His business was doing badly and he was working long hours. He ate irregularly, smoked
heavily and drank substantial quantities of alcohol. He had notices a number of raised areas
(xanthomata) on his hands and legs. His doctor found by questioning that some members of his
family had died relatively young from heart attacks. Patient’s blood was taken and biochemical
analysis was performed. A fasting blood sample was assayed for plasma lipids (table 1).
Table 1. Plasma lipid analysis
Lipid Patient Normal

TAG (mM) 1.7 0.6-3.2
Cholesterol (mM) 9.5 3.7-6.8
The cholesterol content of each of the main plasma lipoproteins was detected in laboratory and
presented in the table 2.
Table 2. Cholesterol analysis of plasma electrophoretic components in mM
Subject β Pre-β α
Normal 3.18 0.41 1.37
Patient 7.70 0.70 1.14
Fibroblasts were cultured from Brian’s skin. The ability to bind radiolabeled LDL was compared with
that of control fibroblasts (figure 2). After incubation with LDL their 3-hydroxy-3methylglutaryl-CoA
(HMG-CoA) reductase activity was also measured (figure 2).
Brian was given general advice about his life-style and put on a course of oral cholestyramide (a
synthetic anion-exchange compound which is not absorbed from the gut) and lovastatin (a competitive
inhibitor of HMG-CoA reductase). Four months later, his fasting plasma cholesterol has fallen by 30%.
Figure 2. Effects of LDL concentration on binding of radiolabelled LDL to cultured fibroblasts
(a) and on the activity of HMG-CoA reductase (b).
Questions:
What is the origin of raised areas around muscle-tendon?
What is the rational for determination of blood lipids and lipoproteins?
How is the atheromatous plaque thought to arise?
If you had been Brian’s doctor what recommendations would you have made concerning his life-style?
Patient has a brother, a sister and a teenage son. Is it worth to examine them and how?
Concept of the problem: hypercholesterolemia and its consequences.
Clinical symptoms: xanthomata on shin near Achil’s tendon.
Aim:
To understand metabolism of cholesterol, the role of hypercholesterolemia in development of
atherosclerosis; to know molecular mechanisms of atherosclerotic injury to blood vessels.

At the end students must know:
• The role of cholesterol in human organism, biochemical pathways of its synthesis and
excretion.
References:
1. R.K. Murray, D.K. Granner, P.A. Mayes, V.W. Rodwell. Harper‘s Biochemistry, 23 ed., Appleton
and Lange, Norwalk, Connecticut, 1993, p. 271-276; 278
2. P.C. Champe, R.A. Harvey, D.R. Ferrier. Lippincott‘s Illustrated Reviews: Biochemistry, 3 ed.
Lippincott Williams and Wilkins, 2005, p. 217-222.
• Blood lipoproteins, their metabolism and role in the pathogenesis of atherosclerosis.
Biochemical analyses for evaluation of cholesterol metabolism, interpretation of the data of
such analyses.
References:
and Lange, Norwalk, Connecticut, 1993, p. 254-256, 276-278; 280-281.
• The role of hypercholesterolemia in the development of atherosclerosis and molecular

mechanisms of atherosclerotic injury to blood vessels.
References:
1. C. Smith, A.D. Marks, M. Lieberman. Mark‘s Basic Medical Biochemistry: A Clinical
Approach, 2 ed., 2005, p. 641-643.
• Metabolism of membrane phospholipids, possible damage to phospholipids and their

consequences.
References:
1. Harper‘s Biochemistry, 23 edition. R.K. Murray, D.K. Granner, P.A. Mayes, V.W. Rodwell.
Appleton and Lange, Norwalk, Connecticut, 1993, p. 245-251.
• Risk factors and development of atherosclerosis

Clinic of Pathological Anatomy
References:
I.L. Robbins and R.S. Cotran. Pathologic basis of disease, 7th ed., 2005, p. 516-524.
• Classification and mechanisms of action of antihyperlipidemic medicines, changes in plasma
lipoprotein levels, related theraputic effects and benefit-risk ratio.
Subject: Pharmacology
Unit: Institute of Physiology and Pharmacology
References:
1. Mysek MJ, Harvey RA, Champe PC. Lippincott‘s Illustrated Reviews: Pharmacology. 6th ed.
Philadelphia: Lippincott Williams & Wilkins; 2014.
2. Katzung BG. Basic and Clinical Pharmacology. 13th ed. Boston: McGraw-Hill; 2014.
Mutschler E, Geisslinger G, Kroemer HK, Ruth P., Shafer-Korting M. Arzneimittelwirkungen.
Lehrbuch der Pharmakologie und Toxikologie. 10 Aufl. Stuttgart; 2012.
4.5. Case 4. Persistent thirst
So far, a girl of 17 has been of good health. Today, however, she has visited her doctor because she had been
worrying about loosing weight despite of normal nutrition. Within 2 last months she has lost 5 kg of her body
weight. Now, she feels tired, has lost endurance (until recently she enjoyed walking), suffers of thirst constantly,
her mouth is dry and urination is frequent. During her medical examination, the doctor perceived a sharp odor of
girl’s breath. The doctor has sent specimens of the girl’s blood and urine for biochemical analysis. The analysis
of blood showed that glucose concentration was as high as 20 mmol/l (normal concentration is 3,3-5,5 mmol/l).
Glucose and ketone bodies were found in the urine.
How can you explain the presence of glucose and ketone bodies in girl’s urine?
Are these findings related to subjective sensations of this patient?
What additional examinations have to be performed to confirm diagnosis?
Concept of the problem: regulation of metabolism of carbohydrates, fats and proteins and
concequences of disturbances of this regulation.
Clinical symptoms: polydipsia, polyuria, hyperglycemia, ketonuria.
Aim
To understand principles of metabolism regulation by pancreatic hormones, ascertain concequences of

regulation disturbances on functioning of tissues and whole organism.

For completion of the problem analysis, students should know:
• Features of external and internal structure of the pancreas as one of the biggest gland of
digestion, to define the pancreas as exocrine gland (characterisation of pancreatic duct system)
and as endocrine gland (know how to characterise pancreatic islets and their location in the
pancreas), know functions of the pancreas and other glands of digestion (liver), their agedependent
alterations.
Subject – Human anatomy
References:
1. Gray‘s anatomy, 39 ed., Elsevier, Churchill -Lvingstone, 2005, p. 179-180, 1231-1237.
• Histological structure of the pancreas; be able to recognise histological sections of the
pancreas, differentiate pancreatic islets and cell types.
Subject – Histology
References:
1. Jungeira L.C. et al. Basic Histology, 2005, p. 321 -339
• Principles of synthesis and secretion regulation of both insulin and glucagon.
References:
and Lange, Norwalk, Connecticut, 1993, p. 582-584; 585-586.; 595-596.
• Features of structure and molecular mechanisms of action of insulin and glucagon

References:
and Lange, Norwalk, Connecticut, 1993, p. 590-594.
• Regulation of metabolism of carbohydrates, fats and proteins by insulin.

References:
• Principles of diagnostics of diabetes mellitus; to have notion about complications of diabetes
mellitus and treatment.
Subject – Essentials of Medical Diagnostics
References:
1. Parveen Kumar and Michael Clark. Clinical medicine. W.B.Saunders Company, 2005, p. 1101-
1153.
1. Epstein P. et al. Clinical examination, 2003, p. 30-40.
• Mechanism of regulation of blood glucose concentration, biochemical markers of diabetes
mellitus, principles of glucose tolerance test and its interpretation.
References:
• Pathogenesis, morphology, complications and death causes in diabetes mellitus.

References:
I.L. Robbins and R.S. Cotran. Pathologic basis of disease, 7th ed., 2005, p. 1197-1201.
• Classification, pharmacological and clinical properties of antidiabetic agents.
Subject: Pharmacology
References:
• Abnormalities of carbohydrate metabolism, their etiology; etiology and pathogenesis of

diabetes mellitus.
References:
1. Pathophysiology; Lee-Ellen C. Copstead and J.L. Banasik, 5th ed. Saunders Elsevier 2013. p. 816-
826
2. Pathophysiology. The biologic basis for disease in adults and children; McCance K., Huether S. E.
Elsevier Mosby. 2010. p. 745 – 765.
4.6. Case 6. Dizziness
A 55-year-old unemployed labourer man B.C., had been a heavy beer drinker for years and
was admitted to hospital after collapsing in the street. He was clearly unsteady on his feed, vomit,
confused and with strong smell of alcohol on his breach. His blood alcohol concentration was 78 mM.
Physical examination revealed tender enlargement of the liver. He complained on general loss of
appetite, fatigue, early-morning nausea and frequent gastrointestinal problems. Occasional vomiting of
blood had been reported and enlarged gastro-esophageal veins (verices) were detected.
His wife M.C., aged 42, also presented with gastrointestinal problems and frequent diarrhea.
She had been under considerable stress at work and admitted to concerns about her alcohol
consumption.
It was felt advisable to perform a set of liver function tests on both patients and the results are
shown in Table 1. The blood calcium and magnesium levels were low and man B.C. urinary urea
excretion was also low. In addition, his blood clotting time was found to be impaired.
Table 1. Biochemical tests of liver function

Blood levels B.C. M.C. Normal range
Total protein (g/l) 68 77 60-84
Albumin (g/l) 31 39 35-50
Total bilirubin (µM) 58 15 3-15
Alkaline phosphatase (U/I) 725 339 100-300
Alanin transaminase (U/I) 35 94 5-35
Aspartate transaminase (U/I) 42 177 10-40
γ-Glutamyl transferase (U/I) 790 463 7-45
What happens with alcohol in the liver?

What is significance of the biochemical test of liver function?
Which of the patient’s state is better and why?
Why alcoholism is not only medical but and social problem?
Concept of the problem: Disturbances of metabolism causes intoxication and after-effect of its
progression.
Clinical symptoms: confusion, unsteadying on his feed, nausea, vomiting, diarrhea, enlargement of the
liver, loss of appetite, fatigue
Aim
To get knowledge’s about disturbances of metabolism, pathological and morphological alterations of
the liver and other organs in patients with alcoholism and psychosocial aspects of this problem.


• Anatomy of the wall components of the digestive canal, structural and functional features.
Anatomic structure, topography and function of the liver; its intraorganic blood vessels.
Subject – Human Anatomy
References:
1. Gray‘s anatomy, 39 ed., Elsevier, Churchill -Lvingstone, 2005, p. 1213-1225
2. Atlases of anatomy
• Regulation and phases of gastric secretion. Role of gastrointestinal hormones.
References:
1. Ganong WF. Review of medical physiology. 23 ed. New York: Lange Medical Books / McGraw-
Hill; 2010, p. 431-435, 443-448.
Hill; 2005, p. 482-488, 491-495.
• Origin of gastointestinal motility. Motor functions of stomach and their regulation.
References:
Hill; 2010, p. 469-471, 473-475.
Hill; 2005, p. 480-482, 494-495.
• Functions of small and large intestine and their regulation. Role of enteric nervous system.
Mechanism of defecation.
References:
Hill. 2010, p. 448-449, 475-478.
Hill. 2005, p. 479, 504-511.
• Biochemical mechanisms of protein digestion. Mechanism of HCl synthesis in stomach.
References:
1. Murrey R.K., Granner D.K., Mayes P.A., Rodwell V.W. Harper‘s Biochemistry. 23nd ed.,
Appleton & Lange, 1993, p. 609- 621.
2. Champe P.C., Harvey R.A. Lippincott‘s illustrated reviews: Biochemistry 2nd ed, Lippincott-
Raven publishers, 1994, p. 229-233.
3. Smith C., Marks A.D., Lieberman M. Marks‘ Basic Medical Biochemistry: A Clinical
approach.2nd ed, Lippincot Williams & Wilkins, 2005, p. 687- 696.
4. J.W.Baynes, M.H.Dominiczak Medical Biochemistry. 4th ed. Saunders, 2014, p.122-125; 236-237.
• Liver failure, etiology, pathogenesis and changes of body functions. Portal hypertension.
References:
• 1. Pathophysiology; Lee-Ellen C. Copstead and J.L. Banasik, 5th ed. Saunders Elsevier 2013. p.
756-767
• 2. Pathophysiology. The biologic basis for disease in adults and children; McCance K., Huether
S. E. Elsevier Mosby. 2010. p. 1482 - 1494.
• Etiology and pathogenesis of the alcoholism, morphological alterations of the pancreas, liver
and gastrointestinal canal and death causes in patients with this disease. Endoinfectional
processes of digestive canal and pancreatitis.
References:
1. I.L. Robbins and R.S. Cotran. Pathologic Basis of Disease, 7th ed., 2005, p. 421-424, 812-815,
816-819, 870-871..
• Metabolism of amino acids, detoxification of ammonia and subsequences of the disturbance of
this process.
References:
1. Murrey R.K., Granner D.K., Mayes P.A., Rodwell V.W. Harper‘s Biochemistry. 23nd ed., Appleton
& Lange, 1993, p. 287-352.
2. Champe P.C., Harvey R.A. Lippincott‘s illustrated reviews: Biochemistry 2nd ed, Lippincott-
Raven publishers, 1994, p. 229-268.
3. Smith C., Marks A.D., Lieberman M. Marks‘ Basic Medical Biochemistry: A Clinical
approach.2nd ed, Lippincot Williams & Wilkins, 2005, p. 683- 746.
Devlin MD. Textbook of Biochemistry with Clinical Correlations. Wiley-Liss; 6th ed., 2006, p. 743-
787.
• Role of the liver in detoxification processes, its molecular mechanisms.
References:
1. Gibson G.G., Skett P. Introduction to drug metabolism, 3 ed., Nelson Thornes publishers,
2001, p. 1-84.
2. Coleman M.D. Human drug metabolism. John Wiley & Sons, Ltd, 2005, p. 1-127.
3. J.W.Baynes, M.H.Dominiczak Medical Biochemistry. 4th ed. Saunders, 2014, p.395;398-404.
1. Devlin M.D. Textbook of biochemistry with clinical correlations. Wiley-Liss; 6th ed, 2006,
p. 414-432.
2. Marshal W.J., Bangert S.K. Clinical chemistry, 5th ed. Mosby, 2004, p. 85-103.
3. McPhee S.J., Lingappa V.R., Ganong W.F. Pathophysiology of disease; an introduction to
clinical medicine, 4th ed., Lange medical books/McGraw-Hill, 2003, p. 380-419.
• Clinical assessment, complications and treatment of the disturbances of the liver and
gastrointestinal canal.
Subject – Essentials of Medical Diagnostic
References:
1. Lynn S. Bickley .Guide to physical examination and history taking. Lippincott Williams and
Wilkins, 2007, p. 359-409.
2. Parveen Kumar and Michael Clark. Clinical medicine .W.B.Saunders Company, 2005, p. 265-
418.
• Psychosocial aspects of alcoholism
Subject – Environment Medicine
Department of Environment and Occupational Medicine
References:
1. Telksnienė R., Lukauskas A. Readings in healthy nutrition, 2002, Kaunas, p. 18-20.
2. Gurr M. Healthy lifestyles. Nutrition and physical activity. ILSI Press, 1998, p. 35-39.
http://www.who.int/topics/alcohol_drinking/en/
5. Lectures
5.1. Biochemical mechanisms of nutrients digestion. Regulation of digestion. (2 h)

In charge – professor L. Ivanovienė
Description
Main classes of nutrients. Differences in their structure. Essential nutrients (essential fatty acids,
minerals, vitamins). Degradation of nutrients in mouth: role of salivary enzymes - α-amylase and
lysocime in digestion of carbohydrates. Degradation of nutrients in stomach: mechanism of formation
and action of hydrochloric acid, mechanism of action of proteolytic enzymes. Role of lingual and
gastric lipase in degradation of lipids in stomach. Digestion of nutrients in duodenum: specificity of
pancreatic enzymes. Role of bile acids in degradation of lipids. Mechanism of activation of pancreas
enzymes. Absorption of digestion products. Putrefaction.
5.2. Heme catabolism: relationship to formation of bile pigments. (2 h)
In charge – professor V.Borutaitė
Description
Characteristics of hemoproteins, their catabolic pathways. Pathways bilirubin formation. Transport of
bilirubin to liver and bile. Composition and function of bile. Synthesis of bile acids its regulation. Role
of cholesterol in metabolism of bile acids. Bile as main form of elimination of cholesterol. Formation
of urobilins in intestine. Jaundice.
5.3. Histologic structure of digestive system. (2 h)

Department of Histology and Embriology
In charge – professor A.Valančiūtė
Description
Embryological origin and main developmental stages of special parts of digestive system. Histologic
structure of the oral cavity: lips, tongue, hard and soft palate, teeth, minor and major salivary glands.
Common and special points of structure of the digestive tube: esophagus, stomach, small and large
intestines. Major glands in digestive system: pancreas and liver. Microscopic structure of liver lobulae,
liver blood circulation, ultrastructure of hepatocytes, bile excretion. Structure of pancreas exocrine and
endocrine parts, secretion of hormones.
5.4. Pathological physiology of digestion. The disorders of liver functions (2 h.)

Institute of Physiology and pharmaology (Pathological Physiology)
In charge - lect. D. Akramienė
Description
Disorders of motor (vomiting, hiccup, eructation) and secretory (hyper- and hypiacidity) functions of
the stomach and consequences of stomach resection. Their etiology, pathogenesis, disorders of body
functions. Peptic ulcer disease, etiology, pathogenesis. Diarrhea and constipation, their etiology,
pathogenesis, disorders of organism functions. Liver failure, etiology, pathogenesis and changes of
body functions. Portal hypertension, etiology, pathogenesis, disorders of body functions. Jaundice,
etiology, pathogenesis, disorders of body functions.
5.5. The understanding of clinical analysis data for diagnosis of digestive system and
liver diseases. (2 h)
In charge – lect. E .Mašanauskienė
Description
Examination of main symptoms of patients suffering from digestive system and liver diseases (pain,
nausea, vomit, waterbrash, disorder of swallow, distension, diarrhoea, constipation, haemorrhage, pain
in the right side, jaundice, itch). Analysis of digestive system and liver: analysis of faeces, H. Pylori
diagnosis, pH-metry, fibroesophagogastroduodenoscopy, endoscopic and echoscopic analysis, bilirubin
and liver enzymes tests. Syndromes: acute abdominal pain, GERL syndrome, syndromes of
haemorrhage, malabsorbtion. Understanding of liver cirrhosis and alcoholic liver diseases.
5.6. Gastrointestinal functions and their regulation (2h)

Responsible person – lect. I. Korotkich
Description
Swallowing. Nervous and humoral regulation of secretory and motor functions of the stomach.
Regulation of the secretion of pancreatic juice and bile. Regulation of functions of small and large
intestines. Defecation.
5.7. Metabolism of triacylglycerols and phospholipids. (2 h)

Responsible persons – prof. L.Ivanovienė
Description
Mechanism of the synthesis of triacylglycerols: substrates, their origin, and the synthesis enzymes.
Mechanisms of the degradation of triacylglycerols (tissue lipolysis): enzymes and the ways of control.
Hormonal regulation of the degradation and synthesis of triacylglycerols. Connection between the
synthesis of phospholipids and triacylglycerols, and intercompetition. The synthesis of triacylglycerols
from phosphatidic acid. Compounds activating the synthesis of phospholipids. The biosynthesis of
sphingolipids. Plasmalogen – a platelet-activating factor. The consequences of defects in
phospholipids.
5.8. Disorders of carbohydrate metabolism: Hyperglycaemia and hypoglyceamia.

Diabetes mellitus, its etiology, mechanisms of pathogenesis, changes of body
functions. (2 h)
Institute Physiology and Pharmacology (subject Pathological Physiology)
In charge - lect. D. Akramienė
Description:
Causes of disturbances in carbohydrate metabolism. Hyperglycaemia and hypoglycemia; causes and

and pathogenesis. Etiology and pathogenesis of diabetes mellitus, changes in metabolism, its acute and
chronic complications.
5.9. Metabolism and transport of cholesterol. (2 h)

Department – Biochemistry
In charge – prof. L.Ivanoviene
Description:
Cholesterol and products of its metabolism. Biosynthesis of cholesterol, its regulation. Isoprenoid
compounds. Formation of esters of cholesterol. Transport of cholesterol: from intestine, liver,
extrahepatic tissues. LDL and HDL metabolism. LDL receptors. Coefficient of atherogenecity. HDL.
Lecitin:cholesterol-acetiltransferase and apoD (cholesterol transport protein). Excretion of cholesterol.
Hypercholesterolemia, its causes.
5.10. Antidiabetic and antihyperlipidemic agents (2 hours)

In charge: dr. R.Jankūnas
Description:
Insulin preparations: classification, pharmacodynamics, pharmacokinetics, indications for use, routes of
administration and adverse reactions. GLP-1 analogues: pharmacodynamics and adverse reactions. Oral
hypoglycemic agents (metformin, sulfonylureas, meglitinides, pioglitazone, alpha-glucosidase
inhibitors, DPP-4 inhibitors and SGLT-2 inhibitors): pharmacodynamics and adverse reactions.
Precautions to avoid hypoglycemia, warning signs and agents administered for its therapy. Role of
antihyperlipidemic agents in multifactor intervention strategy to reduce cardiovascular risk.
5.11. Regulation of metabolism by hormones of pancreas: molecular mechanism of

action and signs of insufficiency. (2 h)
In charge – professor L. Ivanovienė
Description
Regulation of secretion of glucagon and insulin. Mechanism of glucagon action: target cells,
transduction of glucagone signal to the cell, effects of glucagon on carbohydrate and lipid metabolism.
Cell targets of insulin. Receptors of insulin. Intracellular signal transduction pathway of insulin.
Mechanism of catabolic and anabolic insuline effects. Deficiency of insulin secretion and action.
Somatostatin and other peptides, which regulate pancreatic secretion.
5.12. Mechanisms of regulation of blood glucose concentration. (2 h)
In charge – prof. V.Borutaite
Description
Mechanisms of glucose uptake from blood to tissues: Insulin as an essential factor of glucose uptake
from blood. Role of glucagon in maintainance of stabile blood glucose concentration under short
periods of starvation, e.g. night-fast. Maintainance of constant blood glucose concentration under long-
lasting starvation. Glucocorticoids: synthesis and scretion, regulation of aforementioned precesses,
molecular mechanisms of glucocorticoid action. Hyper- and hypocorticism.
5.13. Diabetes mellitus, its pathogenesis and morphology, complications and death
causes. (2 h)
Clinic of Pathological anatomy

In charge – prof. R. Gailys and prof. V.Lesauskaitė
Description
Morphological changes of the pancreas. Classification of diabetes. Pathogenesis of diabetical macro-
and microangiopathies, localisation and outcomes of the most common alterations. The most common
complications and death causes in diabetes mellitus.
5.14. Notion of metabolic endocrine diseases. (2 h)

Clinic of Internal diseases
Description
Clinical examinations implicated in diagnosis of endocrine diseases that manifest as striking metabolic
abnormalities. Complains: weakness, obesity, thirst, polyphagia, plyuria. Clinical examinations:
anthropometry, glucose tolerance test, examination of glycemia. The main symptoms of diabetes
mellitus are revise as well as diagnostic criteria, complications, notion about treatment of diabetes
mellitus.
5.15. Amino acid metabolism. Ammonia detoxication. (2 h)

In charge – professor V. Borutaitė
Description
Stages of amino acid catabolism. Types and main enzymes of amino acid deamination in human body.
Aminotransferases, diagnostic value of plasma aminotransferases. Transport of ammonia in the
circulation and detoxication of ammonia. Mechanism of urea synthesis and disorder consequences.
Amino acid decarboxylation. Biogenic amines. Detoxication of products of protein putrefaction in large
intestine. Metabolism of carbon skeletons of amino acids. Synthesis of creatinine, biological
importance. Regulation of amino acid metabolism. Parenteral nutrition. Amino acids – drugs.
5.16. Pathologic anatomy of alcoholism. General endoinfectional processes and

pacreatites. (2 h)

In charge – prof. R.Gailys, prof. V.Lesauskaitė
Description
General morphological manifestations of alcoholism, its complications and reasons of death.

Endoinfections of digestive tract and ulcer disease. Bellary stones and pancreatities.
5.17. Liver role in detoxification processes. Molecular mechanisms of the

biotransformation of xenobiotics and autobiotics. (2 h)
In charge – prof. L.Ivanovienė
Description
Liver role in the metabolism of carbohydrates, lipids and proteins. Liver role in detoxification of
xenobiotics and autobiotics. Metabolism of the xenobiotics in the liver: three phases of
biotransformation; role of cytochrome P450 in biotransformation; I phase biotransformation reactions –
oxidation, reduction, hydrolysis reactions; II phase reactions – conjugation with glucuronic acid,
sulphuric acid, acetic acid, thiosulphates, α-amino acids, glutathione, double conjugation; methylation.
Metabolism of alcohol (ethanol). Detoxification of protein decay products appeared in large intestine.
5.17. Pathologic anatomy of alcoholism. General endoinfectional processes and
pacreatites. (2 h)

In charge – prof. R.Gailys, prof. V.Lesauskaitė
Description
General morphological manifestations of alcoholism, its complications and reasons of death.

Endoinfections of digestive tract and ulcer disease. Bellary stones and pancreatities.
5. 18. Psychosocial aspects of alcoholism. (2h)

Department of Environment and Occupational Medicine
Responsible person – Prof. R. Radišauskas
Description
Harm of alcoholism: influence on physical and mental efficiency – attention, thinking, orientation,
mobility of intracentral communication, sensomotoric rate of response and other alteration of
psychophysiological functions. Quality of work, productivity, industrial and home traumatism. Alcohol
and traffic causalities. Alcohol and psychosocial climate within the family. Alcohol, criminality and
suicide. Influence of alcohol on health (short accents): central nervous, analyzers, heart and vessels,
breeching, digestive, endocrine and other systems. Alcohol and cancer.
6. Practicals
6.1. Anatomic structure of major digestive glands. Intraorganic and extrahepatic
ducts of bile. Anatomy of gall bladder. Morphofunctional features of pancreas as
major digestive gland. (3 h)
Unit– Institute of Anatomy

In charge – associate professor V. Gedrimas
Aim: to learn in details anatomy of major digestive glands, macroanatomic and internal structure of
liver and pancreas, anatomic parts and location of gall bladder, peritonisation, vascularisation, bladder
duct and its connection to liver ducts, formation of common bile duct, variations of connection,
positioning of duct in ligament of duodenum in liver, connection to pancreas duct, anatomy of opening
of bile duct major duodenal papilla. To study in details structure, topography, vascularisation of
pancreas, to be able to define pancreas as gland of external secretion, to know its ducts and their
location including variations, connection to bile ducts, to define pancreas as endocrine gland: structure,
location and function of pancreas islets.
Objectives: to study external anatomy of liver. To better understand internal structure of liver, to
describe segments, lobules. To study anatomic museum preparations, which illustrate anatomic
structure, position, size, and visible parts of gall bladder duct, and to characterise pecularities of its
positioning, and their clinical anatomy, to understand anatomy of other extrahepatic bile ducts. To
revise anatomy of duodenum, to find longitudinal wrinkle by using sections of this organ, to find major
mammilla in it. To discuss flow of bile and pancreas juices by inserting a thin flexible probe into major
mammilla.
To be able to show anatomic parts, structural components, ducts of pancreas in anatomic preparations,
models, pictures and sets of internal organs, prepared for dissection. To understand location of pancreas
islets, describe vascularisation, frequent variations and anomalies of pancreas.
References:
Gray‘s anatomy, 39 ed., Elsevier, Churchill-Lvingstone, 2005
6.2. Digestion of lipids. Effect of bile on pancreatic lipase activity. (3 h)
In charge – prof.L.Ivanoviene; prof. R.Morkuniene; prof. V.Borutaite
The aim:
To evaluate the effect of bile on digestion of dietary lipids
Objectives:
1. To investigate digestion of lipids by pancreas enzymes
2. To evaluate the effect of bile acids on digestion of lipids by pancreas enzymes
3. To discuss the molecular mechanism of effect of bile acids on digestion of lipids
References:
Nutrient uptake. Laboratory manual on biochemistry. FC
1. To get knowledge on liver cirrhosis and alcoholic liver diseases.
6.3. Structure of the wall of digestive tract (3 hr.).

In charge – prof. A.Valančiūtė
Aim
To know and to understand the general structure of digestive canal and the structural differences of its
separate parts.
Objectives. To comprehend the histological structure of different parts of the digestive canal, and the
importance of epithelial cells, glands of the wall of digestive canal, and smooth muscles in the process
of digestion and absorption of nutrients.
Acquired competence: To be able to distinguish under the microscope the following histological
preparations: oesophagus, cardia, fundus of the stomach, pylorus, duodenum, jejunum, ileum, large
intestine, vermiform appendix. It is acquired to recognize different structural elements in every
histological preparation and to explain the purpose of these structural elements. To acquire general
40
knowledge on the embryological origin of digestive system: the time of germ appearance and the
sources of development.
Questions:
1. General characterization of the histological structure of the digestive canal wall and the
structural differences of its separate parts. Structural features related to the function.
2. Types and role of the epithelial cells of digestive canal.
3. Glands in the wall of digestive canal.
4. Elements of the immune defence system in the wall of digestive canal.
In the esophagus preparation to be able to distinguish the main layers of oesophagus wall: mucous with
squamous stratified non keratinized epithelium, subepithelial connective tissue with the esophageal
cardiac glands near the stomach, submucous connective tissue with mucous glands and large vascular
net, muscular layer, nerve plexuses.
In the transition between esophagus and stomach preparation to be able to find the transition place from
esophagus into the stomach, to recognise all layers of the oesophagus wall, cardiac glands in the
esophagus and columnar gastric epithelial cells, epithelium covering the gastric mucous membrane and
its pits, the subepithelial layer of the cardia with the glands of the mucous membrane.
In the fundus of the stomach preparation to be able to distinguish all layers of the gastric mucous
membrane: mucous, submucous layer, muscular layer and seruos covering. In the subepithelial
connective tissue to recognise gastric(fundic) glands and four types of cells: mucocytes of the gland
neck; chief (zymogenic) cells; parietal cells, gastric endocrine cells.
In the pylorus preparation to distinguish mucous, submucous and muscular layers, serous covering and
pylorus glands.
In the duodenum preparation to distinguish the mucous membrane and villi, subepithelial connective
tissue, glands of the submucous layer, blood-vessels of the submucous layer and intramural nerve
ganglia in the muscular wall.
In the jejunum preparation to be able to recognise the structural differences between jejunum and
duodenum, to distinguish the mucous membrane, submucous, muscular and serous layers.
In the ileum preparation to recognise low and sparce villi and abundant grouped lymph nodes (Peyer’s
patches) in the intestine wall. To distinguish all layers of the ileum preparation.
In the large intestine preparation to distinguish all main layers of the wall: mucous membrane,
subepithelial mucous layer, muscular mucous layer, submucous layer, muscular layer and serous
covering.
In the vermiform appendix preparation to recognise mucous membrane, much thinner crypts, lymph
nodes.
References:
1. Jungeira LC. et al. Basic Histology, 2005, p. 287 -316
2. Langman’s Medical Embryology, 2001, p. 270-285
6.4. Clinical analysis of digestive system and liver. Syndromes of injury. (3 h)

Aim:
to analyse clinical data of digestive system and liver and syndromes of injury.
Objectives:
1. Clinical data analysis
2. Analysis of main clinical syndromes
Skills:
1. To interpret clinical analysis data for diagnosis of digestive system and liver diseases.
2. To understand main syndromes of digestive system and liver injury.
Questions analysed:
1. Complaints of the patients suffering from digestive system and liver diseases.
2. Clinical analysis of diagnosis of digestive system and liver diseases.
3. Main clinical syndromes: acute abdominal pain, dispeption, GERL, malabsorbtion,
haemorrhage, jaundice, portal hypertension, liver deficiency.
4. To get knowledge on liver cirrhosis and alcoholic liver diseases.
References:
1. Parveen Kumar and Michael Clark. Clinical medicine. W.B.Saunders Company, 2005, p. 347-
419.
Aim: to analyze clinical data of digestive system and liver and syndromes of injury.
6.5. Histological structure of oral cavity organs (3 hr.)

Department of Histology and Embriology
In charge– prof. A.Valančiūtė
Aim:
To analyse the histological structure of oral cavity, salivary glands and their ducts.
Objectives:
To comprehend the importance of different parts of digestive system: teeth and salivary glands in the
process of digestion and absorption of nutrients.
Acquired competence: To be able to distinguish under the microscope the following histological
preparations: a lip, parotid salivary gland, sublingual salivary gland, submaxillary salivary gland, teeth,
tongue.
Questions: Embryological origin of different parts of digestive system. Oral cavity and the structures
therein. General characterization of the histological structure of the digestive canal wall and the
structural differences of its separate parts. Structural features related to the function.
In the lip preparation to be able to recognize the skin area, transitional and mucous parts. In the skin
area to distinguish stratified squamous keratinized epithelium, hair roots, sabeceous and sweat glands,
and connective tissue with the blood-vessels. In the transitional part to distinguish the epidermic
granular and thin non keratinized layers, subepithelial connective tissue with high papillae and
capillaries imparting the reddish colour to the lips. In the mucous part to distinguish the stratified
squamous non keratinized (possessing lower papillae of the connective tissue) epithelium, mucous and
serous glands, striated muscles.
In the parotid salivary gland preparation to be able to recognize the parenchyma and stroma of the
glands, lobules, serous alveoli, secretory ducts, connective tissue.
In the sublingual salivary gland preparation to be able to recognize the mixed terminal parts of
secretory gland, acinus, predominant mucous cells and demilunes of serous cells within and in a
connective tissue – secretory ducts.
In the submaxillary salivary gland preparation to be able to recognize the serous (proteinaceous) and
mixed (mucoserous) alveoli of the glands, in the connective tissue between lobules – ducts and
bloodvessels.
In the tooth preparation to recognize the stages of the tooth development: Irst - bud , IInd – cap, and
IIIrd – belland crown stages of the development.
In the tongue preparation to recognize the foliate papillae covered by the stratified squamous non
keratinized epithelium, and the connective tissue papillae with the blood-vessels therein. In the lateral
surface of epithelium to recognize the taste buds. Also to recognize filiform papillae covered with
squamous stratified keratinized epithelium.
References:
Jungeira LC. et al. Basic Histology, 2005, p. 281 –286, 317 -321
6.6. Determination of creatinine in urine. Determination of carbamide (urea) in urine.

(3 h)
Aims:
1. To quantify the daily amount of creatinine excreted with urine, to use data obtained to evaluate
functional state of skeletal muscle and kidney.
2. To determine the amount of carbamide in urine.
3. To be able to interpret data obtained and to evaluate the efficiency of processes of amonia
detoxification.
Objectives:
1. To learn how to determine the amount of creatinine in urea and to calculate daily amount of
excreated creatinine in urine.
2. To get knowledge on metabolism of creatine and creatinine and their biological significance.
3. To practice in interpretation of changes in creatine and creatinine concentrations and realation
to physiological and pathological processes.
4. To be able to evaluate changes in creatine and creatinine concentrations and in activity of
isoenzymes of creatine kinase in biological samples during pathological or physiological
processes.
5. To get knowledge on metabolic production of ammonia, its toxicity and ways of detoxification
in human organism.
6. To skill in determination of the main product of ammonia detoxification – carbamide in
biological fluids.
7. To be able to evaluate changes in carbamide concentrations in biological fluids during various
pathological processes.
References:
6.7. Structure and histophysiology of large digestive glands (3 h)

In charge – prof. A.Valančiūtė
Aim:
To learn histological structure of the liver, ultrastructure of hepatocytes, system of blood supply to the
liver, histological structure of the exocrine part of pancreas and pancreatic ducts.
Objectives:
During studies of structure of liver and ultrastructure of hepatocytes, to understand bile secretion,
significance of blood circulation system, the role of phagocytic cells in immune response. To study
structure of exocrine part of pancreas, ultrastructure of secreting cells, histological structure of ducts of
the pancreas.
Skills:
Students will learn to distinguish histological preparations by microscope, to identify structural
elements in the histological preparations and to explain their significance.
Questions:
1. Structure of pancreas exocrine part, ducts, significance of exocrine part of pancreas for
digestion.
2. Histology of the liver and blood supply system.
3. Macrophagocytes in the liver and their significance.
In pancreas preparation to identify acini lined by conus-form cells – exocrinocytes of pancreas with
acidophylic apical parts (zymogen granules) and basophylic basal parts, septa of connective tissue with
capillaries, intercalated and intralobular ducts, islets of pancreas.
In human liver preparation to identify lobules of the liver, central vein of the lobule, portal spaces with
bile ducts, lymphatics nerves, blood vessels in the corners, plates of multi-angular hepatocytes,
sinusoidal capillaries between them.
In preparations of pig liver, to identify lobules surrounded by connective tissue between lobules, central
vein and plates of hepatocytes, bile ducts, arteries, veins and nerves in the corners of the lobule.
Gallbladder preparation – to distinguish layers of gallbladder wall: epithelial lining, folds of mucosa,
muscles and adventitia.
References: Jungeira LC. et al. Basic Histology, 2005, p. 321 -339
6.8. Clinical evaluation of obesity. Diabetes mellitus. Fundamentals of diagnostics,
complications, notion of treatment. (3 h)
Clinic of Internal diseases
In charge – lect. E .Mašanauskienė, prof. A.Naudžiūnas
Aim:
To analyse clinical evaluation of obesity and principles of diabetes mellitus diagnosis; to have a notion
of diabetes mellitus complications and treatment
Objectives: to analyze types of obesity and clinical diagnostics; to know principles of diabetes mellitus
diagnostics; to have a notion of diabetes mellitus complications and treatment.
Skills gained:
1. To be able to rate normal body mass and obesity.
2. To know clinical and laboratory signs of diabetes mellitus.
Questions analysed
1. Causes of body mass gain and appetite.
2. Rates and types of obesity.
3. Estimation of normal body mass.
4. Clinical symptoms of obesity and notion of treatment.
5. Causes of diabetes mellitus.
6. Glucose tolerance test.
7. Diabetic and hypoglycemic coma.
8. Fundamentals of clinical and laboratory diagnostics of diabetes mellitus.
9. Notion of diabetes mellitus complications.
10. Notion of treatment of diabetes mellitus, diabetic and hypoglycemic coma.
References: Epstein P. et al. Clinical examination, 2003, p. 30-40.
6.9. Determination of cholesterol concentration in blood serem. Determination of

cholesterol, high density lipoproteins, low density lipoproteins and tiacylglycerols by
automatic analyzer Cardio-Check. ( 3 h)
Aim
To learn how to determine and to calculate cholesterol and its transfering lipoprotein concentrations in
human blood sereum as well as to interpret obtained results.
Objectives:
1. To determine concentration of cholesterol in human blood plasma by Ilck.
2. To calculate concentration of colesterol in both systemic and non-systemic units.
3. To determine concentrations of cholesterol, high density lipoproteins, low density lipoproteins
and triacelglycerols in blood serum by automatic analyzer.
4. To evaluate the reasults and to interpert them.
References: Nutrient uptake. Laboratory manual on biochemistry. FC
6.10. Pathological anatomy of diabetes mellitus and obesity. (3 h)

In charge – prof. R. Gailys, prof. V. Lesauskaitė
Aim:
To identify macro and micro preparations with macro and micro angiopathies and to indicate possible
causes of death; to study pathological anatomy of the obesity; solve morphologic diagnostic tasks.
Nephroangiosclerosis diabetica histological slide (H+E ir PAS reaction). Pay attention to thick walls of
the loops of glomerular capillaries. There are PAS positive deposits in the walls glomerular capillaries
and the mesangium as well. Some glomeruli are atrophic and sclerotic, surrounded by connective
tissue.
References:
1. I.L. Robbins, R.S. Cotran. Pathologic basis of Disease, 7 th edition, 2005, p. 461-465, 1197-
1201, 1209
2. R. Butkus, J. Čeponis, R. Gailys, v. Lesauskaitė. Manual to laboratory practice in general and special
pathological anatomy.
6.11. Antidiabetic agents (2 hours)
In charge: dr. R.Jankūnas
Aim:
To gain basic knowledge on classification, pharmacological and clinical properties of antidiabetic
agents.
Objectives:
1. Desribe and compare mechanisms of action and effects of antidiabetic agents on target
tissues/enzymes including pancreas, hepatocytes, muscles, adipose tissue, kidneys, SGLT-2, DPP-4
etc.
2. List and compare most important adverse reactions of antidiabetic agents.
3. Explain pharmacodynamic basis of most important adverse reactions of antidiabetic agents.
4. Desribe major risks of insulin therapy.
5. Explain relation of pharmacokinetic properties to timing of administration (dosage interval and
relation to meals) of insulin preparations.
6. Relate pharmacodynamic properties of antidiabetic agents to their use depending on the diabetes
type.
References:
6.12. Protein digestion. Effect of pepsin. Analysis of gastric juice. Patological

components of gastric juice. (3h)
Aim
To understand mechanism of protein digestion by pepsin.
Subjectives
1. Evaluate effect of hydrochloric acid on pepsin action.
2. Evaluate factors that arouse pepsin inactivation.
3. To know molecular mechanism of pepsin action. Perform quantitative analysis of gastric juice.
4. Calculate acidity of gastric juice.
5. Acquit with essential types of gastric juice and its clinical importance. Determine pathological
compounds of gastric juice.
References:
6.13. Alcoholism. Diseases and syndromes of digestive system. (3 h)

In charge– prof. R. Gailys, prof. V. Lesauskaitė
Aim:
To help students to get theoretical knowledge’s and practical skills to evaluate morphology of alcohol-
induced injury of digestive canal, pancreas and liver, study pathology of the endoinfective processes.
Objectives:
To isolate preparation that illustrate morphology of alcoholism and preparations that illustrate colitis,
appendicitis, candidosis, bile stone disease and acute necrosis of pancreas and ulcer disease; dissolve
morphological diagnostic tasks.
Hepatocyte in case of alcoholism. Electron micrograph (x30 000). Pay attention and draw alcoholic
“hyaline” (Mallory bodies) within the cytoplasm of hepatocytes.
Alcoholismus: lipidosis hepatocytorum et cirrhosis hepatis. Histological slide (H+E). Pay attention to
fat hepatocytes and to the changed architecture of the liver, which is caused by the proliferation of
connective tissue and regenerating hepatocytes. Find out so called untrue liver lobules (pseudolobuli)
with proliferating small bile ducts and interstitial infiltration by immune cells.
References:
1. I.L. Robbins, R.S. Cotran. Pathologic basis of Disease, 7 th edition, 2005, p. 421-424, 812-819,
870-871, 928-933.
2. R. Butkus, J. Čeponis, R. Gailys, v. Lesauskaitė. Manual to laboratory practice in general and special
pathological anatomy.
6.14. Changes of plasma glucose level during diabetes mellitus
Instutute of Physiology and Pharmacology
Subject Pathological physiology
In charge– dr. D.Akramienė
Objectives:
1. To understand the use of the terms insulin, Type I diabetes mellitus, Type II diabetes mellitus.
2. To understand how fasting plasma glucose levels are used to diagnose diabetes mellitus.
3. To understand the assay that is used to measure plasma glucose
Description:
The simulatory laboratory work will be performed. You will develop a Glucose Standard Curve and
measure fasting plasma glucose levels in the blood samples from different patients.
Literature:
Pathophysiology; Lee-Ellen C. Copstead and J.L. Banasik, 5th ed. Saunders Elsevier 2013. p. 816-826
7. Seminars
7.1. Features of structure of the digestive canal wall and liver (2 h)
In charge – associate professor V.Gedrimas, dr. I.Saburkina
Aim:
To know structure and localisation of the digestive canal parts such as mouth, fauces, oesophagus,
stomach, small and large intestine; to know structural principles of food stuff digestion and absorption
(structure of mucosa, features of blood and lymph circulation).
Objectives:
At the end of your independent studies (preparing for a seminar), using material of dissection and
preparations, under instructor supervision structures of parts of the digestive canal – mouth, fauces,
oesophagus, stomach, and gut wall (structure of mucosa, its folds, glands and etc.), collocation of
blood and lymph vessels under mucosa, muscular layers, process of peristalsis are ascertained.
Structures, implicated in absorption of components from mash moving along the digestive canal, and
their transfer by blood of portal vein into liver are being discussed. Hepatic porta, and their structures –
hepatic artery, portal vein, bile ducts are being demonstrated. Anatomy of intraorganic circulation as
well as collocation of portal vein, hepatic vein, bile duct and role of liver in utilization of absorbed
nutrients are ascertained.
References.
1. Gray‘s anatomy, 39 ed., Elsevier, Churchill - Lvingstone, 2005, p. 581-633, 986-990, 1143-
1157, 1139-1143.
2. Anatomy atlases
7.2. Obesity evaluation and prevention. Evaluation of diet caloric content.

(2 h)
Department of Environmental and Occupational Medicine
In charge – assoc. prof. D. Lukšienė
Aim:
To get acquainted to principles of healthy nutrition and to distribution, epidemiology and prophylaxis
of obesity.
Objectives:
1. To analyse causes of obesity and to determine main principles of obesity prophylaxis.
2. To discuss distribution of obesity and its social-economical conditions.
3. To determine main principles of obesity prophylaxis.
4. To evaluate dietary caloric content and to compose dietary daily needs.
References:
1.Ustinavičienė R, Lukšienė DI. Human nutrition: [electronic book]. Kaunas: Lithuanian University of
Health Sciences, Lithuanian Academic e. library (eLABa), 20130522 , 2012. 65 p.
1. http://www.who.int/nutrition/publications/obesity/en/index.html
2. Caballero B. The global epidemic of obesity: an overview. Epidemiol Rev. 2007;29:1-5.
7.3. Antihyperlipidemic agents (2 hours)

In charge – dr. R. Jankūnas
Aims:
1. To consider the role of the antihyperlipidemic agents as multifactor intervention strategy to
reduce cardiovascular risk.
2. To describe the pharmacological and clinical properties of antihyperlipidemic agents.
Objectives:
1. List non-pharmacological interventions to correct hyperlipidemia.
2. Describe mechanism of action of statins; relate it to changes in plasma lipoprotein levels.
3. List and describe indications for use of statins.
4. List and describe major adverse reactions of statins.
5. Provide quantitavive estimation of benefit-risk ratio of statins.
6. Describe mechanism of action of bile acid-binding resins; relate it to changes in plasma
lipoprotein levels, indications for use and adverse reactions.
7. Describe mechanism of action of fibrates; relate it to to changes in plasma lipoprotein levels
and indications for use; list their adverse reactions.
8. Describe mechanism of action of niacin; relate it to changes in plasma lipoprotein levels; list its
adverse reactions.
9. Explain why niacin has not currently been used as anyihyperlipidemic agent.
References:
3. http://www.ncbi.nlm.nih.gov/pubmed/
4. http://www.compendium.uk
.
7.4. Analysis of amino acid metabolism using metabolic

pathways (2 h)
Aim:
To know amino acid and nucleotide metabolic pathways and understand possible subsequences of
metabolism disturbances.
Objectives:
1. To be able to characterize types of amino acid deamination, to relate changes in aminotransferase
(transferase) amounts in blood serum and pathents‘ clinical condition.
2. To be able to follow up amino groups transfer from amino acids to the ammonia ions and its
conversion to urea. To be able to describe sourcesof ammonia in the organism and mechanism of it’s
toxically action.
3. To get used in analyzing of metabolic pathways for identification of glucogenic amino acid and
ketogenic amino acids. To get ability evaluate production of energy during amino acid metabolism.
References:
1. http://www.sigmaaldrich.com/life-science/metabolomics/learning-center/metabolic-
pathways.html
2. Murrey RK, Granner DK, Mayes PA, Rodwell VW. Harper‘s Biochemistry. 23nd ed., Appleton &
Lange, 1993, p. 353-377.
3. Champe PC, Harvey RA. Lippincott‘s illustrated reviews: Biochemistry 2nd ed, Lippincott-Raven
publichers, 1994, p. 243-356.
4. Smith C, Marks AD, Lieberman M. Marks‘ Basic Medical Biochemistry: A Clinical approach.2nd
ed, Lippincot Williams & Wilkins, 2005, p. 747- 780.
1. Devlin MD. Textbook of biochemistry with clinical correlations. Wiley-Liss; 6th ed, 2006, p. 743-
787.
8.Examination programme
8.1. Human anatomy
1. Connection between the structure and function of the intestine wall layers.
2. Classification of the salivary glands according their size, location in the body and salivary content.
The ducts of large salivary glands, and their release places in the mouth.
3. Structural and functional differences of the anatomical pharynx elements.
4. Structural components of the gastric mucous and submucous membranes, and their structural
relationship with the function of stomach.
5. Characterization of liver intraorganic blood circulatory system.
6. Structural and functional features of the bile ducts.
7. Structural components of the pancreas functioning as exocrine gland.
8.2. Physiology
1. Factors affecting secretion of hydrocloric acid in stomach. Machnisms of their action.
2. Phases of gastric juice secretion and their features.
3. Regulation of gastric motility and emptying. Vomiting.
4. Nervous and humoral regulation of the secretion of pancreatic juice and bile.
5. Regulation of functions of small and lage intestines. Defecation.
8.3. Human histology and embryology

1. Embryologic origin of the digestive system, main stages of development.
2. Histological structure of the teeth.
3. Embriological origin of the teeth and main stages of the development.
4. Histology of the oesophagus.
5. Similarities and differences of histological structure of small and large intestine. Types of epithelial
cells in different parts of intestine.
6. Similarities and differences of histological structure of major salivary glands.
7. Histological structure of cardiac, fundic and pyloric parts of the stomach. Role of stomach fundic
glands in digestive process.
8. Structure of clasical hepatic lobule. Blood circulation in the lobule. Ultrastructure of hepatocytes,
secretion of bile.
9. Structure of exocrine and endocrine part of the pancreas.
10. Elements of organism‘s immune defense system in digestive system.
11. Glands in different parts of digestive tract and their role in digestive process.
12. Histological structure of the tongue.
13. Histological structure of the lips.
8.4. Pathological anatomy. This is a preliminary programme of exam on pathological

anatomy course
1. Lipidosis, its kinds, causative factors, morphogenesis, morphology, outcome and signifficance.
Lipidic tezaurismoses, local accumulation of cholesterol and cholesterol esters.
2. Pathological anatomy and complications of the obesity.
3. Disorders of bilirubin metabolism. Jaundice, its mechanisms of development.
4. Calculi (stones), its mechanisms of formation, localisation and morphology. Disorders of urates
metabolism.
5. Cholelithiasis and cholecystitis, its morphology and complications.
6. Diabetes mellitus, its classification, pathogenesis, morphology, complications and causes of
death.
7. Alcoholism, its pathogenesis, morphology, complications and causes of death.
8. Nonspecific immune responce, its morphogenesis, morphology, cursus, outcome and functional
signifficance.
9. Pathogenesis, morphology and complications of appendicitis.
10. Pathogenesis, morphology and complications of peritonitis.
11. Pathogenesis, morphology and complications of ulcer disease.
12. Benign and malignant tumors of esophagus and stomach, its kind of growing, morphology,
complications and causes of death.
13. Tumors of intestines, its morphology, complications and causes of death.
14. Tumors of liver, gallbladder, bile ducts and pancreas, its morphology, complications and causes
of death.
8.5. Pathological physiology

1. Disorders of motor (vomiting, hiccup, eructation) and secretory (hyper- and hypiacidity)
functions of the stomach and consequences of stomach resection. Their etiology, pathogenesis,
disorders of body functions. Peptic ulcer disease, etiology, pathogenesis.
2. Diarrhea and constipation, their etiology, pathogenesis, disorders of organism functions.
3. Liver failure, etiology, pathogenesis and changes of body functions. Portal hypertension,
etiology, pathogenesis, disorders of body functions.
4. Jaundice, etiology, pathogenesis, disorders of body functions.
5. Carbohydrate metabolism disorders (hyperglycemia, hypoglycaemia, and diabetes mellitus.
Their etiology, pathogenesis, disorders of body functions.
8.6. Essentials of Medical Diagnostics
1. Obesity. The clinical signs and di agnostics.

2. Characteristics of symptoms of diabetes mellitus.
3. Glucose tolerance test. Indications for application. Interpretation of test results.
4. Criteria of diagnostic of type 1, type 2 and gestacional diabetes mellitus and understanding about
treatment.
5. Complications of acute and chronic diabetes mellitus.
6. Symptoms of gastrointestinal (GI) and liver diseases.
7. Instrumental invetigations applied for diagnosis of gastrointestinal and liver deseases.
8. Examination of stool, meanings of patological findings.
9. Examination of clinical, biochemical enzymes analysis of liver.
10. Main gastrointestinal syndroms: abdominal pain , dyspepsion, GERD, malabsorption, bleeding
from GI tract.
11. Main liver syndroms: jaundice, portal hypertension, liver failure.
12. Understanding of liver cirrhosis and alcoholic liver disease.
8.7. Biochemistry
8.7. Biochemistry
1. Digestion of polysaccharides, absorption of products of digestion.
2. Digestion of lipids (TAG, phospholipids, cholestrol esters), absorption of products of
digestion.
3. Digestion of proteins, absorption of products of digestion.
4. Biosynthesis of hydrochloric acid in the stomach and its functions. Determination of acidity
of gastric juice.
5. Structure of bile acids, role of bile in nutrient digestion.
6. Metabolism of hemoproteins.
7. Bile: main components; pigments and their metabolism.
8. Bile acids: origin, sites of production, characterization of structure, importance of bile in
digestion.
9. Reaction sequence of glycogen breakdown, enzymes, regulation, energy value,
physiological significance.
10. Reaction sequence of glycogen synthesis, enzymes, regulation, physiological significance.
11. Metabolism of acetyl-CoA produced in beta-oxidation; ketogenesis (production of ketone
bodies): substrates, reaction, enzymes, products, transportation and consumption of keton
bodies.
12. Synthesis of triacylglycerols in tissues (tissue lipolysis) and its regulation.
13. Breakdown of triacylglycerols in tissues (tissue lipolysis) and its regulation.
14. Biological significance of cholesterol. Origin of cholesterol in human organism. The main
stages of cholesterol synthesis. Regulation of cholesterol synthesis.
15. Approximate composition of chylomicrons, chylomicron formation and metabolism.
16. Approximate composition of very low density lipoproteins (VLDL), VLDL formation and
metabolism.
17. Approximate composition of high density lipoproteins (HDL). HDL formation and
metabolism.
18. General pathways of amino acid catabolism. Deamination of amino acids: ways of
deamination, enzymes, their specificity, coenzymes, products and their metabolism.
Diagnostic significance of aminotransferases.
19. Formation of ammonia and its detoxication in human organism.
20. Metabolism and elimination of xenobiotics.
21. Metabolism of ethanol. Mechanisms of ethanol toxicity.
22. Synthesis of insulin, secretion and its regulation in human organism. Target cells of insulin.
Structure of insulin receptors, mechanism of intracellular signal transduction. Physiological
effects of insulin.
23. Synthesis of glucagon, secretion and its regulation in human organism. Target cells of
glucagons. Location of glucagons receptors, mechanism of intracellular signal transduction.
Physiological effects of glucagon.
24. Mechanisms of regulation of glucose concentration in blood: role of glucagon,
glucocorticoids and insulin.
8.4. Pharmacology
1. Classification, common features and differences of antidiabetic agents.
2. Preparations of insulin: classification, pharmacodynamics, relation of timing of administration
with pharmacokinetic properties, indications for use, adverse reactions.
3. GLP-1 analogues: pharmacodynamics, indications for use, adverse reactions.
4. Sulfonilkarbamidai: pharmacodynamics, indications for use, adverse reactions.
5. Meglitinidai: pharmacodynamics, indications for use, adverse reactions.
6. Metformin: pharmacodynamics, indications for use, adverse reactions.
7. Rosiglitazone: pharmacodynamics, indications for use, adverse reactions.
8. α-glycosidase inhibitors: pharmacodynamics, indications for use, adverse reactions.
9. DPP-4 inhibitors: pharmacodynamics, indications for use, adverse reactions.
10. SGLT-2 inhibitors: pharmacodynamics, indications for use, adverse reactions.
11. Adverse reactions of antidiabetic agents. Hypoglycemia: prevention, warning signs and agents
administered for its treatment.
12. Statins: pharmacodynamics, indications for use, adverse reactions.
13. Bile acid binding resins: pharmacodynamics, indications for use, adverse reactions.
14. Fibrates: pharmacodynamics, indications for use, adverse reactions.
15. Niacine: pharmacodynamics, adverse reactions.
8.9. Environmental and occupational medicine

1. Obesity, its definition, prevalence and causes.
2. Body mass index, its evaluation.
3. Daily energy requirement (DER) and dietary composition assessment.
4. Main principles of obesity prophylaxis.
5. Psychological reasons of alcoholism.
6. Social and economic reasons of alcoholism.
7. Psychosocial damage of alcoholism.
8. Prevention of alcoholism.
Process of examination and evaluation.
1. Examination conditions and rules are set by a document The Regulation of studies issued on June
20, 2014. LUHS Senate order Nr. 47-05. Student rights and duties are under full regulation of this
document.
2. The exam on NUTRIENT UPTAKE is organized by the Department of Biochemistry. Date and time of
the exam are scheduled. The information is available at:
http://pm.lsmuni.lt/tvarkarasciai/show.php?a=semester&sem=MF4sem20142015.
3. Instructions about student allocation in examination rooms are available at Intranet of the University
FC as much as 3 days before the exam.
4. Composition of the exam. The exam is composed of 9 subjects. Format of subject-based questions is
MCQ and short answer questions. The content of questions comme from the module programme (see
above). Total value of exam questions make 100%. Contribution of specific subjects to the total
depends on their complexity and the duration of studies (contact and independent work h). In the
auditoria, you will be provided by a set of processed questions. Guestions of a particular subject are
printed out on separate pages which are cliped together. Numbering of subject-based questions starts at
1. Instructions how to make your answers are provided at the first subject- approached page.
5. Evaluation. Each department and institute which contributes to the module makes evaluations on
specific subject-based questions. The departments receive student papers in anonimous way (without
names and groups but with particular code). Common grade is composed by the department of
biochemistry after decoding of evaluation data. Student grades are posted on electronic register
http://pm.lsmuni.lt/pazangumas/login.php.
6. Feedback. Students can get familiar with their mistakes only after anouncement of all grades in
electronic register. Therefore they should know their individual code numbers from the exam
organizing department. Knowing the code numbers, other departments can provide you with needed
information.

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Study Programme Medicine

Supervisor of the module: prof. L.Ivanovienė (laima.ivanoviene@lsmuni.lt)

Subjects and teachers in charge:

What do these alterations indicate?

Learning objectives and contents

• Features of histology of digestive system and liver

McCance K., Huether S. E. Pathophysiology, Elsevier Mosby. 2010. p. 1485-1487.

• Characteristics and catabolic pathway of hemoproteins

Learning objectives and contents:

• Structure of carbohydrates glycogen and glucose, principles, regulation and biological

• To relate processes of energy formation and transmission to muscle contraction-relaxation

• Repeat! Muscle contraction physiology from the module Locomotion.

What mechanisms are responsible for the overweight of this man?

Learning objectives and contents

• The biosynthesis of fatty acids in human body.

• Prevention of obesity and evaluation of dietary on a caloric basis

Table 1. Plasma lipid analysis

Lipid Patient Normal

Clinical symptoms: xanthomata on shin near Achil’s tendon.

Learning objectives and contents

• The role of hypercholesterolemia in the development of atherosclerosis and molecular

• Metabolism of membrane phospholipids, possible damage to phospholipids and their

• Risk factors and development of atherosclerosis

To understand principles of metabolism regulation by pancreatic hormones, ascertain concequences of

Learning objectives and contents

• Features of structure and molecular mechanisms of action of insulin and glucagon

• Regulation of metabolism of carbohydrates, fats and proteins by insulin.

• Pathogenesis, morphology, complications and death causes in diabetes mellitus.

• Abnormalities of carbohydrate metabolism, their etiology; etiology and pathogenesis of

Table 1. Biochemical tests of liver function

What happens with alcohol in the liver?

Learning objectives and contents

To complete an analysis of this problem the students must know:

5.1. Biochemical mechanisms of nutrients digestion. Regulation of digestion. (2 h)

5.2. Heme catabolism: relationship to formation of bile pigments. (2 h)

5.3. Histologic structure of digestive system. (2 h)

5.4. Pathological physiology of digestion. The disorders of liver functions (2 h.)

In charge - lect. D. Akramienė

5.6. Gastrointestinal functions and their regulation (2h)

5.7. Metabolism of triacylglycerols and phospholipids. (2 h)

5.8. Disorders of carbohydrate metabolism: Hyperglycaemia and hypoglyceamia.

In charge - lect. D. Akramienė

Causes of disturbances in carbohydrate metabolism. Hyperglycaemia and hypoglycemia; causes and

5.9. Metabolism and transport of cholesterol. (2 h)

5.10. Antidiabetic and antihyperlipidemic agents (2 hours)

5.11. Regulation of metabolism by hormones of pancreas: molecular mechanism of

5.12. Mechanisms of regulation of blood glucose concentration. (2 h)

Clinic of Pathological anatomy

5.14. Notion of metabolic endocrine diseases. (2 h)

5.15. Amino acid metabolism. Ammonia detoxication. (2 h)

5.16. Pathologic anatomy of alcoholism. General endoinfectional processes and

Clinic of Pathological Anatomy

General morphological manifestations of alcoholism, its complications and reasons of death.

5.17. Liver role in detoxification processes. Molecular mechanisms of the

Clinic of Pathological Anatomy

General morphological manifestations of alcoholism, its complications and reasons of death.

5. 18. Psychosocial aspects of alcoholism. (2h)

Unit– Institute of Anatomy

1. To get knowledge on liver cirrhosis and alcoholic liver diseases.

6.3. Structure of the wall of digestive tract (3 hr.).

6.4. Clinical analysis of digestive system and liver. Syndromes of injury. (3 h)

Clinic of Internal Diseases