Year 1 MET1: Metabolism 1

Lecture: Introduction to the Metabolism Module

Lectures: Overview of Biochemistry

Lecture: The Gut (Introductory Lecture)

1. Overview of the GI tract
2. Understand link between anatomy/physiology and clinical presentations
3. General understanding of mechanisms.

Lecture: The Gut as an Immune Organ

1. Know the main types of harmful organisms that can colonize the gut
2. Understand the role of the gut in the interphase between the outside world and the body .
3. Understand how antigens are sampled in the gut and the main types of immune cells involved in the gut immune response.
4. Understand by which mechanism T cells are primed and home to the gut to deliver the immune response
5. Understand gut Immunoglobulins production and secretion.
6. Examples

Lecture: Histology of the Gut

1. Describe the changing nature and function of the mucosae in the alimentary tract.
2. Describe variations in the basic wall plan at particular sites (i.e. junctions, retroperitoneal regions).
3. Explain how the mucosa of the small intestine is adapted to increase its surface area for absorption.
4. Define the acronyms MALT and GALT.
5. Outline the cellular composition of the epithelia in each part of the alimentary tract.
6. Outline the basic components that make up the wall of the alimentary tract.

Lecture: Digestion and Absorption

1. Absorption of nutrients
2. Causes of general malabsorption
3. Specific malabsorptive states
4. Understand the 3 phases of digestion and absorption
5. Anatomical features of the midgut

Lecture: Gut Health

1. Understand the anatomy and key roles of the gastrointestinal tract
2. Describe role of gut brain axis and microbiota in IBS
3. Define intrinsic and extrinsic nervous system of the gut
4. Describe the gut brain axis and its role in normal GI function
5. Describe the role of microbiota, prebiotics and probiotics in GI functions
6. Understand and describe common upper and lower GI conditions

Lecture: Gut Motility

1. Basic elements of control
2. Different movements of the colon
3. Introduction to reflex control & feedback regulation
4. The peristaltic reflex
5. Describe the movements of the oesophagus, stomach and intestine during hunger and after eating.

Lecture: Glycolysis and Glucose Oxidation

1. Outline the potential metabolic fates of glucose-6 phosphate
2. Describe the mechanisms of glucose uptake into cells and distinguish between facilitative glucose transporters (GLUTS) with respect to their tissue distribution and kinetic properties.
3. Explain the significance of the regulatory and kinetic properties of glucokinase and hexokinase with respect to their tissue locations and physiological roles.
4. Discuss how PFK responds to intracellular messages.
5. Describe how glycolysis produces ATP by substratelevel phosphorylation.
6. Relate glycolysis to the metabolism of glycerol, fructose and pentose sugars.

Lecture: Glycogen Synthesis and Mobilisation

1. Discuss the circumstances under which glycogen synthesis and degradation will occur.
2. Discuss how the key enzymes glycogen synthase and glycogen phosphorylase are controlled by reversible phosphorylation influenced by hormonal action.
3. Explain the different roles of glycogen storage in muscle and liver in relation to the metabolic fate of glucose 1-phosphate.
4. Outline the role of liver glycogen as a source of blood glucose during a normal feeding cycle.
5. Describe the structure of glycogen.

Lecture: The Anterior Abdominal Wall

1. Understand the anatomy of the anterior abdominal wall
2. To be able to identify the surface anatomy of the anterior abdominal wall
3. Be able to identify the 9 regions of the abdomen
4. Describe the general arrangements of the gastrointestinal tract and associated viscera.

Lecture: Mouth to Oesophagus

1. To understand the motor nervous supply to the muscles of mastication, facial expression, soft palate, tongue, pharynx and oesophagus.
2. To understand the sensory nerve supply to the face, teeth, tongue and pharynx.
3. To be able to identify the major anatomical features of the mouth

Lecture: Introduction to the Abdominal Examination

1. List the nine divisions and four quadrants of the abdomen and relate these divisions to the underlying anatomical structures
2. Appreciate the examination techniques required to perform superficial and deep palpation of the abdomen
3. Appreciate the examination techniques required to assess a patient for hepatomegaly and splenomegaly
4. Appreciate the examination technique of balloting (for renal enlargement).
5. Appreciate how to auscultate for bowel sounds.

Lecture: Gastric Secretions

1. Gastric secretions in health- neurohumoral control
2. Gastric secretions in disease- peptic ulcer disease and reflux disease

Lecture: Liver and Gallbladder

1. Describe the storage functions of the liver
2. Describe the components of the biliary tree (including the sphincter of Oddi)
3. Describe the role of the liver in glucose homeostasis
4. Give an overview of the role of the liver in carbohydrate, lipid and protein metabolism
5. Discuss the role of the liver in protein synthesis
6. Describe how the liver acts as an organ of detoxification
7. Outline the formation and functions of bile
8. Describe the enterhepatic circulation of bile
9. Describe the origin, metabolism and excretion of bilirubin
10. Describe the function of the gallbladder and its control

Lecture: Gluconeogenesis

1. Outline the role of lipids as metabolic fuels.
2. Discuss how the metabolism of pyruvate, glycerol and amino acids contributes to gluconeogenesis.
3. Discuss the interactions between gluconeogenesis and fatty acid metabolism.
4. Discuss the significance of gluconeogenesis in fasting and exercise.
5. Describe the role of gluconeogenesis in maintaining blood glucose concentrations.

Lecture: Tricarboxylic Acid (TCA) Cycle & ETC

1. Describe the reciprocal interaction between the metabolism of glucose and fatty acids.
2. Discuss the TCA cycle with respect to oxidative metabolism and ATP synthesis.
3. Discuss the control of the TCA cycle.
4. Discuss how cells adapt metabolically to hypoxia.
5. Explain the significance of the biosynthetic role of the TCA cycle.

Lecture: Fat Metabolism

1. Describe how fatty acids are transported into the mitochondrial matrix and oxidised there.
2. Describe how fatty acids are synthesised and how this is controlled with respect to fatty acid breakdown.
3. Discuss the significance of ketone body metabolism under normal conditions and in disease states.
4. Discuss lipolysis and its regulation.

Lecture: The Blood Supply to the Gut

1. Describe the blood supply to the liver and explain the formation of the hepatic portal vein
2. Understand the anatomy and distribution of the 3 unpaired arteries of the abdominal aorta

Lecture: Peritoneum

1. Understand the extent and the subdivisions of the peritoneal cavity.
2. Describe the location and the function of the visceral and parietal peritoneum.
3. Outline the embryology of the foregut, the midgut and the hindgut and the formation of the peritoneal cavity.
4. Describe the difference between retroperitoneal organs and intraperitoneal organs.

Lecture: Extremes of Metabolism

1. Discuss the critical role of AMP and AMP kinase in the regulation of energy metabolism during exercise.
2. Describe how key pathways of energy metabolism are activated during exercise (glycogenolysis, pyruvate oxidation and the TCA [Krebs'] cycle).
3. Describe the relative contribution of the various metabolic fuels to energy metabolism during exercise.
4. State reasons why skeletal muscle fibres might become fatigued during prolonged exercise.
5. Explain the contributions of different metabolic pathways to the maitenance of the starved space.
6. Understand the effects of metabolism of ethanol on carbohydrate and fat metabolism.
7. Describe the mechanisms by which the body metabolises alcohol.
8. Understand the role of metabolism in the immune system, the Warburg effect and appreciate the role of metabolism in Cancer.

Lecture: Lipoprotein Handling

1. Describe the structure and composition of the main classes of lipoprotein, including very-low density lipoproteins (VLDL).
2. Outline the process of lipogenesis and its control.
3. Describe the role of lipoprotein lipase.
4. Discuss the role of low-density lipoproteins (LDL).
5. Describe the contribution of LDL to atherogenesis and clinical treatments to lower serum LDL- cholesterol levels.
6. Discuss the significance of high-density lipoproteins (HDL).

Lecture: Nitrogen Metabolism

1. Describe the role of urea as the excretory form of surplus nitrogen in humans.
2. Discuss nitrogen homeostasis and nitrogen balance.
3. Outline the metabolic fates of amino acids.
4. Describe the metabolic classification of amino acids.
5. Discuss, with examples, the metabolic significance of glutamate, glutamine, and ?-ketoglutarate.

Lecture: Imaging of the Gut

1. Be familiar with representative images of common diseases of the digestive tract.
2. Know which investigation technique is most appropriate for each region of the digestive tract.
3. Understand how endoscopy of the digestive tract is performed.
4. Understand the main imaging techniques used for investigation of digestive tract disorders.

Lecture: Metabolic Insight from Genetic Disease

1. Define inherited metabolic disorders and list common inherited metabolic disorders.
2. Outline the metabolic impact of Von Gierke's disease.
3. Outline the biochemical basis and consequences of galactosaemia.
4. Outline the biochemical basis and consequences of McArdle's disease
5. Describe the consequences of a deficiency of liver fructokinase or fructose 1-phosphate aldolase.
6. Outline the inherited metabolic disorders of amino acid metabolism
7. Describe the consequences of phenylketonuria.
8. List the genetic causes of dyslipidaemia.
9. Describe the consequences of familial hypercholesterolaemia.

Lecture: Micronutrients

Lecture: Body Fluids Compartment