students guidebook 2012 blok5

8/12/2019 Students Guidebook 2012 Blok5

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Fakultas Kedokteran

Universitas Mataram

S t u d e n t s

G u i d e b o o k

Block V:METABOLISM &

ENERGY

5th

edition 2012

Contributors:

Seto Priyambodo Ardiana EkawantiHadian RahmanIda Ayu Eka Widiastuti

Maulid HidayatMonalisaPutu AdityaRaehan BahraenWahyu Sulstiya AffarahDewi SuryaniMarie Yuni AndaniYunita Sabrina


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Met ab o l i s m an d en e rg y

Students Guidebook5 t h E d i t i o n 2 0 1 2

B l o c k c o o r d i n a t o r :

dr. Seto Priyambodo , M.Sc

C o n t r i b u t o r :Seto Priyambodo Ardiana EkawantiHadian RahmanIda Ayu Eka WidiastutiMaulid HidayatMonalisaPutu AdityaRaehan BahraenWahyu Sulstiya AffarahDewi SuryaniMarie Yuni AndaniYunita Sabrina

Fakultas KedokteranUniversitas Mataram


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Preface

Sufficient amount of nutrients are required by an individual to stay healthy. Humanbody cannot synthesize all of the required nutrients; therefore individuals always need to

consume an adequate and appropriate food. The process in which nutrient from food could

be utilized by cells and tissues requires several process: digestion, absorption, metabolism

and utilization. Students are expected to learn these concepts in the nutrition and

metabolism block.

Within this block, various learning strategies will be applied to provide students

with a better understanding of nutrition and metabolism concepts. A problem based

approach is the core of the learning strategies. This method requires active participation of

students within the whole learning process in which, therefore, students are at the centre of

the learning process.

Since students participation is necessary, the acquisition of new knowledge and

skills is largely depended on students activities. This guidebook is developed to assist

students during their study in this block. We realize that this guidebook has some

limitations. Therefore, suggestions and comments would be well appreciated.

Mataram, March 2012

Vice Dean I

Dr. Doddy Ario Kumboyo, Sp.OG (K)

NIP. 195204091980031010


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Ta b l e o f Co n t e n t s

Introduction

_______________________________________________________________

1

Expected Outcomes

________________________________________________________

3

Learning Strategies

________________________________________________________

6

Evaluation

________________________________________________________________

9

Referrence

_______________________________________________________________

11

Annex 1: Scenario

_________________________________________________________

12

Annex 2: Time Table

_______________________________________________________


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Fakultas Kedokteran Unram

In t roduct ion

Block Name: Metabolism and Energy

A human adult eat tons of food each year. Metabolism and Energy block attempts to answer

the question why by emphasizing on the concept of digestion, metabolism and utilization of nutrients

to fulfill human body requirement. As seen in figure 1, mass flows of nutrient undergo several

processes: digestion, metabolism and utilization. Digestion processes consist of mechanical

digestion, chemical transformation and nutrient absorption in gastrointestinal tract. After being

absorbed, nutrients are converted into energy, heat and specific body component by several chemical

transformation processes. These products are then used for growth and development, repair of tissue

damage, basal metabolism and activities. The remaining nutrients are put as deposit in certain part of

the body. In individual with certain health status, the nutrient requirement will be different. Moreenergy may be required to fulfill high metabolism processes while some other products are required to

repair tissue damage.

Figure 1. Conceptual basis for understanding nutrition and metabolism

Nutritionalinput

Physiologicaloutput

Metabolism

Food compositionRequirementMeal sizeFood origin

Mechanical digestionChemical transformationNutrient absorption

Digestion

Interconversions of absorbed monomersAnabolic reactions (Synthesis of body specificcomponents)Catabolic reactions (Energy / ATP or Heat)Formation of excretion products (waste)

Basal metabolismGrowth and development

Tissue repairNutrient depositActivityHealth status

I n s i

d e

h u m a n b o

d y


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During this block, students need to understand the concept illustrated above in depth and link

it with several clinical settings, i.e. nutritional, organ and metabolic disorders. To facilitate this

understanding, two major themes are applied in this block, including 1) nutrition for normal individual

well-being, and 2) nutrition in certain clinical settings, i.e. nutritional, organ, and metabolic disorders.The first theme, nutrition for normal individual well-being, is addressed to answer the following

question:

Where can people get required nutrients from?

What will happen when food enters the gastrointestinal tract?

What are the roles of nutrients for normal individual?

Will the requirement differs in various stages of life?

Studies have shown that nutrition is essential in maintaining human well-being, particularlynutrients that cannot be synthesized by the body such as essential amino acids, water-soluble and

fat-soluble vitamins, minerals, and the essential fatty acids. The body also requires an adequate

energy substrate, metabolizable carbohydrate, indigestible carbohydrate (fiber), additional nitrogen,

and water.

The requirement of nutrients varies in different stages of life, i.e. newborn, infant, childhood,

adolescence, adult, the elderly, and pregnancy. In general, nutrients are required for producing

energy for work, basal metabolism, growth and tissues repair, and regulation of the body function1

.The balance between intake and utilization of nutrients will then determine the well-being of

individuals.

In order to fulfill an adequate amount of nutrients, a person needs to consume various source of

food in a considerable amount. Different dietary products provide a variety of essential nutrients.

Furthermore, when foods enter the body, they undergo a range of digestive process in the human

gastrointestinal tract, which include physical and chemical processes. Some nutrients are absorbed

loosely while others are absorbed in very small amount. Therefore, ones need to know the function of

gastrointestinal tract in providing nutrients for the body. After being absorbed, what will happen to

those nutrients? Will it be utilized directly?

A range of metabolism process is required to transform circulated nutrients into substrates that

can be used directly by human tissues. The nutrients may be used for different purposes in the body.

Once there is an excessive amount of nutrients, they will be stored as nutrient deposit or being

excreted. The balance between intake and utilization is necessary to ascertain normal functioning of

the body.

1 Almatsier, S, 2002. Prinsip dasar ilmu gizi. Jakarta: PT Gramedia Pustaka Utama.


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Clinically, imbalance nutritional intake and requirement may result in several disorders, e.g.

deficiency syndrome (vitamin A deficiencies, stunting, wasting, etc) and over nutrition (obese, vitamin

toxicity, etc). Disorders of organ and metabolism, e.g. diabetes, renal failure, heart disease, liver

abnormalities, hypertension, and diabetes, may influence nutritional stability. These disorders maylead to a decrease or increase of excretion, detainment of nutrients in the blood vessels, etc. The

second theme will provide the basis of understanding the clinical consequences of under- and over

nutrition, as well as the nutritional adjustment in certain organ and metabolic disorders.

Duration of the block : 7 effective weeks

Eligibility for this block: Have completed block 1, 2, 3 and 4

Did not fail in more than 2 previous blocks

Expected Outcome

After completing this block, students are expected to be able 1) to construct dietary plan for

normal individual, 2) to construct dietary plan for patient with nutritional disorder (malnourished

individual), and 3) to construct dietary plan for patient with organ disorders (kidney, heart and liver)and metabolic disorders (diabetes and hypertension), 4) to practice a long life learning, and 5) to

communicate effectively with colleagues and other professionals. In order to achieve this outcome,

students should master the following constructs:

1. Nutrition for normal individual wellbeing

1.1. Explaining the anatomy, physiology and histology of digestive system in providing nutrients

and maintaining energy stability.

1.2. Explaining the principles of human diet (source and metabolism of nutrient).

1.3. Explaining the nutritional requirement in different lifecycle.

1.4. Explaining the concept of energy stability, energy production and expenditure.

1.5. Able to collect and apply basic interpretation skills in a given data regarding diet (secondary

data) to validate scientific information systematically.

1.6. Able to use data and scientific evidence in approaching individual dietary plan.

1.7. Performing anthropometric measurements to assess nutritional status.

1.8. Identifying, deciding, and determining appropriate laboratory measurement to assess

nutritional status.


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2. Nutritional disorders

2.1. Explaining the pathogenesis and pathophysiology of nutritional disorders (nutrient

deficiencies and excessive syndromes).2.2. Explaining the effect of non biological factors related to nutritional disorders.

2.3. Explaining the principles of drug and food interaction on gastrointestinal tract.

2.4. Interpreting and explaining clinical and laboratory data to determine the diagnosis of

nutritional disorders.

2.5. Explaining common health promotion and preventive approaches related to community

nutrition.

3. Organ disorders

3.1 Explaining the principles of dietary treatment for patient with organ and metabolic disorders.

3.2 Exploring and recording clearly dietary plans for patients with organ and metabolic disorders.

3.3 Explaining and deciding when to give parenteral and enteral dietary route

4. Long live learning

4.1 Developing capability to be updated with scientific and technological advancement.

4.2 Critically analyze medical literature and appropriately applied to students patient.

5. Ethics, moral and profesionalism

5.1 Appreciating others without preferences in certain personal status.

5.2 Presenting a case clearly and efficiently.

5.3 Constructively responding other people opinions

5.4 Providing sufficient time and paying attention to when other professionals (dieticians)

expressed their idea or consideration.

The following objectives are required in developing understanding related to the constructs above:

1. Explaining the anatomy of gastrointestinal tract and its related apparatus and glands

2. Explaining the histology of gastrointestinal tract

3. Explaining the basic principle of gastrointestinal tract function, including a) the motility, b) the

neurological and hormonal control, and c) blood flow regulation of gastrointestinal tract


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4. Explaining the secretory function of gastrointestinal tract, including a) gastrointestinal secretion, b)

types and characteristics of gastrointestinal glands, c) factors determining gastrointestinal

secretion, and d) bile composition and function.

5. Explaining the transport and absorption mechanism nutrition in gastrointestinal tract, including a)digestion process (mechanic and chemical process), b) the role and function of esophagus,

gaster, intestinum tenue and intestinum crassum in the transport mechanism of nutrients and food

blending process, c) the digestion of carbohydrate, protein and fat, and d) basic principles of

water, electrolytes and nutrient absorption.

6. Explaining the physiology of hungry behavior

7. Explaining and calculating the requirement of energy in different life cycle, i.e. newborn

(premature and aterm), infant, childhood, adolescence, adulthood (including pregnant andlactating mother) and geriatric

8. Explaining and calculating the requirement of nutrients (macro- and micronutrients) in different life

cycle, including a) pregnancy and breastfeeding, b) neonates (premature and aterm), infant and

child, c) adolescence, d) adult, and e) geriatric

9. Formatting daily human diet based on recommended dietary allowance (RDA)

10. Applying knowledge on nutrition and metabolism to explain certain popular diet, e.g. blood type

diet, herbal diet, etc

11. Explaining different sources of nutrients from daily diet, including a) macronutrients (lipid,

carbohydrate and protein) and b) micronutrients (vitamins [water- and fat-soluble vitamins) and

trace element [calcium, iron and iodium])

12. Explaining the process of distribution, metabolism and excretion of macro- and micronutrients in

the human body

13. Explaining the body control (neuronal and hormonal) in maintaining energy stability

14. Explaining the role of macronutrients in maintaining energy stability

15. Explaining the role of micronutrients in the normal function of the body

16. Explaining the composition of energy-source nutrients in various types of dietary products

17. Explaining the concept of energy expenditure, including expenditures for basal metabolism,

activities and sickness

18. Explaining the association between nutritional intake and social environment

19. Explaining the pathophysiology of macro- and micronutrients deficiencies and excesses

20. Explaining the pathogenesis of macro- and micronutrients deficiencies and excesses

21. Explaining the risk factor for acquiring nutritional disorders (deficiencies and excesses)


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22. Explaining the impact of acquiring nutritional disorders (biological and non biological impact)

23. Measuring body weight, height, waist, arm circumference, and head circumference

24. Explaining various laboratory measurement required to assess nutritional status (lipid profile,

hemoglobin, serum protein, etc)25. Explaining the route of nutritional intake (enteral and parenteral) in clinical settings

26. Explaining the basic principles of oral drug administration, including a) types, and b) the

mechanism of food and drug interaction

27. Providing examples of drugs that interact in the gastrointestinal tract

28. Explaining the principle that underlies the needs to perform dietary adjustment (macro- and

micronutrients) in organ and metabolic disorders

29. Explaining the dietary composition (macro- and micronutrients) for individual with organ andmetabolic disorders

Learn ing S t ra teg ies

Strategies used to deliver educational materials in this block consist of tutorials, lecturers,

laboratory works, and students assignments. Tutorial with problem based approach is the heart of the

learning strategy. Other strategies are required to complete student understanding on a given

problem/topic.A. Tutorials

The tutorial approach is developed based on the problem-based learning (PBL) principle in which

students are at the center. Therefore, students themselves are responsible for their own learning

process. Students decide for themselves what they want to learn and have considerable control over

the choice of literature. During the tutorials, they are divided into group of 10-12 students to discuss a

given problem using a procedure called the seven jump approach. This approach is conducted in the

following consecutive phases, including:

Step 1 : Clarifying unfamiliar terms

Step 2 : Problems definition

Step 3 : Brainstorm

Step 4 : Analyzing the problems

Step 5 : Formulating learning objectives

Step 6 : Self-study

Step 7 : Reporting


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In general, the tutorial process for each case is conducted in two group work. During the first group

work, students will work in a group for a given case until they come out with learning objectives (step

5). After the first session, student will conduct a self-study and report their finding in the second

session. These processes are repeated for the whole tutorials. During each week, students are givensufficient time to consult with expert their difficulties in understanding certain topics.

The problems discuss in the tutorial groups consist of 1) vacation to Bali, 2) my second pregnancy,

3)old baby, 4) diet oh diet, and 5) Mama Mias problem. These problems are addressed to cover all

of the given objectives/outcome, except for medical and certain other skills.

During the process, students have a number of roles to take, i.e. one student acts as a chair,

another as a scriber and the whole process is supervised by a tutor. The chair and scriber are chosen

randomly and every student will get their turn to be the chair and scriber. Both of them have importantroles in maintaining the learning atmosphere of the group.

B. Lecturers

Lecturer provides fundamental knowledge on certain aspect in metabolism and energy and

enhances students understanding on difficult topics further. Overall, lecture represents 12% of all

educational processes. The following topics are given during lecturers:

The anatomy of gastrointestinal tract

The histology of gastrointestinal tract and its accessory glands

Neurological and hormonal control of gastrointestinal tract

Transport mechanism of nutrient, water and electrolytes in gastrointestinal tract

Overview of nutrients metabolism

Basic principles of human dietary intake

Laboratory tests for nutritional disorders (syndrome deficiency or excessive of nutrients)

Food supplementation and fortification

Drug and food interactionBeside the above topics, there are four other lectures on medical research and statistics, i.e. 1)

probability, 2) research subject, unit analysis and sampling, 3) research variables, and 4) sample size

measurement.


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C. Laboratory works

In order to prove a better understanding regarding to metabolism and energy, students will be

provided with four laboratory works in this block. These laboratories include histology, anatomy, and

medical skill laboratories.The anatomy laboratory is required to enhance students understanding on gastrointestinal

anatomy. Students will be divided into three groups and undergo two sessions of laboratory work.

The histology laboratory is required to enhance students understanding on gastrointestinal

histology and accessory glands. Students will be divided into three groups.

Skills laboratory will provide students with skills in performing anthropometric measurements and

vein puncture. The following methods will be used during students laboratory work, including lecture,

demonstration, structured and self exercise on anthropometric measurement, vein and arterialpuncture.

D. Student assignment

Overall, there are two assignments in this block, journal reading and case-study. Students will

work in a group of 10-12 persons for both assignments.

Journal reading

In this assignment, certain journal will be provided for each group of students. The students

will analyze the content of the journal according to scientific writing procedure. Analysis should be

made from the medical nutrition perspective. The case will be provided during the third week of the

block.

The essay is written in A4 paper, with arial font, 11 points, and 1.5 cm space. The essay

should have been completed and handed to the following email address:

[email protected]

Case study: individual nutrition in certain clinical conditions

Each group will conduct a visit to instalasi gizi of NTB Province General Hospital. During the

visit, student should collect relevant information on a given case. Students will be guided for

nutritional visit to the patients by a dietician and attend nutritional outpatient polyclinic. The cases

consist of 1) nutrition in pregnancy, 2) nutrition for children under five, 3) nutrition for patient with

metabolic disorders, 4) nutrition for patient with organ disorder, and 5) nutrition for the elderly. This

assignment is addressed to provide students capabilities in 1) collecting, analyzing, and interpreting

information related to nutrition in clinical setting, 2) applying knowledge on nutrition in certain clinical

setting, and 3) performing appropriate case presentation skill.


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Following the visit, student will then analyze the case from the medical nutrition perspective.

The result of the study will be presented in mini seminar attended by relevant expertise. Written report

shall be provided and collected on line to the following email address

[email protected]

The following experts shall attend the seminar, including dietician, pediatrician, obstetrician,

and internist. They will provide feedback on students presentation and assess the presentation using

a given assessment tool. Final mark of this case study will be determined based on the presentation

(40%) and written report (60%).

Evaluat ionThe evaluation of student achievement during the metabolism and energy block consist of

three components: 1) overall block achievement, 2) medical skill performance, and 3) medical

research capability. The following table summarizes the contribution of these components in students

final mark as well as categories assessed in each component.

Component of assessment Score percentage

Tutorial assessment

Laboratory workStudent assignment

Jurnal reading

Case study

Final examination

Oral examination

Written examination

CBTMedical skill

Vein puncture

anthropometry

2.5%

7.5%5%

40%

60%

70%

20%

70%

10%

15 %

50%

50%

Students that attend all session on time (maximum tolerance time 15 minute) will be granted

with 2.5% of overall block achievement score. This attendance is also one of the pre-requisite of

following final examination, both oral and written examinations.


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Practical examination will be provided for anatomy and histology laboratory. The assessment

consists of a set of questions pointed on specific part of human gastrointestinal tract. The aim is to

explore students knowledge on gastrointestinal tract anatomy and histolgy.

In this blok, medical skill performance, particularly anthropometric measurement skills, will beassessed. Scenarios will be given and students are asked to perform appropriate anthropometric

examination and vein puncture procedure. Standardized checklist is used to assess students

performance along with OSCE to assess students skill.

Both students assignments will be assessed using standardized checklist. Tutors of the block

shall act as the assessor. Specifically for case study, students final mark comes from both

presentation and written report. Standardized checklists will be developed to include students

presentation and scientific written skill, as well as understanding on a given topic.Oral examination will be conducted for 15 minutes for each student. Tutors will act as the

assessor. Each assessor will be equipped with a list of questions and expected answers in a checklist

format as part of the assessment tool. The aim is to assess students understanding regarding the

concept applied in this block. Each student will be given a case related to the expected outcome of

the block. After reading the scenario, students will be asked to provide general overview on the topic

and followed with discussion session with assessor.

Written examination constitutes as the largest proportion in the overall block achievement. This

examination will provide information regarding students general understanding of the concept applied

in this block.. Multiple choice questions (MCQ) with vignette are at the heart of it

Co m p u t e r Ba se d Te s t ( CBT ) w i l l b e c o n d u c t e d f o r p r e p a r i n g t h e

s t u d e n t s t o U K D I . I t c o n s i s t o f 1 0 % o f f i n a l e x a m i n a t i o n p r o p o r t i o n . T h e

examination will be held in computer laboratory. Multiple choice questions (MCQ)

with vignette are also at the heart of it.


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Reference American Dietetic Association, 2000. Manual of Clinical Dietetics, 6th edition. American Dietetic

Association, Chicago Illinois.

Baynes and Dominickzak, 2003. Medical Biochemistry. Mosby Co, Singapore.

Bowman, BA & Russell, RM, 2001. Present Knowledge in Nutrition, 8th edition. ILSI Press,

Washington, DC.

Brody, T, 1999. Nutritional Biochemistry, 2nd edition. Academic Press, California.

Guyton, AC and Hall, JE, 2006. Textbook of Medical Physiology, 11th edition. Elsevier Saunders,Philadelphia.

Harkness, R, 1984. Interaksi Obat. Penerbit ITB Bandung, Bandung.

Hoffer, LJ, 2001. Clinical Nutrition: Protein-energy malnutrition in the in patient. CMAJ, 165:10.

Jones, JP, 2002. Clinical Nutrition: Functional Food. CMAJ, 166:12.

Melmon and Morrelis, 2000. Clinical Pharmacology, 4th edition. McGraw Hill, New York.

Montgomery, et al, 1993. Biochemistry. Mosby Co, Singapore

Moore, KL & Dalle, AF, 2006. Clinically Oriented Anatomy, 5th

edition. Lippincott Williams & Wilkins,Philadelphia.

Murray, et al, 2003. Biokimia Harper, ed 25. EGC, Jakarta.

Pi-Sunyer,FX, 2000. Over nutrition and Under nutrition as Modifiers of Metabolic Processes in

Disease States. Am J Clin Nutr; 72 (suppl): 533S-7S.

Saladin, 2007. Anatomy & Physiology: The Unity of Form and Function, 4th edition. McGraw Hill Co,

New York.

Sediaoetama, AD, 1993. Ilmu Gizi I. Dian Rakyat, Jakarta.

Setiawati, A, 2005. Farmakologi Dasar dan Klinik. Balai Penerbit FK UI, Jakarta.

UNICEF, 1991. Strategy for improved nutrition of children and women in developing countries.

UNICEF policy review, New York.

WHO, 1999. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health

workers.

Wilson, et al, 1991. Harrisons Principles of Internal Medicine. Mc-Graw Hill Co, New York

Wiryo, H, 2004. Malnutrisi Berat: Patofisiologi, Penilaian, Pengobatan, Rehabilitasi danFollow up.

UPT Mataram University Press, Mataram.


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SCENARIO 2: MEDICAL STUDENT ASSIGNMENT

Desta and Gisell, two student in medical Faculty, their lecturer gived them a task to make summary ofdaily nutrition and energy requirement each of family member in their home. Desta lives with his

father, mother, grandfather and younger sister in home. Desta is 19 years old now, his younger Sister

is 13 years old, his father and mother are 40 years old and his grandfather is 63 years old. Desta

usually plays futsal after finished his campus activity in the afternoon. his grandfather commonly does

daily activities by gardening and reading newspaper. His mother has bad problem with her weight

body because [of overweight] her body is very big. Meanwhile his grandfather appears more skinny.

Meanwhile, Gisell lives with her older brother, her sister in-law, and two nephews each of them fouryears old and eleven months. her sister in-law was pregnant now and her old nephew was sick since

two days ago, he has got fever and have to get bedrest.

Could tou help Gisell and Desta to make summary of daily nutrition and energy requirement each of

their family member?

Reference


Washington DC. Part 6: Nutrition and the Life Cycle, p403-46.

American Dietetic Association, 2000. Manual of Clinical Dietetics, 6th edition. American Dietetic

Association, Chicago, Illinois. Part 2: Lifecycle Nutrition, p69-158.

UNICEF, 1991. Strategy for improved nutrition of children and women in developing countries.

UNICEF policy review, New York.

SCENARIO 3: How do I will be skinnier?


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Roni is a senior high school student, and now he is in the last year. When he was a young boy he hada dream to be a policeman. Unfortunately, after he knew that becoming a policeman need specificrequirements including an ideal body weight. Therefore, he was unable to apply for the policeacademy this year. Based on the last antrophometric examination 3 month ago his body weight was90 kg and height 168 cm, thus his nutritional status was obese. From now on, he has a program todecrease his BW by changing some of his habbit . He consumes fast food and chocolate almosteveryday. Fast food predominantly contain carbohydrate and fat. He read from an article in thenewspaper that fast food is harmful, it can cause weight gain and increase the risk for CVD. As hewas determinant to chase his dream to be a policeman, so he said goodbye to fast food.

Reference


Association, Chicago Illinois. Part 1: Nutrition Assessment, p3-67.


Association, Chicago Illinois. Chapter 23: Obesity, p365-386.

Brody, T, 1999. Nutritional Biochemistry, 2nd edition. Academic Press, California. Part 4: Regulation of

Energy Metabolism, p157-261.Guyton, AC and Hall, JE, 2006. Textbook of Medical Physiology, 11th edition. Elsevier Saunders,

Philadelphia. Chapter 67: Metabolism of Carbohydrates, and Formation of Adenosine Triphosphate,

p829-39.

Guyton, AC and Hall, JE, 2006. Textbook of Medical Physiology, 11th edition. Elsevier Saunders,

Philadelphia. Chapter 68: Lipid Metabolism, p840-48.


Philadelphia. Chapter 69: Protein Metabolism, p852-57.Saladin, 2007. Anatomy & Physiology: The Unity of Form and Function, 4th edition. McGraw Hill Co,

New York. Chapter 26: Nutrition and Metabolism, p986-94 and p996-1007.

WHO, 1999. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health

Workers.

SCENARIO IV


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Micronutrient Deficiency

A 40 year-old woman came to Puskesmas with mass in her neck since 2 years ago. The mass seemsto grow bigger but no complaint for pain nor swallowing. Her other complaints are getting tired easily,

dry skin and constipation. Since she lives in mountain area far from city, the source of food sheconsumed are mainly come from nearby. She also did not know whether the salt used in her foodcontain iodine or not. At the moment, she is 3 months pregnant and worried the disease she has willaffect the growth of her fetus. Doctor explains that she is having micronutrient deficiency, which isiodine deficiency. What micronutrients needed by our body to function well and what are theconsequences of lacking or excess of them?

Reference


Philadelphia. Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and

Minerals, p875-80.


Washington DC. Part 3: Fat-Soluble Vitamins, p127-164.


Washington DC. Part 4: Water-Soluble Vitamins, p127-72.Bowman, BA & Russell, RM, 2001. Present Knowledge in Nutrition, 8th edition. ILSI Press,

Washington DC. Chapter 26: Calcium, p273-280.


Washington DC. Chapter 29: Sodium, Chloride, and Potassium, p302-10.


Washington DC. Chapter 30: Iron, p311-328.


Washington DC. Chapter 32: Iodine and the Iodine Deficiency Disorders, p344-351.

Brody, T, 1999. Nutritional Biochemistry, 2nd edition. Academic Press, California. Part 9: Vitamins,

p491-692.

SCENARIO 5:The Wonders of the Human Body


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Lula is a student in the Medical Faculty. One day, she bought a snack from a nearby shop. Four hours

later she suffered nausea and vomit which was followed by diarrhea. She feels that her symptoms

were mild, therefore postponed to seek help from the doctor. Despite her symptoms she was still able

to eat although not as much as usual. To her surprise, the next day she felt better. She then consultedher condition to one of her lecturer. The lecturer then assumed that she might suffered from mild food

intoxication. To give better understanding on her condition, she was given an interesting article. An

interesting paragraph in the article is stated as follow:

The human body is exposed to a wide array of xenobiotics during the course of our lifetime.

Our bodies are capable in managing environmental product and also excessive intake of

certain substance, thus minimize potential damage of various exposures. This is due to therole of certain organs that have developed complex enzymatic mechanisms. Nevertheless,

it should be pointed out that the mechanism of detoxification and excretion itself exhibit

significant individual variability, and are affected by many factors. As a consequence, the

ability of detoxification and excretion of one individual may differ from the other.

Reference

Bowman, BA, and Russell, RM, 2001. Present Knowledge in Nutrition, 8th edition. ILSI, WashingtonDC. Chapter 50: Diabetes Mellitus, p.

American Dietetic Association, 2000. Manual of Clinical Dietetics, 6 th edition. American Dietetic Association, Chicago Illinois. Chapter 20: Diabetes Mellitus, p.


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Annex 3

Name Phone number

dr. Seto Priyambodo, MSc 0817450525 Block coordinator

dr. Ida Ayu Eka Widiastuti, MFis 081239553313 1st week Coordinator and Medical skilllaboratory instructur

dr. Moulid Hidayat 081237352335 1st week Coordinator, Medical skill laboratory

instructor, SOCA coordinator.

dr. Hadian Rahman 08175737921 2nd week Coordinator and Medical skill

laboratory instructur

dr. Raehanul Bahraen 08175752861 2nd week Coordinator and Tutor

Dr. Ardiana Ekawanti, M.Kes 081353496220 3rd weeks coordinator, Medical skill laboratoryinstructor and Written test coordinator

Dr. Wahyu Sulistia Affarah 081803150805 3rd weeks coordinator and Medical skill

laboratory instructur

dr. Putu Aditya Wiguna 081907212887 4th week Coordinator, Tutor and CBT

Coordinator

dr. Monalisa, SpM 081317303637 4th week Coordinator and Tutor

Dr. Marie Yuni Andari, Sp.M 08123218548 5th week Coordinator and Tutor

dr.Dewi Suryani, M.ID 082139223981 5th week Coordinator and Tutor

dr. Yunita Sabrina, M.Sc. PhD. 087864718100 Journal reading coordinator and Tutor.

students guidebook 2012 blok5

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