FoCP week 11: Consolidation - Gastroenterology

Nothing particularly interesting really happened duringt this week.

It was gastroenterology revision week so I was suppossed to go around the wards to start putting those I've learnt back in week 4 where I was taught everything I should know about the stomach and all the structures around it with their related diseases and illnessess and sure enough, one of the most common presentation is jaundice.

I went to see a patients with an extremely severe jaundice due to Alcoholic liver disease he looks neon yellow against his fair skin. His disease profile was pretty typical for the likes of him who had been drinking too much alcohol (one friend who also talked to him said he would drink as many as 116 units a week, almost 6 times greater than the suggested limit).

In his case, too much alcohol took a toll on him by way of liver cells destruction resulting into severe release of billirubin (let's not go into details here) which resulted into him being jaundice or having yellow-tinged skin. While his abdomen didn't appear severely distended (another friend had mentioned that he had undergone some fluid draining from the abdomen), patients with alcoholic liver disease would also present with ascites or enlarged abdomen due to fluid accummulation in the space around the stomach.



ascites - to you alcholics out there, you have been warned!

What made his case very interesting was the fact that he was very confused due to hepatic encephalopathy. Basically, the desctruction of liver cells results into toxins being released into the blood stream (the liver is where all the toxins in our body are filtered so you'd put yours under extreme stress and pressure when you drink too much alcohol or take too many recreational drugs!) and some of the toxins would affect the brain thus leading to confusion and drowsiness. So yeah, his confusion and disorientation made history-taking ten times more difficult. One minute he was talking about his daughter and another he was talking about his dog chasing after a donkey and I couldn't make neither head nor tail with his botched recollections. It didn't help that he was beyond restless, apart from talking in slurred speech which was another feature of his hepatic encephalopathy. When I asked to examine him, he reluctantly gave in insisting that I had done it already and he kept on asking me when I'd finish as I examined him. Hard as it was, I think I got it easy because according to the stories going around between my friends, some of them got cursed by him with some really extreme words!

Aside from that incident, the whole experience for the week was generally okay. I went to see some endoscopy being done which involved a fibre optic tube being pushed down patients' throat all the way to the stomach and intestines to examine the lining of the wall to see if there were any ulcers or growth or any abnormalities. Interesting as endoscopy was, it was more interesting to see flexible sigmoidoscopy and colonoscopy which involved inserting the same kind of tube into one's anus all the way up the colon, again, to see if there were any abnormalities. Another interesting procedure I got to see was PEG or percutaneous endocopic gastrotomy that involved inserting a tube into a patient's stomach through the abdomen to help feeding when oral intake is not sufficient for any reasons (difficulty swallowing etc.). It really was one of the most invasive procedure I've seen in which a thread was inserted into the patient's stomach through the abdomen to be pulled out of the mouth before attaching a tube to the thread to be pulled all the way down and out of the stomach through the same hole made to insert the thread in the first place. It wasn't pleasant watching it so I guess it ma sbe beyond horrible for the patient seeing she was only under mild sedation and not general anaesthetic.

All in all, the week did help increase my interest in gastroenterology. It really isn't my favourite topic when it comes to learning the theory but the practice was certainly more interesting. Maybe I'm just morbid that way seeing as I enjoy the idea of putting tubes into people's passages, back or front. Owh =O!!!

Just kidding =p!