An Introduction to Gastroenterology

Hello Readers,

Here is a brief look into Gastroenterology.

Gastroenterology is a branch of the medical field focused primarily on the digestive system and its disorders. Physicians practicing in this field of medicine are called gastroenterologists. Gastroenterologists study and treat diseases affecting the gastrointestinal tract, which includes the organs from the mouth to anus: the esophagus, the stomach, the small intestine, the large intestine, the pancreas, the liver, the gallbladder, and the colon. There are specialists in this field who decide to specialize even more into the field of the digestive system by becoming, GI radiologists or GI oncologists by choosing to complete an additional two to three year fellowship. Gastroenterology is not the same as gastroenterological surgery or of colon and rectal surgery, both of which are actually specialty branches of general surgery.

                 

Gastroenterologists usually perform two procedures to view the organs of the digestive system: a Colonoscopy and an Upper-GI Endoscopy.

• Colonoscopy: It is a procedure typically performed to examine the large intestine for diseases such as colorectal cancer. To perform this procedure, gastroenterologists use a long thin flexible tube, called a colonscope, which is equipped with a small video camera and light to delve into the rectum and colon. The objective of this being to look for polyps that sometimes plague the rectal wall which are sometimes indicators of cancer. If polyps are discovered, they are often removed during this procedure and sent to a lab to be cultured in order to determine whether or not these polyps are cancerous.
• Endoscopy: An endoscopy is a helpful procedure in the diagnosis or evaluation of various problems that affect the digestive system. They are typically performed when patients complain of difficulty or of painful swallowing, pain in the stomach or in the abdomen region, gastric bleeding, stomach ulcers, tumors in the digestive system, and with problems occurring with the gall bladder or pancreas or bile ducts. An endoscope is used during this procedure, which is a long thin flexible tube equipped with a tiny video camera and light. The gastroenterologist uses the controls on the endoscope to safely guide the instrument inside the lining of the upper digestive system.

With theses procedures they typically diagnose common diseases such as Polyps, Hemrroids, Diverticulosis, and Diverticulitis.

• Polyps are a small abnormal growth, typically benign, with a stalk protruding from a mucous membrane. They can usually be broken down into three classes:
• Hyperplastic polyps, which are usually small, are located in the end-portion of the colon (the rectum and sigmoid colon), and have no potential of becoming malignant. It is not always possible to distinguish a hyperplastic polyp from an adenomatous polyp based upon appearance during colonoscopy, which means that hyperplastic polyps are often removed or biopsied to allow microscopic examination.
• Adenomatous polyps make up Two-thirds of polyps found in the colon.  Most of these polyps do not develop into cancer, although they have the potential to become cancerous. Adenomas are classified by their size, general appearance, and their specific features as seen under the microscope.
• Malignant polyps are Polyps that contain pre-cancerous or cancerous cells. The optimal treatment for malignant polyps depends upon the extent of the cancer (when examined with a microscope) and other individual factors.
• Hemrroids are a swollen group of veins in the region of the anus. This disease is sometimes called Piles.
• Diverticulosis is often found with a test done for other reasons, such as flexible sigmoidoscopy, colonoscopy, or barium enema. Most people with diverticulosis have no symptoms of where the bacteria, diverticula, are present in the intestine without signs of inflammation and will remain symptom free for the rest of their lives.
• Diverticulitis is an inflammation of a diverticulum. It occurs when there is thinning of the diverticular wall. Diverticulitis may be caused by increased pressure within the colon or hardened particles of stool, which can become lodged within the diverticulum. Both of these events probably decrease blood flow to the diverticulum.

Thanks for reading!

References:

1. http://emedicine.medscape.com/gastroenterology
2. http://sandiegogastro.com/patient-education/
3. http://www.gastro.org/patient-center/about-gastroenterology

Goodbyes and Hellos: A Conclusion to Internal Medicine and Otolaryngology

Hello Readers,

In a nutshell, Internal Medicine has been a tremendous learning experience. Throughout my first week with this group, I have observed many things. I have observed the trouble that Medicare and Medicaid are causing doctors and patients alike, the sadness that lingers after a patient asks to be taken off medication and instead be given hospice, and the anguish the caregivers have for their wards who alone are faced with an uphill battle of PTSD and Dementia to name a few. But the overall theme that was outright stated spoken to me during my week with Dr. M (internist), Dr. R (Otolaryngologist, who also works in the Internal Medicine office), and Dr. K (another internist whom I spent a fair amount of time discussing the merits and importance of psychological endurance) was, “Do something you love, or you will spend the rest of your life regretting it”.

What resonated the most with my project would be the general observations I made of the personalities that are in their office. While Dr. M Dr. V, and Dr. K hold a strong, strict flexible personality, they are completely contrasted by their staff. Their staff, who are the clerks and nurses and receptionists, are bubbly, sarcastic, witty, and authoritative almost to a fault. That is not to say that they are not hardworking. This palpable difference in personality type has led me to believe more firmly in the idea that there is no specific personality type for every job. For even Dr. M, Dr. V, and Dr. K differ in their demeanor and work ethics. Dr. M likes to start and finish early, she would rather work through lunch and finish all her patients’ charts between appointments then stay late. Before even beginning to fill out the remainder of his charts from each office visit, Dr. K usually would rather see all his patients first, eat lunch, and does not seem to mind working later into the evening. Dr. V on the other hand favors using a Dictaphone over writing everything into patient charts, he seems to prefer to write the minimum and voice his opinions into the recording device. Dr. V too shares Dr. M’s need to power through lunch to get work done, but he also shares Dr. K’s apathetic nature towards working late.

 Despite the obvious differences in the personalities between Dr. and staff, they work together like a well-oiled machine. Their personalities, as different as they are, actually make up for each other’s down fall. The staff makes up for the Dr.’s stringent nature by being humorous and charming, while the Dr.’s cover for the staff by being professional almost to a fault. The Dr.’s then also cover for their own disadvantages by making up for their need to complete work before the end of the day, their need to enjoy a break in the middle of the day, and their need to use technology to aid them in less paperwork. They all cover for each other. With so many personalities in an environment, it is almost hard to say which personality type would best thrive in Internal Medicine when each office has a different group of personalities leading in the office. For all one knows another office could have the exact opposite where the doctors are humorous and the staff are stringent. There are so many factors outstanding a personality test that it is near impossible to determine which personality type would best flourish in Internal Medicine, or Otolaryngology. 

With this idea in mind, I hope to observe the same dynamics when I start next week with Gastroenterology.

Until then,

Goodbye