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

Day Five: Internal Medicine

Day Five:

Hello Readers,

This day had more of a pleasant demeanor to it compared to Day Four. On this day I visited another nursing home with Dr. M and experienced something other than the sensation of depression and sadness.

My experience at this nursing home was the polar opposite of what I felt on Day Four. As I walked past the front doors of the home, I was immediately greeted with the sight of blue and yellow finches. The walls were the color of sunshine and decorated with Valentine’s Day decorations. The patients and nurses within the walls of the home were smiling and joyful despite the circumstance that led to their residence there. At the other home, the walls remained a bleak grey color and were hardly varnished with anything other than patient sheets. Instead of smiles and happiness, the other home had an aura of melancholy and the nurses and patients wore expressions of resignation and anger.

The stark differences I noticed between Day Four’s nursing home and Five’s only serves to support my idea that there are so many factors outside of one experience like there are so many factors outstanding of a personality test that it is almost impossible to say that one person should do this rather than that. To elaborate, let me define what a nursing home is, it is a place for people who don't need to be in a hospital but can't be cared for at home who have nursing aides and skilled nurses on hand 24 hours a day. Basically it is a place where an individual baby-sits someone until they pass. As depressing as the thought of withering away in the presence of people who do not know you and who are usually unable to help, it can be altered. At this nursing home, the elderly people that resided there were living an almost normal life, in both the acute and chronic. Despite the melancholic notion of a nursing home, the effort that the nurses put in they almost made the idea appealing.

What I took away from this comparison was: what an experience can be and are two completely different things and an affirmation that there are more outlaying factors than meets the eye.

Thanks for Reading.  

Research: Jung, Myers, and Briggs

Hello Readers,

For this blog entry I decided to give some more background information on my topic and to show the extensive research that has been done on personality typing.

Research has indicated that that many different personality types tend to have distinct preference in their choice of careers. Based off of well-known research conducted by Carl Jung, Katherine Briggs, and Isabel Myers there are sixteen prominent personality types that have shown a preference towards some and not others.

Carl Jung first developed the theory that every individual has a personality type, where there are two basic kinds of functions: how we perceive things (how we take in information), and how we make decisions (what we base decisions off of). Jung adamantly believed that these two functions were complete opposites. He viewed that within these two categories there were many other options. He believed that one had the ability to perceive information through either ones’ senses or ones’ intuition, but he also believed that one could make decisions based on objective logic as well as subjective emotions. Jung believed that one uses all four functions in our lives, but the frequency that we use them is determined entirely within the individual. His research led him to believe that there is an order of preference of these functions within individuals, where an individual uses their dominant function first, and then relies on auxiliary, and tertiary, and inferior functions that follow up behind. Jung also believed that the dominant factor was so important that it overshadowed all the other functions following the dominant factors: Extroverted and Introverted.

In conclusion, Jung found and determined eight differing personality types:

·      Extraverted Sensing

·      Introverted Sensing

·      Extraverted Intuition

·      Introverted Intuition

·      Extraverted Thinking

·      Introverted Thinking

·      Extraverted Feeling

·      Introverted Feeling

Jung’s work was later extrapolated and made into Katherine Briggs and Isabel Myers own personality test. The mother and daughter duo studied extensively on the work of Jung, and in 1962, they published their own questionnaire: the Myers-Briggs Type Indicator. The results yielded were similar to those of Jung, but the results that Myers and Briggs made differed greatly. Myers and Briggs results differed in their concept of whether a given personality type's (extrovert or introvert) fourth letter J or P (Judging or Perception) was determined by how that type interacts with the external world, rather than by the type's dominant function as Jung hypothesized.

 

This yielded an additional eight spectrums of personality types:

·      (Modern types: ESFP, ESTP)

·      (Modern types: ISTJ, ISFJ)

·      (Modern types: ENFP, ENTP)

·      (Modern types: INFJ, INTJ)

·      (Modern types: ESTJ, ENTJ)

·      (Modern types: ISTP, INTP)

·      (Modern types: ESFJ, ENFJ)

·      (Modern types: INFP, ISFP)

This is where I will leave now,

Thanks for reading!