Image: "Polyp"The endoscope looks like a black hose that is as thick as a finger. A camera sticks out from the end. The scope is snaked either up through the mouth or from below during a colonoscopy (a very uncomfortable procedure).
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To visualize the internal geography in the digestive tract, an endoscope was used today during our clinical interlude in the GI/Endoscopy Department at the VAMC. Colonoscopies are performed to visualize the colon and bowels, primarily to screen for colon cancer. If you are male and over fifty (or have a family history of colon cancer), you will probably have to endure this procedure. Rest assured, the procedure is typically performed under anesthesia.
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The stomach and colon should have nice regular folds on the mucous membrane. Any unexpected outpouches that form on the walls are bad. They are called polyps and can become cancerous if left to grow uncontrollably.
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These polyps are "mean-looking," as the attending put it and need to be nipped. Once identified, a blue dye is injected to outline the submucosal layer. Using a plier-like instrument, the GI internist can return to the site, open the mouth of the pliers, and clip away the polyp. Once removed, the polyp is sent for biopsy and a tatoo (carbon-based blue ink) is left at the site to assess any future growth.
During interlude, 2 other classmates and I, stood alongside the GI fellow and observed how this exam is done. Two screens projected the live footage from the scope that was advanced through digestive system. We were protected by an oversized yellow smock (that reminded me of those smocks you were in kindergarten when finger painting). How I miss finger-painting...When we first arrived on site after traversing the labyrinth of white buildings that is the VA, we were a bit anxious and confused about our role. It was like we were picked up and thrown into a completely different world.
The goal of interlude (as stated on the index card they gave us) was "designed to introduce 1st year medical students to the inpatient setting early in their careers. Similar to a medical anthropologist, the student will observe, study and discuss the cultures of inpatient units..."
Is medical anthropology a fancy term for shadowing?
While most of our classmates were spending the day in in-patient settings, we were in an out-patient setting. "They cheated you from an internal medicine team experience," said one of the GI fellows.
In all honesty, everything is new to me and I was just interested in learning about GI and what a typical day is like for individuals on the service by interacting with health care providers and patients. We did make a trip to the ICU, where we observed scoping from the mouth in a patient with COPD. We also saw how dialysis is performed in a patient with kidney failure.
When our attending, the "liver guy" arrived, we spent the afternoon with him. He specializes in disorders that affect the liver, such as cirrhosis and portal hypertension. The patient we saw had an uncanny resemblance to Leonardo Da Vinci, except our patient was pale and had a distended abdomen. I look forward to learning more about his story tomorrow, when my classmates and I will interview him.
After making our journey back to campus (it takes 2 buses to get home), we culminated our evening with a UCSF Advisory College Holiday Party, where we enjoyed good food and wonderful company, while exchanging stories of the day's adventures. I definitely had my share of scoping stories to share. And there will be more to come tomorrow during Day 2 of Interlude.
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