Human Anatomy at Colby

Arianne Thomas: My JanPlan Experience – pt. 1

February 22nd, 2015 · Comments Off on Arianne Thomas: My JanPlan Experience – pt. 1

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This JanPlan gave me many unique opportunities, and I learned so much about the human body in so many different ways beyond just classroom lectures. We spent hours in lab studying models, histology slides, real bones, and a real pig heart. We went on “field trips” to the art museum, where we identified different anatomical features in pieces of art, and to the athletic center, where we learned about our own heart rates, respiration, and metabolism. We completed a Grand Rounds project, which is where medical professionals present a patient’s issues and treatment for the purpose of educating medical students as well as other doctors. We were given the opportunity to work with high schoolers interested in the sciences during a mentoring session where we were taught them a little bit about what we were studying in class and helped them plan out science fair project ideas.

Some of my favorite learning experiences organized by Dr. Klepach was bringing in different speakers who talked to us about what they do in their day to day lives and the issues they seek to fix. The first speaker was Dr. Zak Nashed, a radiologist who specializes in peripheral artery disease. PAD is a circulation problem where arteries that supply blood to the extremities get clogged by the hardening of arteries, often times leading to a stroke or a heart attack. It can cause damage to the endothelial lining of the arteries, an increased permeability and adhesion of molecules, and if it goes untreated there could be a complete obstruction. One treatment option is medical management, where the risk factors could be modified (by exercising, losing weight, or stopping smoking) or a pharmacologic intervention could be used to regulate hypercholesterolemia, hypertension, or diabetes. Another treatment option, which Dr. Nashed specializes in, is interventional radiology through endovascular techniques. These are minimally invasive procedures where medical professionals use image guided tools to perform balloon angioplasty and place stents to open up narrowed arteries due to plaque build up. The third and most extreme treatment option is to perform a bypass graft or an amputation.

The other speaker who came to talk to us was Dr. Peter Millard who is an epidemiologist, someone who studies causes and patterns of diseases in different populations. He talked to us about his work with diseases in Africa, making the interesting point that where he worked in Mozambique is about the same distance from Liberia as it is from New York, but in reality New York is a lot closer because there is more traffic between the two places. He explained that geographic proximity is different from travel patterns and the way disease spreads has a lot more to do with traffic than geographic proximity. He also talked about the prevalence of HIV across different parts of Africa, and possible correlation between these rates of HIV and circumcision. Another interesting aspect of epidemiology he talked about was the importance of disease prevention on economic and social levels.

Having these speakers come in to talk with us was an integral part of my learning experience in the Anatomy and Physiology class because it opened my eyes to all the various aspects that the sciences, biology in particular, encompass. Having both parents working in the medical field has always fostered an interest in a profession in the medical field, but I have never had a concrete idea of what I specifically would like to do. These opportunities of having two very different speakers come talk to us made me more aware of the various directions my degree in biology can take me and interested in looking into different careers that I would have never thought about before.

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Tags: Bi265j · Guest Speakers

Arianne Thomas: My JanPlan Experience – pt. 2

February 22nd, 2015 · Comments Off on Arianne Thomas: My JanPlan Experience – pt. 2

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Going into my first JanPlan two years ago I didn’t know what to expect. The only thing I had known about it that it was a time to step out of your comfort zone, take a different class, and explore other aspects of learning. I signed up for the Catholic Church and Hollywood class that year because it fulfilled two distribution requirements. I thought that the class would be a breeze. Not only did I hear from upperclassmen that it was an easy class, I was also raised in the Catholic Church and went to a Catholic school for most my life, and therefore had to take church history and other religious classes throughout my high school experience. Turns out, the class was easy. The class met three times a week, and every single day we watched a movie, the hardest part of the class being keeping my eyes open for three hours in the dark room. There were three relatively short essay assignments and there was no final.

My sophomore year, I decided to step out of my comfort zone. I took the African Music class being not at all musically inclined other than my experience with the recorder in the third grade. Since the class fulfilled the art distribution requirement, and I’m even less artistically inclined, I figured I would manage. A normal class day consisted of singing, drumming, and dancing. There were no assessments other than a few performances at a local church and during the Martin Luther King Day celebration.

I knew this year would be different when I signed up for Anatomy and Physiology. My mom, a retired flight nurse in the Air Force, recalled taking full semesters of both Anatomy and Physiology while in college. She was surprised that we could fit in all the information in just one month, recalling specific parts and functions of the human body that she was required to know. I knew it would be a lot of hard work, but I was prepared to dedicate my month to working hard. Going over the syllabus on the first day, I was a little bit overwhelmed with the amount of material, quizzes, and projects we were going to accomplish during the month. Dr. Klepach also warned us that people often get C’s and D’s on the quizzes and tests, which was worrisome as my grades and my GPA are always a primary concern. On top of it all, our professor wanted us to keep logs of our eating, exercising, and sleeping habits and to monitor our stress levels. Within the first few days of the class, I was completely overwhelmed by all the work and studying I had to do and called my mom for some support, only to hear her say “I told you so.” It was a matter of days until about a third of the class switched into a different class. The first week proved to be the hardest, listening to two hour long lectures and taking detailed notes on top of studying for a few quizzes and a lab test. It was really encouraging to hear Dr. K’s words of praise after the class average on our first lab test was 40%, well above the average of last year’s class. Although the subsequent weeks lightened up and my personal scores improved, the most important lesson I learned was balancing my life. Previously, when I got swamped with school work, I would often cut out exercising or a full night’s sleep to catch up with work. Dr. K stressed the importance of a healthy lifestyle, and this transformed me to be a better student. It not only forced me to stay on top of my work, but also kept me healthy during the time of the year when many people get sick. This aspect of the class was crucial in showing me that a healthy, balanced lifestyle can be achievable even with a rigorous school schedule, which is something I believe many college students tend to forget.

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Tags: Bi265j · Human Health

Grand Rounds: Celiac Disease

January 28th, 2015 · Comments Off on Grand Rounds: Celiac Disease

Ari Thomas, Laurel Edington and Danielle Levine

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Grand Rounds Synopsis

A 42-year-old man presented with a chief complaint of chest and abdominal discomfort that had begun suddenly two days before as a sharp left upper quadrant pain radiating to his back, associated with nausea and early satiety, and that increased in intensity over the next two days. The next day, he experienced substernal chest pressure consistent with his usual angina, but which did not respond to a single sublingual nitroglycerin tablet; it only resolved completely after IV morphine, ketorolac (an NSAID), chewable aspirin, and three more sublingual nitroglycerin tablets. He had experienced no recent abdominal trauma, vomiting, rectal bleeding or black stools.1

The patient’s past medical history includes hypertension, hyperlipidemia (excess blood lipids), and coronary artery disease (myocardial infarction at 32 years of age, with coronary artery angioplasty with stent placement, and subsequent bypass grafting).1,2 For more than ten years before presentation (since the coronary-artery bypass surgery), he has experienced chronic diarrhea that has worsened since his cholesterol-lowering medication was increased 6 months ago.1  During the past six months, he has experienced daily headaches, nocturia (excessive urination at night), feeling warm at night, an unintentional weight loss of 35 lbs, and occasional early satiety.1,2  Although he has a family history of colon cancer, a colonoscopy performed 4 months prior was unremarkable.1

The abdominal and chest pain, weight loss, and history of gastrointestinal symptoms suggested an acute chest syndrome, acute abdominal syndrome, inflammatory disorder, or cancer. An acute coronary syndrome was unlikely and an echocardiogram and chest radiography confirmed this. The physical exam ruled out acute chest syndromes, but sensitivity in the upper right quadrant suggested an upper abdominal disorder. Lipase, aminotransferase, and amylase levels were elevated, suggesting pancreatitis, liver injury (from an infection or drug use) or disease, or liver cancer. A CT scan of the abdomen ruled out pancreatitis and colon and small bowel disorders, but showed enlarged jejunal lymph nodes. An exploratory laparotomy was performed and the lymph nodes showed reactive follicular and interfollicular hyperplasia and lipogranulomas, suggesting an inflammatory abdominal disorder. Evidence of lymphoproliferative disorders was absent, ruling out cancer. A small-bowel biopsy showed flattened villi and intraepithelial lymphocytes, which suggested celiac disease. Positive IgA tissue transglutaminas and IgA endomysial antibody tests, the most specific and sensitive tests for celiac disease, were positive and confirmed the final diagnosis.1

The patient was advised to follow a gluten-free diet with an intramuscular iron supplementation as well as a multivitamin for general vitamin and mineral deficiencies.3 The gluten-free diet includes avoiding foods made out of wheat, rye, barley, oats, and processed foods that may contain wheat flour.4

Based on the patient’s symptoms, doctors diagnosed the patient with celiac disease. This disease is an autoimmune disorder that is provoked by intaking various forms of gluten and affects the small bowel. The intestinal symptoms of this disease include abdominal pain, diarrhea, a mild elevation of aminotransferase levels, and an increased risk of pancreatitis. Abdominal pain in the patient may have been due to transient intussusception related to celiac enteropathy.  Celiac disease also has extragastrointestinal system effects such as rashes, arthralgias, neurologic and psychiatric effects, fatigue, and infertility.4 Patients also suffer from malabsorption of nutrients which can lead to weight loss, iron-deficiency, and osteoporosis. Patients have an abnormal immune response to the gliadin component of the gluten protein, where type 1 helper T cells cause inflammation in the epithelium and lamina propria of the small intestine, which alters the structures of the intestinal villi and therefore causes malabsorption.3 Celiac disease may also accompany type 1 diabetes, thyroiditis, and hepatitis.1

Celiac disease is different than a gluten sensitivity.5 Although the symptoms are similar, a person with a gluten sensitivity does not have the intestinal damage that a person with celiac disease has. Patients with a gluten sensitivity also do not have the IgA tissue transglutaminase or IgA endomysial antibodies that patients with celiac disease have.6 Since blood tests and intestinal biopsies will not diagnose a gluten sensitivity, using a process of exclusion helps to diagnose the sensitivity.5 Both disorders are treated by following a strict gluten-free diet.5,6

References:

  1. Ole-Petter Riksfjord Hamnvik, M.D., Fidencio Saldana, M.D., Bruce D. Levy, M.D., and Joseph Loscalzo, M.D., Ph.D. N Engl J Med 2014; 371:1333-1338.
  1. Medline Plus: Medical Dictionary. Besthesda, MD: U.S. National Library of Medicine, 2012. (Accessed January 13, 2015 at http://www.nlm.nih.gov/medlineplus/mplusdictionary.html.)
  1. Leffler, D. Celiac Disease Diagnosis and Management: A 46-Year-Old Woman With Anemia. Jama 2011; 306:1582–1592.
  1. Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. American College of Gastroenterology Clinical Guideline: Diagnosis and Management of Celiac Disease. The American Journal of Gastroenterology 2013, 108:656–677.
  1. Non-Celiac Gluten Sensitivity.  Ambler, PA.: National Foundation for Celiac Awareness, 2015. (Accessed January 25, at http://www.celiaccentral.org/non-celiac-gluten-sensitivity/).
  1. Gluten Sensitivity.  Woodland Hills, CA.: Celiac Disease Foundation, 2015.  (Accessed January 25, at http://celiac.org/celiac-disease/non-celiac-gluten-sensitivity/).

Tags: Grand Rounds