Human Anatomy at Colby

Danielle Levine: Heart Dissection and MMSA Visit

February 24th, 2015 · Comments Off on Danielle Levine: Heart Dissection and MMSA Visit

Danielle Levine (’15, Biology)

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While taking Introduction to Anatomy and Physiology this JanPlan, I was given the opportunity to perform a wet dissection of a pig heart. Having learned about the surface and blood vessel structural features via the study of powerpoint slides, listening to class lectures, and studying plastic models, the wet dissection gave me the opportunity to view the anatomy learned in an actual heart. Studying a list of anatomical features and seeing pictures of them on paper is a very different experience from actually getting one’s hands “dirty” and exploring a real heart and seeing what those structures actually look like.

Besides being able to dissect the heart in lab, one of my favorite activities of the semester was when during the following week we dissected another pig heart with visiting high school students, and were able to show them everything we had learned about the heart the week before. On Martin Luther King Jr. Day, a number of high school students from different schools in Maine visited Colby for the day as part of a collaboration between the Maine Math and Science Alliance and the Colby Goldfarb Center; we were able to show the students around the lab and talk to them about anatomy and physiology, as well as help them with potential science fair project ideas.

That day, our class began with a lab practical that covered the eye, the ear, and the nervous and cardiovascular systems before the high school students arrived; after we finished the exam, we met the high school students who would be spending the day at Colby with us. Each lab group of Colby students partnered with two high school students, my group with Cierra, a sophomore from Dover-Foxcroft, and Shea-Lynn, a home schooled junior. After introducing ourselves, we took the high school students on a tour of our lab, showing them all the different models we use to help us learn about human anatomy. In addition, we went over with them the lab practical exam that we just took, explaining what the answers were (of course, we had an answer key, and we had gone over the answers in class after we had finished the exam), and the physiological significance of the various anatomical structures identified. This was a very enjoyable experience, as not only did it reinforce my knowledge of the material, but it also gave me the opportunity to share that knowledge with these students by teaching them a little bit of anatomy and physiology.

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After the lab tour, we had enough pig hearts left over from the previous week, and so we were able to dissect another pig heart, this time letting the high school students perform the dissection while we helped and taught them about the different structures and features of the heart they were looking at – this teaching was reinforced by the use of pictures and models of the heart.

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After successfully dissecting the heart and exploring its anatomic features (and after lunch), we talked about potential Maine Science Fair project ideas for Cierra and Shea-Lynn; they came up with some interesting topics such as the effect of emotions on heart rate and blood pressure. The day was very rewarding, as it gave me a feeling of competence in that I was able to teach others material I had learned in the course – not to mention, it was also a lot of fun!

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Pictures of two of the heart models we used to study the cardiovascular system and teach the high school students with.

Tags: Lab · Special Activities

Danielle Levine: My Experience in Bi265j

January 31st, 2015 · Comments Off on Danielle Levine: My Experience in Bi265j

Danielle Levine (’15, Biology)

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To complete the Biology major at Colby, one has to take a minimum of six biology lab classes. As a senior biology major who at the end of the fall semester needed to take one more biology lab class, I chose to sign up for BI265 Introduction to Anatomy and Physiology for my January course rather than take an additional lab course (I will be taking the second semester of physics, which also has a lab) in the spring with my busy tennis team schedule. Having been warned before the class started that anatomy and physiology courses are a lot of work and a whole lot of memorization, I was expecting and prepared for an intensive month – but as the first week started, I found I was not quite ready for this class! During the first week, I was very nervous about the class – very concerned and stressed about the workload – and I remember wondering if I made the right decision to take the class, or if I should have just taken another lab course in the spring. After having now finished the class, I am very grateful for the opportunity to have taken BI265 with Dr. Klepach, as I truly enjoyed the class (excepting, of course, that first very difficult week!) to the fullest extent. I would recommend this class to every biology major, pre-med student, or any student at Colby just interested in learning how the human body works.

The class was, in fact, a lot of work, from studying for quizzes for almost every lecture, to listening to podcasts of lectures and labs for the next day, to making and presenting a Grand Rounds powerpoint to physicians and nurse practitioners, to studying for hours on end memorizing and identifying different anatomical structures and features on plastic models in the lab. However, the amount of material I learned and the understanding I achieved with respect to the structure and function of the human body was unimaginable to me before I took the class. The sheer volume of knowledge to be gained from this course is reason enough to recommend this class to other Colby students.

As a pre-med student, I am easily caught up with concern over my grades, GPA, exams and assignments, but taking this class reminded me of the importance of seeking to understand and learn material for oneself and for one’s own knowledge rather than for the primary purpose of getting a certain grade on an exam. As I hope to become a medical professional one day, this class had many practical aspects beyond the classroom; I was able to practice presentation skills via the class’s Grand Rounds presentation project, build a foundation of human anatomy and physiology for medical school (which I hope to go to!), learn how to succeed under stressful situations, and finally, balance my schedule keeping in mind the importance of maintaining a healthy lifestyle.

In taking this course, I was given many wonderful opportunities, such as being able to perform a wet dissection of a pig heart, and then being able to help visiting high school students perform a dissection on another pig heart, teaching them and sharing with them the material I had learned about the cardiovascular system the week prior, listening to guest lecturers, including Dr. Zak Nashed, who discussed interventional radiology and peripheral artery disease, and Dr. Peter Millard, who spoke about the field of epidemiology. Overall, I enjoyed this course very much, as it was a wonderful opportunity that I believe prepared me for the future after I graduate from Colby this spring, and reinforced my decision to pursue a career in medicine.

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Here are some of the models used during lab and for studying for the lab practical exams.

Tags: Bi265j

Danielle Levine: Grand Rounds

January 31st, 2015 · Comments Off on Danielle Levine: Grand Rounds

Danielle Levine (’15, Biology)

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One of the opportunities I had during this Jan Plan course was to participate in a Grand Rounds Presentation; Grand Rounds, in which physicians give lectures to their peers, including other physicians and medical students, on a medical topic is a common tradition in medical education. In groups of three students, we were able to pick any topic of interest for a fifteen minute oral presentation that we would present at the end of the semester. Given the vast array of medical topics that could be picked for a presentation, we looked to academic medical sources, including the New England Journal of Medicine, for possible past case studies that we could research and discuss. After scrolling through dozens of case studies, and clicking on articles with titles that seemed very interesting and then reading the articles’ summaries, we finally settled on an interesting case subject, one about celiac disease or gluten-induced enteropathy, that we considered particularly relevant given the current emphasis on the effects of gluten in the diet in popular culture.

In this case study, a 42-year old man presented to the emergency room with the chief complaint of chest and abdominal discomfort; given his additional history of unintentional weight loss and chronic diarrhea for ten years following coronary artery bypass grafting, an inflammatory disorder or a cancer of the chest or abdomen were differential diagnostic considerations. After multiple tests were performed, including an invasive exploratory laparotomy done after a CT scan showed enlarged jejunal lymph nodes, a small bowel biopsy revealed the diagnosis of celiac disease given the presence of flattened villi and intraepithelial lymphocytes. Today, celiac disease can be diagnosed via a simple blood test for IgA tissue transglutaminase and IgA endomysial antibodies. This case study demonstrates the importance for physicians, especially given the increasing incidence of celiac disease, to test for it non-invasively when a patient’s symptoms may be suggestive of it.

The diagnosis of celiac disease has been increasing in the developed world, at least in part due to the availability of new non-invasive tests to diagnose the autoimmune disorder. Also, there has been an increase in the diagnosis of non-celiac gluten sensitivity, which has been an even more significant factor in the increase in the number of people now adhering to a gluten free diet in the developed world. Unfortunately, some people do not have a true gluten-related disease or sensitivity, but are adopting a gluten free diet in a fad-like way. This is unfortunate because a gluten free diet can cause its own problems, such as nutritional (in particular, certain vitamins) deficiencies, and a lack of fiber in the diet leading to bowel-related issues.

Given the occurrence of a generalized increase in autoimmune disorders today, the hygiene hypothesis has been offered as a possible explanation, the basic tenet of which is that given increasingly prevalent strict hygienic practices, children today are exposed to fewer pathogens, and as a result can develop autoimmune disorders in which their own immune systems attack self antigens. Given the increasing numbers of people diagnosed with autoimmune disorders, it is hoped that research into celiac disease as well as other autoimmune disorders will lead to improved treatments of and ways to prevent them.

This Grand Rounds presentation was very informational as it allowed us to research a current topic of interest and, in so doing, learn the signs and symptoms that may exist at presentation of a certain disease (in this case, celiac disease), and how that disease may ultimately be diagnosed. As celiac disease is likely to continue to be a relatively common disease in the developed world, I believe this experience will be helpful to me, since I hope to become a physician someday. Being able to present our research to our peers as well as physicians and nurse practitioners, that is, to emulate something a real physician might engage in, was a wonderful experience. Furthermore, my mom, as a physician, talks about attending Grand Rounds Presentations every week at a hospital in New Jersey, and for me to be able to present a case study in the same manner was a fun and great opportunity.

 

 

Tags: Grand Rounds · Human Health

Grand Rounds: Celiac Disease

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

Ari Thomas, Laurel Edington and Danielle Levine

Grand_Rounds_Celiac_Disease powerpoint_pdf

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