Human Anatomy at Colby

Laurel Edington: MMSA Mentoring Session

February 24th, 2015 · Comments Off on Laurel Edington: MMSA Mentoring Session

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One of my favorite parts of this month was mentoring high school students involved in the Maine Math and Science Alliance. Each grand rounds group was paired with two high school students. The two girls my group worked with were named Shea-Lynn and Cierra. Shea is a home-schooled junior and Cierra is a sophomore at Dover-Foxcroft. The plan for the day was to show them around the lab, talk to them about anatomy and physiology, and help them come up with ideas for a science fair project.

Before the students arrived, we took our second lab practical and then walked around talking about the answers to the exam so that we could show the high school students what we have been learning over the past week.

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IMG_5584            When they arrived and we were in our groups, we went through the entire exam with them. We all looked at the models and slides, explained the answers to each question, and explained the functions of each anatomical structure. This was great because it reinforced the material. Over the past few days I had been trying to memorize all of the structures of the neurons/spinal cord/brain, eyes and ears, and the cardiovascular system. By explaining the structures and functions to Shea and Cierra, it helped me to learn and understand the material even more.

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After the lab tour, each group dissected another pig heart since there were some hearts left over from the week before. I was really excited that I was able to be involved in a dissection on this day because I wasn’t able to be in class when we did the dissections the week before. Shea and Cierra, although a little timid at first, dove right in and were able to find the aortic and pulmonary valves very quickly. They did the of the dissection while we instructed and did a little demonstrating.

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The last part of the day (after a quick lunch break) was used to help the students come up with topics for science fair projects based on anatomy and physiology. Cierra’s family owns a farm with over 50 beef cows so she wanted to do a project based on livestock. Together, we all came up with the idea of seeing how different types of food affect the growth of the cows. If she did this project, she was thinking of finding the mass and other size measurements for the cows of different ages and comparing the measurements between the cows that were fed hay and the cows that were fed grain. Shea was interested in determining if different emotions caused changes in blood pressure and heart rate. We talked about having people watch different videos that would cause them to experience different emotions and then she would take heart rate and blood pressure measurements before and after the videos to detect any changes. This day was very rewarding because we were able to reinforce what we have been learning, help high school students become excited about science, and we were able to have a great time.

 

 

Tags: MMSA Mentoring Session · Special Activities

Laurel Edington: My Experience in Bi265j

February 23rd, 2015 · Comments Off on Laurel Edington: My Experience in Bi265j

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This January, I was given the opportunity to take the Introduction to Human Anatomy and Physiology janplan class. I’m a senior biology major and have finished all of my major requirements so I didn’t need to take this class, but I’m interested in the material and figured that it would be helpful to be at least familiar with human A&P when I’m eventually in medical school.

During the first week of class, I thought that the workload was too much and I considered dropping the class. Throughout this week, Dr. Klepach kept reinforcing that the first week was the hardest and that he really just wanted us to learn how to deal with a heavy workload and learn the material while still eating three meals a day, working out each week, getting eight hours of sleep each night, and keeping our stress level low. At first, I thought this was insane. How was I possibly supposed to learn all of these bones and muscles and not be stressed?! However, throughout the month, I realized that this was possible. The way the class was set up allowed work to be spread out so that we continued to reinforce the material through quizzes and preparing for lecture and class. By doing this, studying for a bigger exam or working on a bigger project ended up not being as stressful or time consuming as I imagined it would be.

The following weeks were still intense but were more manageable. Although we had quizzes before most lectures, another lab practical, a grand rounds presentation, and a few lab assignments left, Dr. Klepach’s advice of studying to learn the material and not for the grade really helped to make the class less daunting. As a premed student, I’m used to focusing only on the grades I receive and my GPA, but this class made me focus on actually knowing the material. Out of all of the classes I’ve taken at Colby, I’ve learned the most in this class. I don’t think this is because of the sheer amount of material thrown at us and if only a little stuck with us, it would be more information than some classes teach in a semester, but rather that I was actually working to learn the information and not just studying so that I could remember the material only in order to do well on the next test.

I highly recommend this class. I think it’s a great class for any premed student, any biology major, as well as any student who is just interested in anatomy and physiology. We were given so many interesting opportunities that no other class really offers. I can’t think of another biology class that performs any sort of dissection, that teaches the important skill of giving a grand rounds presentation, or that has lectures from specialists such as Dr. Zak Nashed and Dr. Peter Millard. During this month, we learned so much and we only just scratched the surface. I found this class so fascinating and wish that it could have been a semester long, or even a year long, course.

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Tags: Bi265j

Laurel Edington: Grand Rounds – Celiac Disease

February 23rd, 2015 · Comments Off on Laurel Edington: Grand Rounds – Celiac Disease

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During the last week of class, we presented our grand rounds talks that we’ve been working on all semester. This was a great experience because it allowed us to practice giving a grand rounds lecture, which is a common presentation in the medical community. Each group of three picked a topic, which could be a case study or an overview of a disease or medical treatment, and then presented as if they were doctors talking about an interesting patient, new procedure that they’re performing, etc.

This year, the weather didn’t exactly cooperate with us. We were supposed to have a practice session during class on Tuesday and then go to Augusta to present our talks along with Kents Hill students at Maine General. Because of the snow day and horrible driving conditions, neither of these events happened and we had to present our final product with little group practice. Thankfully, my group was able to practice together before the weather was too bad, but practicing during class and at Maine General would have been helpful.

My group decided to present a case study on a 42 year old man with chest and abdominal pain. We found this study through the New England Journal of Medicine and it was used as a hugely teaching moment instead of a typical grand rounds talk. In this case study, the man’s symptoms were textbook for celiac disease but physicians performed a number of tests, including an invasive and non-diagnostic procedure, before even thinking of the possibility of celiac disease. This case study was not used to teach medical students and medical professionals about a rare disease or an interesting case, it was used to enforce the fact that celiac disease is becoming increasingly common and physicians need to be aware of it and perform the simple diagnostic blood test for the disease when a patient comes in presenting characteristic symptoms.

Through this presentation, we learned the difference between celiac disease and non-celiac gluten sensitivity. With celiac disease, there is damage to the intestines and an IgA tissue transglutaminase and IgA endomysial antibody tests can be performed to diagnose the condition, this is not the case with a gluten sensitivity. Both conditions, however, are treated with a strict gluten-free diet. This is becoming a popular new diet in people who don’t suffer from celiac disease or non-celiac gluten sensitivity. People who are using this fad diet and who don’t have celiac disease or a gluten intolerance are at risk for developing new gastrointestingal problems.

This project was a great way to expose us to this sort of presentation since the majority of the class is interested in the medical profession and grand rounds are a common occurrence. This was an especially interesting experience because we were able to present in front of nurses and doctors, which made the experience that much more real. It also reinforced the material we had learned throughout the class because we had to explain the disease based on the anatomy and physiology. I’ve been to multiple grand rounds during my summer internships and I never thought that I would be able to understand a case as well as those doctors, but this experience showed me that I am more than capable and therefore, was an awesome experience.

Tags: Grand Rounds

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