2day woke up at around 9am, shit, going to be late, luckily could make it on time before Dr. Lim came to the office, haha. Was with Dr. Lim the whole morning. Saw colonoscopy and gastroscopy.Colonoscopy found a polyp and diverticuli. Gastroscopy discovered an erosion near the pylorus end and some abnormal mucosal (suspect of Helicobacter pylori but the urea test was negative), acid reflux into lower part of esophagus causing some inflammation.This is the first time for me to see gastroscopy.Putting endoscope from the mouth is really torturing, have to swallow the endoscope and cannot have any vomiting reflex. Hmm...so how long is the rectum?? 6 inches...what other structures are 6 inches? Well, duodenum, ureter and even an erect penis.Remember, diverticuli are always adjacent to the taenia, because it is the place where the blood vessels going into the mucosal layer, so that's the weakest point and is prone to Diverticuli (Outpouching of the gutwall). What is the complication of diverticular disease? Hmm...start from the most important 1 first- Diverticulitis, then bleeding and then perforation. Treatment-high fibre intake to soften the stools, antispamodic(anticholinergic) drugs to relax the smooth muscle of the gutwall. There are 2 types of diverticuli-left and right. Sites prone to it is cecum (in Asia) and sigmoid colon(in UK/US??). Risk of inflammation is higher for the left diverticular disease because of the harden stool instead of watery stool which can cause blockage and inflammation. Well, we also were asked about left and right vagus nerves, muscarinic and nicotinic receptors. Saw 2 surgeries today. First surgery is ORIF (Open Reduction Open Fixation) of the right humerus and biopsy.Open reduction internal fixation is a method of surgically repairing a fractured bone. Generally, this involves either the use of plates and screws or an intramedullary (IM) rod to stabilize the bone.It was done by an orthopedic surgeon-Dr. Francis Ting. Second surgery is a heart surgery. It is to close up an ASD (Atrial Septal Defect) on a young man. We missed the cutting open the sternum part, but can saw the pericardium, heart was pounding, cool!!There were a lot of blood pumped out into the machine.Traditionally,Coronary artery bypass graft (CABG) surgery is performed with the assistance of cardiopulmonary bypass (Bypass machine, formerly known as heart-lung machine). The heart-lung machine allows the hearts beating to be stopped, so the surgeon can operate on a surface which is blood-free and still. The heart-lung machine maintains life despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.
Lesson of the day:
Dr. Lim (General Surgeon) & Dr. Francis Ting (Orthopedic Surgeon) said:
ANATOMY is very important!! We suck in anatomy because our teaching system is different from others. We learnt by system so there will be missing gaps in our knowledge of anatomy.As a surgeon, you really need to know the anatomy well so not to injure any vessels or nerves around the part you are going to operate on...
p/s: Sunny Hill Ice-cream, yummy!!
As time flies, as people changed,this is the only place to keep the memories still..."http://ickesangelo.blogspot.com"
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