Of Colonoscopies and Sleep Deficit

Another week of Medical School is done. In attempt to stay awake at some point this week I found a website that figured out how many weeks it is until I graduate, presuming I survive that long. It is almost a bit scary. Our course is 145 weeks long, the last 54 weeks are clerkship, we have 8 weeks of holidays and 83 weeks of instruction. Thus, having completed four weeks we have 79 weeks of instruction remaining to learn all that we need to know before we begin our clerkship. Time is such a precious commodity and it is slipping away so quickly. It feels like we just started class the other day but I've now been here for a month and I'm certain that the next 141 weeks are going to go at the same rate and I will be finished.

I've observed that I'm not a very good time manager and one of my biggest challenges is going to bed at night. This is partly a result of daytime procrastination and partly a result of the fact that I'm a night owl. The problem is that we had classes or activities of some description at 8:30 every day this week. That really cut down on my sleep in time and it made it a bit challenging to take anything away from lectures when I was functioning on not enough sleep. I'm quite fortunate though - almost all of the lectures in this course are podcast - they are recorded during the lecture and then uploaded to iTunes where we can download them. Thus, while I write this I am multi-tasking by listening to a lecture about alcoholic hepatitis and non-alcoholic fatty liver disease. This is the second time I've listened to it and hopefully by the time it is finished I'll have got the majority of important points from it.

There are two new words that I'm quite partial to. The first is asterixis - it is a symptom of hepatic encephalopathy and refers to a characteristic tremor of the hand when it is extended. The second is a phrase - scleral icterus and refers to yellow eyes (rather the 'white' of the eye) which is characteristic of jaundice.

Today we watched two colonoscopies. We were in a small theatre in the screening clinic and we watched the procedure via a live video feed. The colonoscopist was miked so she 'walked' us through the colon and a polypectomy. It was pretty cool! We've learned quite a bit about the large intestine but to see it in living colour with the healthy, vascularized, pink colon wall was fabulous. There was a small polyp we watched get burnt off as well so it was fascinating. It is amazing what you can do with technology today. It was also fascinating to see the variation between the lining of the terminal ileum which is lumpy from lymphoid tissue and has a carpet of columnar epithelium that looks like 'shag carpeting' compared to the smooth pink squamous epithelium of the large intestine. The border is very distinct. I've found it quite interesting how precise the borders in the body are. There are visible lines between different tissues at places like the gastro-esophogeal junction at the ileocecal junction and elsewhere. Another rather nifty thing was retroflexion. This is when the colonoscopist turns the tip of the colonoscope back 180 degrees on itself. This allowed the colonoscopist to view the rectal-anal junction (an important spot to check for pre-cancerous polyps) and you could see the scope being squeezed by the anal spincter. The same procedure can be performed during an endoscopy to examine the fundus or top of the stomach and the gastro-esophogeal junction where the esophagus and stomach join.

Anyways, I'm off to a bonfire and a nice sleep in tomorrow. I need to listen to some more lectures and by Monday morning I'm going to know a lot more about Hepatits, Gall Stones, and Liver tests but for now it is Friday night and I'm off.