Ophtalmology

I've finished my ophtalmology-exam too now. Feels good! Got an A! Yey! It was an oral exam, as usual, and I picked three questions;

1. Examination of refraction
2. Contact lenses
3. Primary glaucoma

Pretty good questions, if you ask me!

It is an interesting subject, but at the same time, quite boring... The professor was really nice, though! He told us about different patient stories, fex a patient who got a cactus in his eyes... Ouch!

He took a picture of my eye, so I'm posting it here for you!

Gastroscopy - not very plesant!!!!

I went to prof. Hyrdel to speak about my diploma thesis; IBD, on wednesday. There are a couple of doctors at the department who are helping me with a questionnaire for patients with Ulcerative Colitis and Crohn's disease, and I went to see how their progression was. Unfortunately they didn't have anything for me then, so I had to come back another day. Just before I left prof. Hyrdel's office, he grabbed my arm and asked me;
'Do you have a Helicobacter pylori infection?'
'Ehmmmm... Not that I know of.. Why?'
There is a rash on my jaw, just under my mouth that never seems to go away, and the professor told me that as many as 90% of patients with a Helicobacter pylori infection have it. He suggested that I should come back on friday (today) and have a gastroscopy - with himself.
Sure, I thought! No problem. A gastroscopy isn't that bad.. At least the ones I had seen weren't that bad...
A friend of mine in the year below wanted to come and see the endoscopy with me, cause she's never seen one before. Ofcourse she could come! It's just nice to have someone there!!!
Today I had it. I knew it was gonna be uncomfortable... But not as bad as it was... It was horrible!!! Once he put it into my esophagys, I couldn't breath. I got some kind of tracheal spasms and ofcourse a massive gag-reflex. I vomited and vomited, and couldn't breath! I almost pulled it out myself, cause of the strangling, but they told me to be calm and try to breath. Thank God my friend was there, cause she calmed me down quite a lot. I managed to breath eventually, but it was like a dog which had just been playing for half an hour... Not very plesant.
The bad thing was not having the fibroscope in my esophagus or stomach. I couldn't really feel that. The bad thing was my epiglottis... Quite horrible, actually.
It was worth it, though! He found out that indeed I had a pyloric inflammation. He took some biopsies + duodenal juice for microbial examination. Most likely it is H. pylori, but I will find out for sure in 2 weeks. One more thing he discovered was a mild GERD. So now, just like my mum and aunt, I have GERD... I haven't really felt it, so it's just a very mild form, thank God. Good thing he found out about that as well, though!

Endometrial carcinoma....

I got some really bad news last week... My mum has got a tumor of her uterus, and from what she said, it sounded like endometrial carcinoma...
Just hearing the word 'cancer' and 'mum' together, makes me shiver... I am really scared of it! I didn't use to be until we had about it at school. I have several family members who have lived with cancer for many years, so I used to think it wasn't that bad... I knew it could be bad, but I guess I put all my trust in the doctors, and think and hope they do their best to cure their patients!
After having oncology at school, my views on cancer started changing... I'm really scared of it, and I hope that my mum will be fine!!!
She hasn't had any biopsy taken yet, so the diagnosis is not definite. Hopefully she will get a scheduled hour pretty soon. I expect her to go through a hysterectomy, and hope she will get that scheduled asap!!!
I love her, and I need her! She has to get well!!!

Pathophysiology exam = B

I had my exam in pathophysiology today. I got a B!!! Yey! Really happy about that!
I had to take a written exam first, and then the oral. In the oral, I got 3 questions;

1. Systemic hypotension and syncope (fainting)
   
2. Pathophysiology of chronic renal insufficiency
3. Mechanisms involved in alteration of endocrine system function

First i wasn't too happy about my questions, cause they are quite big (at least 2 and 3), but as I started preparing, I realized I really knew my stuff. Felt pretty good too.
I don't know how many pages I wrote, but I wrote down a lot!
Feels good to be done with that subject. It's huge, but really interesting. I'm glad I know it pretty well, cause as the professor said; 'It will help you in your further studies.'

Sprains and strains

Sprains

A sprain is an injury to a ligament. Ligament injuries involve a stretching or a

tearing of this tissue.
A sprain typically occurs when people fall and land on an outstretched arm,

land on the side of their foot, or twist a knee with the foot planted well on the

ground. This results in an overstretch or tear of the ligaments supporting that

joint.

Common Types of Sprains

1.
Ancle sprains:

One of the most common injuries in sports and activities. Most ankle sprains

happen when there is an inversion or eversion of the foot. One or more of

the lateral ligaments are injured.

2.

Wrist sprains:

Wrists are often sprained after a fall in which the athlete lands on the hand

when it is outstretched.

Signs and Symptoms of Sprains

· Swelling

· Pain

· Bruising

· Functia laesia (mobility of joint)

Sometimes people feel a pop or tear when the injury happens. These signs and

symptoms can vary in intensity, and it depends on the severity of the sprain.

Sprain Severity

1. Grade I Sprain: A grade I (mild) sprain causes overstretching or slight

tearing of the ligaments with no joint instability. A person with a mild sprain

usually experiences minimal pain, swelling, and little or no functio laesia.

Bruising is absent or small, and the person is usually able to put weight on the

joint.

2. Grade II Sprain: A grade II (moderate) sprain causes partial tear of the

ligament and is characterized by bruising, moderate pain, and swelling.

A person with a moderate sprain has usually some difficulty to put weight on

the affected joint and experiences some funcio laesia. An x-ray or MR may

be needed for diagnosis.

3. Grade III Sprain: A grade III (severe) sprain results in a complete tear or

rupture of the ligament. Pain, swelling, and bruising are usually severe, and the

patient is unable to put weight on the joint. An x-ray is usually taken for

diagnosis and to make sure there is no broken bones. This type of a muscle

sprain often requires immobilization and sometimes surgery. It can also increase

the risk of an athlete having future muscles sprains in the same area.

To diagnose any sprain, the doctor has to ask the patient to explain how the

injury happened. The doctor needs to examine the affected joint, check its

stability and its movement and weight-bearing ability.

Strains

A strain is injury to either a muscle or a tendon. There may be different

severity of the injury; a strain may be a simple overstretch of the muscle

or tendon, or it may be a partial or complete tear.

Common types of strains

1. back strain – when the muscles have

been stiff or poorly maintained. It may also

occur in obese patients.

2. hamstring strain – when the muscles

are used with no warming up, poor flexibility, weak muscles, differences in leg length.

3. tendonitis – usually due to overuse.

Contact sports such as football, hockey, and handball put people at risk for

strains. Gymnastics, tennis, golf, and other sports that need extensive gripping

can increase the risk of hand and forearm strains. Elbow strains can occur in

people who participate in racket sports, throwing, and contact sports.

Signs and Symptoms of Strains

· Pain

· Muscle spasm

· Muscle weakness

· Localized swelling, cramping or inflammation

· Loss of function (severe strain)

Patients have pain in the injured area and general weakness of the muscle

when they attempt to move it. Severe strains that partially or completely

tear the muscle or tendon are usually very painful and also disabling.

Strain Severity
Strains are categorized in a similar manner to sprains:

1. Grade I Strain: This is a mild strain and only some muscle fibers get

damaged. Healing occurs within a couple of weeks.

2. Grade II Strain: This is a moderate strain with more damage to the

muscle fibers, but it is not completely ruptured. Healing occurs within

three to six weeks.

3. Grade III Strain: This is a severe injury with complete rupture of the

muscle. This requires a surgical repair and the healing period can be up

to three months.

Kimmelstiel-Wilson disease (DM)

Mark is writing a presentation for pathology about the Kimmelstiel-Wilson disease now. I wrote about it last year (he's in the year below me), and I was thinking of publishing a bit of what I wrote then on this blog. I haven't written here in some time now, and it's about time to publish something!

Before I public parts of my presentation, I need to say that I wrote it initially in points, so it may be a little hard to read parts of it.

Renal changes in Diabetes Mellitus:

Diabetes mellitus is a group of metabolic disorders sharing the common underlying feature of hyperglycemia (chronic). There is a secondary damage in multiple organ systems; kidneys, eyes, nerves and blood vessels. Long-term complications include development of nephropathy

Renal changes in Diabetes Mellitus include:

1. Glomerulus:

–Kimmelstiel-Wilson disease

2. Renal vessels

–Atherosclerosis

–Arteriolosclerosis

3. Pyelonephritis

–Acute

–Chronic

Renal failure is second only to myocardial infarction as a cause of death from DM.

I will write shortly on Kimmelstiel-Wilson disease.

Kimmelstiel-Wilson disease

Is a nephrotic syndrome and hypertension in diabetics, associated with diabetic glomerulosclerosis.

Alternative names:

–Diabetic nephropathy

–Diabetic/nodular glomerulosclerosis

–Diabetic kidney disease

It is a kidney disease characterized by:

–hypertension (high blood pressure)

–renal lesions

–glomerulonephrosis

–edema

–retinopathy

20-25 % have had DM for several years.

It has a progressive course

Death usually within 2 y. after recognition

It is more frequent in women than in men.

Early detection:

–Thickening of glomerulus’ basement membrane

–Microalbuminuria

Glomerulopathy

Nodular cellular lesions are pathognomonic for the disease

You can also find Kimmelstiel-Wilson lesions, capsular droplets, hyalinization and mesangial expansion.

Features include nephrotic syndrome with proteinuria, hypertension and progressively impaired kidney function. When severe, the disease leads to kidney failiure, end-stage renal disease, need for chronic kidney dialysis or a kidney transplant.

Symptoms:

Early stage has no symptoms.

At later stages symptoms may include:

–Fatigue

–Foamy appearance or excessive frothing of the urine

–Frequent hiccups

–General ill feeling

–Generalized itching

–Headache

–Nausea and vomiting

–Poor appetite

–Swelling of legs

–Swelling, usually around the eyes in the mornings; general body swelling may occur with late-stage disease

–Unintentional weight gain (from fluid build up)

Possible complications include:

–Anemia

–Arteriosclerosis of the renal artery

–Chronic kidney failiure (rapidly gets worse)

–Dialysis complications

–End-stage kidney disease

–Hyperkalemia

–Severe hypertension

–Hypoglycemia

–Infections

–Kidney transplant complications

–Peritonitis (if peritoneal dialysis used)

Yuk

I can't believe it!!!
I've been ill for some days now, with a fever of 39,5'C and a dry cough, and finally I decided to go and see the doctor. My boyfriend came with me and we went to the ER. They sent me further to another department to have a look at my larynx (vocal cords). The doctor who was examining me had desquamations and wounds all over her hands, and she DIDN'T PUT ON GLOVES before examining me!!!! She was in a pretty bad mood, so I didn't dare tell her to put on gloves, but seriously; that was creepy!

They are waaay too bad at using gloves here in Slovakia. I have to give credit to one department, though; the dermatology-department. So it's not all bad, but still bad enough...

These are pictures of something similar to how her hands looked like. I think she had psoriasis, but I'm not 100% sure.


I'm sure she would've used gloves if it was something contageous, but still;
I think everyone should use gloves in medicine.


So to every doctor and nurse out there; use gloves!

The reason why doctors and other medical professionals wear latex gloves is to protect the patient and themselves from infectious matter.