Debate Chamber Medicine Course – day two

We started the day learning how to intelligently guess what some medical conditions are from their names including dysphagia (dys = painful and phagia = engulf) meaning painful swelling, haematemesis (haem = blood and emesis = vomit) meaning vomiting blood, angular stomatatis (stoma = opening) meaning inflammation in the corners of the mouth, and tenesmus (tene = to hold) meaning feeling a constant need to empty the bowels.

We then went on to learn about gastroenterology. Symptoms that may show signs of a bowel condition include acid reflux, bloating, blood/mucus in faeces, increased wind, vomiting, constipation, weight loss, loose stool, hard stomach, nausea and tenesmus.

I learned how to take a patient history including finding out what is happening, what is the next plan, past medical history and family’s medical history, past and current medication, allergies, lifestyle factors, the patient’s concerns and any other relevant information. It is important to decide whether the condition is benign or pathological and chronic or acute.

In deciding treatment the following three things are considered: conservative treatment, medical treatment and surgical removal or repair.

Some common reasons for blood in the faeces or vomit include ulcers, Mallory-Weiss tear from force of vomiting, ruptured oesophagus, and dilation of veins surrounding the gut due to portal hypertension.

We also learned about clubbing of the fingers, Dupuytren’s contracture, Spider Naevil (due to build up of oestrogen), Gynaecomastia (from failure of breaking down oestrogen), Hepatomegaly (enlarged liver), Fibrosis and Cirrhosis, and IBD including Ulcerative Collitis and Crohn’s disease.

Mechanisms that can take place in a person with liver failure include fluid secreted into peritoneum presenting as a swollen belly, jaundice, coagulopathy (replacement of clotting factors lost through heavy blood loss), and a build up of ammonia in the central nervous system interrupting neurones. Symptoms of alcoholism following withdrawal include crawling skin, Delirium Tremens, seizures and hallucinations. The risk of these conditions developing is very high and therefore doctors do not recommend quitting alcohol altogether when attempting to overcome addiction. Furthermore, an interesting problem with alcoholism is that alcohol may interact with the liver and prevent enzymes being released to break down certain medications including Warfarin which is a blood thinner. If Warfarin is not broken down, the blood will become thinner until there is continual bleeding. This effect can be reversed by taking Vitamin K.

In the afternoon we learned some pharmacology including methods of administering drugs, how to assess consciousness and learning why some people fail to take their medications.

Methods of administering drugs include intravenously, orally, enema, inhaling, sublingually, through a central line, topically, by intraosseous infusion, intramuscularly and subcutaneously. The route of administration is chosen depending on time, efficiency, patient choice, location of problem, expertise of the healthcare professional, bioavailability and practicality. Positives of oral administration include its practicality and ease, however it is indirect and may take lots of time to reach the affected area. Intravenous administration can be a problem as lots of people, particularly children, are terrified of needles and there is a high risk of infection. On the other hand the drugs injected acts immediately for faster relief. Inhaling is very good for immediate lung relief, whilst intraosseous infusions have a very high infection risk, a long recovery period is needed and they are very expensive.

I learned that NICE decides which treatments are made available on prescription on the NHS. However, it is not illegal for a doctor to prescribe unlicensed drugs.

To assess consciousness of a patient, we use AVPU; alertness, voice, pain, unresponsive. It is necessary to do this to decide what immediate care must be given.

Reasons for patients’ poor compliance with medical guidelines include laziness of the patient, ethical opinions, wanting to cut down number of medications, the process can be painful, fear of the medication being painful or addictive, forget to take it, a poor patient-doctor relationship leading to the patient not trusting their doctor, denial of having the condition, worrying side-effects or long waiting times.

 

Emily Buchanan

 

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