I don't know how my life is different from that of one in jail. At work I work like a dog, I eat and sleep in the same place, my hostel room is a cramped single room, and I share the bathroom/toilet with at least 13 other people. I can't go anywhere at will because I am forced to come back in a matter of hours for work. Sometimes I don't even get to sleep at night.
The food is really terrible and the hotels nearby are pretty bad too. You can't be seen having fun or laughing as that would indicate to others (including my potential employers) that I take work far too lightly. Since this is a close-knit walled "community" (they like to be called that) everybody know what the other person is doing. And finally I don't have a place to complain to about my living quarters food or timings because no one has the time for that anyway.
I don't want to stay in this place much longer but I don't have much choice. Its very difficult to get into a PG course right now and CMC is the only place where I stand a chance, since I've worked here a while. I don't know many people here and that will definitely go against me since you need people; for company as well as to bail you out in times of need.
What a useless profession! For a few individuals being a doctor is very very lucrative but in general, I think its unrewarding and miserable.
By the way I didn't even mention the pittance of a salary.
Thursday, August 19, 2010
Thursday, July 22, 2010
Charcot's triad (Cholangitis)
For a long time, I had trouble remembering this.
Charcot's Triad, seen in Acute Cholangitis, consists of:
Charcot's Triad, seen in Acute Cholangitis, consists of:
- Fever
- Pain
- Jaundice
If the following two conditions are added, you get Reynold's Pentad which is indicative of Septic Shock in the setting of Acute Cholangitis.
- Shock
- Mental Obtunation
Treat with Fluids, Antibiotics and Emergency Biliary Decompression! The latter can be done with ERCP, Percutaneously or via T Tube Decompression.
Appendix positions
Simple and oft asked question.
Most common: Retroceacal
Other positions: Pelvic, Pre Ileal, Post Ileal, Paracecal.
Most common: Retroceacal
Other positions: Pelvic, Pre Ileal, Post Ileal, Paracecal.
Monday, April 19, 2010
Rants
Why am I forced to study like a dog for my PG Seat? Why does it have to be so competitive? I am competent at surgical diagnosis, decision making and am fairly dexterous in the OR. Why should I be studying Internal Medicine and OG and for God sake Biochemistry?
I am wasting my youth studying. I could have been so much useful doing research and clinical trials related to my field, instead, I am supposed to mug up pelvic diameters and Glycolysis pathways.
Fuck it, I HATE Medicine because of the way it is practiced and I am doing this only for my parents sake. India will never have a decent health program because its doctors are made to stagnate.
I am wasting my youth studying. I could have been so much useful doing research and clinical trials related to my field, instead, I am supposed to mug up pelvic diameters and Glycolysis pathways.
Fuck it, I HATE Medicine because of the way it is practiced and I am doing this only for my parents sake. India will never have a decent health program because its doctors are made to stagnate.
Dumping Syndrome
Well I'm guilty of not posting enough.. I guess its too early for someone to come by visiting the site and commenting, etc..
Dumping Syndrome is a complication of stomach-shortening procedures, commonly used for surgicat management of peptic ulcer disease. It is seen after Vagotomy + Antrectomy (V+A) and Vagotomy + GastroJejunostomy (i.e. V+D where D is for Drainage)
What happens is that the gastric contents get pushed into the Small Intestine faster than usual. So you have a lot of hyperosmolar contents in the Small Intestine and also a huge load of carbohydrate rich material.
There are two types of Dumping Syndrome: Early and Late.
Early Dumping Syndrome is when this hyperosmolar load will cause acute symptoms due to intestinal congestion. A lot of blood is diverted into the mesentric and splanchic vessels and that leads to some abdominal discomfort, headache, dizziness, palpitations (last three due to shock like symptoms), and even diarrhoea.
Late Dumping Syndrome: This is due to reactive hyperglycemia when the large carb load in the Small Intestine leads to hyperinsulinemia; but this further causes hypoglycemia because excess insulin is released
Treatment is Dietary Management. Tell the patient to eat shorter meals, foods rich in protein and fat but less of carbs, and not to drink water while consuming food (so that osmolarity is low).
If these fail, then Octreotide (Somatostatin Analouge) can be given. Acts by Splanchic Vasconstriction, and decreasing intestinal and gastric transit time. It will also inhibit Insulin release. Acarbose will help in decreasing Carbohydrate absorption.
Surgical Management includes:
Dumping Syndrome is a complication of stomach-shortening procedures, commonly used for surgicat management of peptic ulcer disease. It is seen after Vagotomy + Antrectomy (V+A) and Vagotomy + GastroJejunostomy (i.e. V+D where D is for Drainage)
What happens is that the gastric contents get pushed into the Small Intestine faster than usual. So you have a lot of hyperosmolar contents in the Small Intestine and also a huge load of carbohydrate rich material.
There are two types of Dumping Syndrome: Early and Late.
Early Dumping Syndrome is when this hyperosmolar load will cause acute symptoms due to intestinal congestion. A lot of blood is diverted into the mesentric and splanchic vessels and that leads to some abdominal discomfort, headache, dizziness, palpitations (last three due to shock like symptoms), and even diarrhoea.
Late Dumping Syndrome: This is due to reactive hyperglycemia when the large carb load in the Small Intestine leads to hyperinsulinemia; but this further causes hypoglycemia because excess insulin is released
Treatment is Dietary Management. Tell the patient to eat shorter meals, foods rich in protein and fat but less of carbs, and not to drink water while consuming food (so that osmolarity is low).
If these fail, then Octreotide (Somatostatin Analouge) can be given. Acts by Splanchic Vasconstriction, and decreasing intestinal and gastric transit time. It will also inhibit Insulin release. Acarbose will help in decreasing Carbohydrate absorption.
Surgical Management includes:
- Pyloric reconstruction
- Anastomosis of a 10cm intestinal segment between Pylorus and Duodenum
- Roux En Y Gastrojejunostomy
- Conversion of Bilroth II to Bilroth I
Thursday, March 25, 2010
Thyroid: Facts to remember
Most common thyroid malignancy : Papillary CA
Orphan Annie-eyed Nuclei: Seen in Papillary CA
Hurthle Cell CA:
Orphan Annie-eyed Nuclei: Seen in Papillary CA
Hurthle Cell CA:
- Subtype of Follicular
- More invasive, frequent bone mets
- Abundant mitochondria in cytoplasm therefore an eosinophilic appearance
FNAC cannot distinguish between Follicular Adenoma and Carcinoma as this distinction is based on histological changes like capsular and vascular invasion.
Papillary: mainly lymph nodal metastasis
Follicular: mainly blood vessel metastasis
Follicular: mainly blood vessel metastasis
Medullary: mainly lymph nodal metastasis
Chances for multiple foci and bilateral tumors more in Papillary than Follicular
Tumor Markers:
Papillary, Follicular: Thryoglobulin
Medullary: Calcitonin
Aberrant Thyroid tissue (lingual/cervical/intra-thoracic) never occurs in lateral position unless it is a malignancy.
Papillary CA most commonly associated with lateral aberrant thyroid tissue.
MEN Syndrome:
MEN 1
Pitutary Adenoma/Hyperplasia
Parathyroid Adenoma/Hyperplasia
Pancreatic islet cell hyperplasia/adenoma/carcinoma (Neuroendocrine tumors, viz. gastrinoma, insulinoma, etc.)
Les common: foregut carcinoid, pheochromocytoma, lipomas
MEN 2A
Medullary Carcinoma: Thyroid
Pheochromocytoma
Parathyroid Adenoma/Hyperplpasia
Hirschsprung's Disease
Cutaneous Litchen Amyloidosis
MEN 2B
Medullary Carcinoma: Thyroid
Pheochromocytoma
Marfanoid features
Mucocutaneous and GI neuromas
Pulsatile mets are seen in Follicular Thyroid Carcinoma and Renal Cell Carcinoma
On FNAC, if Hurthle Cells are seen along with lymphocytes, it's characteristic of Hashimotos.
Blood Supply of thyroid:
- Superior Thyroid Artery
- Infereior thyroid Artery
- Accesory Thyroid Artery
- Thyroide Ima Artery
STA comes from ECA, Related to External Laryneal Nerve
ITA from Thyrocervical Trunk, from Subclavian Artery. Related to RLN. Supplies parathyroids also.
ATA from tracheal and esophageal arteries
Ima arises from the brachiocephalic trunk or directly from arch of aorta.
Veins:
- Superior Thyroid Vein
- Middle thyroid Vein
- Inferior Thyroid Vein
- Kocher's Vein
ITV drains nto left brachiocephalic vein.
The rest drain into IJV, not EJV
STV may also drain into common facial vein.
Wednesday, March 24, 2010
What I'm doing currently
Well, this post is about my study plans. I'm going to do a thorough read of Das's Surgical Short Cases (the only copy I could manage to get my hands on was this 1991 First Edition, in surprisingly pristine condition).
At the same time I hope to go through Bailey & Love and Sabiston as well. I hope that by the end of this month I should be finished with one reading of Short Cases. I also plan to do some mcq's side by side and maybe I'll finish Surgery wholly by mid-April.
What I'm really worried about are the other subjects I need to study. Who the fuck will want to read Biochemistry and Physiology at this stage of their lives? I don't know if I'll succeed this time.
At the same time I hope to go through Bailey & Love and Sabiston as well. I hope that by the end of this month I should be finished with one reading of Short Cases. I also plan to do some mcq's side by side and maybe I'll finish Surgery wholly by mid-April.
What I'm really worried about are the other subjects I need to study. Who the fuck will want to read Biochemistry and Physiology at this stage of their lives? I don't know if I'll succeed this time.
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