March 8, 2014

seriously loving surgery.

I must say, I've really loved and enjoyed this rotation and am so so sad that my last week is just around the corner! Since my last update, we added 3 new medical students, lost 1 intern, and gained 2 interns. So we are probably one of the largest services right now, with 12 people (counting the attendings). It's funny because all of the other services look at us when we walk by and comment on how huge our team is. I really have enjoyed working with GI surgery and am thankful for how great everyone on the team is. Honestly, everyone is sooo much nicer than I thought they would be!

As for as surgeries go, we've had some pretty interesting cases! One of our patients had a huge abdominal mass that we resected. It probably weighed close to 10 pounds! It was so cool, but the mass has a high risk for malignancy, so that's not so cool for the patient. Another patient presented with some symptoms of bowel obstruction that was thought to be due to an ileus or hernia. When we got into his abdomen, we were shocked to find out that he actually had a fairly large mass that turned out to be lymphoma. Um, we had 1 woman with metastatic colon cancer that underwent tumor debulking, omental resection, and HIPEC (hyperthermic intraperitoneal chemoperfusion). HIPEC is a type of chemotherapy in which the drug is directly exposed to abdominal cavity. It consists of filling the persons abdomen up with the drug, heating it up, and then cycling it through the cavity for 100 minutes. It was pretty cool. Oh, and we had 1 patient with a rectal stump that we prolapsed (outside of the abdomen) and cut off. That was pretty interesting. The rest of the cases have consisted mostly of bowel resections, ileostomies, cholecystectomies, and some others. You may or may not have noticed this, but a lot of the cases we see are related to cancer. My preceptor does a lot of oncological GI surgery, so it's sad to see some of these patients, but also pretty awesome to see these surgeries and how they can drastically change the course of the disease.

We also see a lot of patients with Crohn's and Ulcerative colitis, as well as nonsurgical patients like this one guy with an enterocutaneous fistula. Basically part of this guys colon fused with his skin and formed an opening on his abdomen. So most, if not all, of the food he eats moves through a small portion of his small bowel then drains out of this fistula. Right now he has a bag that fits over it for the contents to drain into, but eventually he will need surgery once the defect gets smaller.

Coming up this week: Gastrectomy, possibly another HIPEC, pancreatic debridement, and maybe a Whipple, plus a bunch of other smaller procedures. So it will be a very busy week, no doubt! And I  hope we have a few lap choles, because for some reason I absolutely love them (classmates, laugh all you want).

So yea, surgery has been great and I'm sad to almost be done. I love seeing these interesting cases, being in the OR, and working with my amazing team. And honestly, I don't mind getting up at 3:30AM, making the patient list at 5AM, rounding at 6AM, and being in the OR sometimes as late as 7PM. I love everything about GI surgery so far and I have to say that this has been one of my favorite rotations. It will surely be better than internal medicine, which I have next:(

This may or may not be my last surgery update, but I'll be sure to write again if anything really interesting happens!

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