Closed Case Friday: Intestinal Issues

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical 57-year-old patient has been experiencing pain in the lower left side of his abdomen and has had a persistent fever for several days. He is constipated and has been feeling nauseous, but has only actually vomited once this week. Our patient has been a smoker most of his life and his BMI is 35. He reports having a diet that is high in red meat and dairy and low in fiber and he does not recall the last time that he engaged in any vigorous exercise. He reports using Advil frequently to relieve joint pain. After conducting a physical examination, his physician orders a liver enzyme test and CT scan. The liver enzyme test is normal, but the CT scan confirms the physician's suspected diagnosis. The physician tells the patient to move to a liquid diet for a few days before gradually introducing solid foods. They have a conversation about gradually improving diet and exercise habits to avoid further complications that could require surgical intervention. She recommends that the patient stop taking Advil and use Tylenol as needed to manage pain.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Diverticulitis

In our hypothetical situation, the physician would have seen evidence of an uncomplicated form of diverticulitis on the CT scan that she ordered, which led her to create the treatment plan described above. Diverticulitis is caused by the inflammation of diverticula, which are small, bulging pouches that can form in the lining of the intestines. These often form in the lower parts of the intestines (such as the colon). Diverticula are common in patients over the age of 40 and don't cause problems unless they become inflamed. If they do become inflamed, patients experience severe abdominal pain, typically on the lower left side of the abdomen (though it is more commonly felt on the lower right side in Asian patients), along with fever, nausea, constipation, and sometimes vomiting.

Mild cases of diverticulitis are typically treated with rest, temporary movement to a liquid diet to allow the intestines to heal before gradually increasing solid food intake, and changes in regular diet and exercise habits. These cases can be accompanied by infection, which may additionally require antibiotic treatment.

In complicated cases of diverticulitis, infections can progress to abscesses or peritonitis, scarring can lead to intestinal blockage, or fistulas can form between sections of bowel. The severity of those kinds of complications can require intravenous antibiotics, draining of abscesses, or surgical interventions, which involve either primary bowel resection or a resection with colostomy.

This condition can be prevented by managing diet and exercise to lower the risk of developing diverticula. Regular exercise, eating enough fiber, refraining from smoking, and drinking enough water can all help to lower your risk of developing diverticulitis.

Thanks for joining us for this week's Mystery Case and we hope to see you next semester!

2018 Fall Semester WALC Winner!

The moment that we have all been waiting for....

The Fall 2018 WALC Champion is:
Danielle Theis!

Danielle's cumulative score for the semester was an impressive 82.5 after collecting 28.5 points over the course of the semester and then picking up a solid 54 points during redemption week. Her feat has earned her a free t-shirt and a place on the Pre-Health Pathways Office's WALC of Fame.

Congratulations on winning this semester's WALC!

Thanks to all of the students who participated in WALC this semester! You can check out the semester rankings on our WALC Leaderboard page. Join us again next fall to compete for fame and glory (as well as for free candy and t-shirts).

See you again next fall!

FHSP Fundraiser TONIGHT!

Mystery Case Monday: Intestinal Issues

Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.

This week's hypothetical 57-year-old patient has been experiencing pain in the lower left side of his abdomen and has had a persistent fever for several days. He is constipated and has been feeling nauseous, but has only actually vomited once this week. Our patient has been a smoker most of his life and his BMI is 35. He reports having a diet that is high in red meat and dairy and low in fiber and he does not recall the last time that he engaged in any vigorous exercise. He reports using Advil frequently to relieve joint pain. After conducting a physical examination, his physician orders a liver enzyme test and CT scan. The liver enzyme test is normal, but the CT scan confirms the physician's suspected diagnosis. The physician tells the patient to move to a liquid diet for a few days before gradually introducing solid foods. They have a conversation about gradually improving diet and exercise habits to avoid further complications that could require surgical intervention. She recommends that the patient stop taking Advil and use Tylenol as needed to manage pain.

Thought Questions:

What is the most likely diagnosis for this patient?

What causes this condition? How is it prevented?

What are the anatomical structures involved in this clinical issue?

What kind of surgical intervention would be needed if this condition progressed?

Leave your comments below and check back on Friday to see how our hypothetical patient was diagnosed!

U.S. Army Suture Lab & HPSP Information Session

Students show their sutured pigs' feet.
From left to right: Gabrielle Smith, Kaitlyn Dickinson, Alexia Hodgson, Kaelyn Kaul, Jordan Fostvedt, Kathryn Weyeneth, & Colin Jones.

Last night, seven of our SD Mines students gathered in the Chemical & Biological Engineering and Chemistry building to learn basic suturing from U.S. Army Health Care Recruiter, Sgt. Christopher L. Sturdevant.

Sergeant Sturdevant demonstrated the most fundamental technique for suturing as the students gathered around. Next, the students were given pieces of pigs' feet that had been cut to simulate a wound. They were then given sutures and allowed to practice suturing the "wound" using what they had just learned from the demonstration. Because of the small group size, students were able to ask questions and interact with Sgt. Sturdevant throughout the suture lab. A few of the students even got to experiment with using sutures with needles of different sizes and strings of different widths and made of different materials.

After the suture lab, students cleaned up before walking upstairs to enjoy free pizza and learn a little more about the Health Professions Scholarship Program (HPSP) that is offered by the U.S. Army for those interested in health professions. The HPSP offers many benefits for students, the most attractive of which is a full-ride scholarship through medical school. Medical schools cost students an average of $200,000 in tuition over four years. Students who earn the HPSP have their tuition and books covered by the U.S. Army (along with a generous living stipend of $2,000+/month) in exchange for a 4+ year commitment to practice in an Army facility after completing your training. There is also a $20,000 sign-on bonus for the program that is paid out over three years while you are in a medical program. While in residency and during the "payback" period, HPSP scholars do not have to purchase their own malpractice insurance as they are covered by the U.S. Army.

To learn more about the HPSP, you can go to https://www.goarmy.com/amedd.html.

RCRH Pre-Shadowing Tour

SDSM&T students who took a pre-shadowing tour at RCRH.
Left to Right: Kaelyn Kaul, Danielle Theis, Alexia Hodgson, Kaylee Wilson, & Kelcy Bentley.

Last week, several SD Mines students gathered near the coffee shop in Rapid City Regional Hospital in anticipation of beginning a pre-shadowing tour of the facility. Preliminary paperwork in hand, they chatted about the kinds of shadowing that they hope to do over the next few months. They were greeted by Holly Perli at 3:30pm and shortly thereafter began their tour.

The group walked through the many hallways asking questions about protocols, equipment, and patient care practices. Health care professionals bustled around in scrubs and lab coats carrying medical supplies and charts between rooms as we continued the tour.

The students were impressed with the quality of the facilities on the various floors and one could feel their excitement about future shadowing grow with each step. Holly enthusiastically answered students' questions as we continued along our journey making stops here and there to look intently at all of the interesting the things around us.

After the tour, our group stood near the entrance for a few minutes discussing what we had seen and what students hoped to do in terms of shadowing at RCRH in the future. It was an exciting introduction to what will be fantastic experiences for each of these students in the coming months!

Obligatory pre-shadowing tour selfie!

If you are interested in shadowing at RCRH or other health care institutions in town, be sure to contact Dr. J and set up an appointment!

Closed Case Friday: Problems in the Pond

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical patient has an itchy rash on her ankles and the lower parts of  both of her legs. Last night, she has been swimming in a pond on her family's property. On the way back home after swimming, she first felt the itch and noticed the rash, but it went away after an hour or so. This morning, both the itch and the rash had returned and the rash looked (and felt) much worse than it had last night. After speaking with her physician, she went home with a corticosteroid cream and planned to avoid swimming in the pond again.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Cercarial Dermatitis ("Swimmer's Itch")

Cercarial dermatitis, a.k.a. "swimmer's itch", is caused by the cercarial stages of parasitic worms burrowing into accidental human hosts and dying within the skin rather than being able to effectively infect human hosts. As these little worms die, they cause the characteristic itchy rash that we saw in our hypothetical patient. This rash can last up to several days, so it is important to help patients avoid scratching to prevent secondary skin infections. The worms that cause cercarial dermatitis are searching for water fowl or other aquatic vertebrate hosts when they accidentally infect humans. The typical life cycle for these parasites begins with eggs being deposited into the water along with feces of a definitive host, such as a duck. The eggs hatch into miracidia and swim through the water until they can infect a suitable intermediate host, such as a snail. After growing and changing inside of the snail, the worms exit their snail host as cercariae, which then seek out definitive hosts, like our duck, to complete the life cycle. It is in this last stage that the cercariae might accidentally make their way into a human host swimming or wading in contaminated water.

While there is no specific diagnostic test for cercarial dermatitis, knowing a little about a patient's history can help distinguish this from other rashes. For example, knowing that our patient's rash began shortly after swimming in a pond, disappeared, and reappeared later, put our patient's actions and symptoms into context that would allow for a reasonable diagnosis of cercarial dermatitis. This condition typically clears itself over time, but again it is important to help a patient avoid scratching to prevent secondary skin infections. Anti-itch lotions, topical corticosteroid creams, and baths with colloidal oatmeal, baking soda, or Epsom salts can be helpful to that end.

Patients can avoid swimmer's itch by swimming in well-maintained, chlorinated pools. Patients who have had swimmer's itch before may experience worse reactions if they get it a second time. A 2015 review article of cercarial dermatitis calls it an emerging disease and asserts that it is responsible for the majority of dermatitis outbreaks worldwide (you can read the article here). While it is possible to treat waterfowl with medication to reduce parasite populations, this requires capturing, treating, and releasing birds individually, which isn't always practical. Control efforts have also targeted killing the snail intermediate hosts, but those efforts often have detrimental effects on other animals. The best way to prevent swimmer's itch is for people to know where cases of swimmer's itch have been reported to originate and to avoid those areas for the season.

Thanks for joining us for this week's Mystery Case and we hope to see you in two weeks!