Back At It Again!

The one day strike that occurred earlier this week was successful, as Dr. Salete explained to us that the doctors got what they were asking for. Now, back to work we go!

There were several cases we saw yesterday. The first one was a one month old baby boy with Hirschsprung’s Disease. This disease causes a problem with the intestines where a certain segment of the intestines fail to relax leading to obstruction . Normally during fetal development, a certain cell type called the ‘neural crest’ cells migrate to the intestines and form nerves to help regulate relaxation of the intestinal muscles. When these nerves fail to develop, certain sections of the intestines can’t relax leading to obstruction and the parts of the intestine that comes before this ‘squeezed’ or tightened area becomes super big (megacolon). Typically, the section that lacks the nerves is removed and the intestines are reconnected.

The one month old we saw will have his surgery at a later time, but we saw the surgeon, Dr. Galindo, put a central line in him. At first, he tried putting in the line using the right subclavian vein, which is pretty typical. But it just wouldn’t work. He tried the left side without success. Finally, he went for the right saphenous vein which finally allowed him to get the line in. That was interesting to see because I’ve never seen that being done on a baby before.

The following case was a young boy about 7 years old whom Erica and I had seen last week during our time on the infectious disease floor. The patient had a history of a serious fall about a month ago and he later presented with difficulty breathing. When they did imaging on him, he was found to have what looked like a large area of abscess near his liver and lungs. He had a chest tube put in which drained a good amount of fluid, but there wasn’t a whole lot of improvement. So he was scheduled for surgery and it was amazing to see that they were able to remove several pus pockets (sorry to those with weak stomachs…).

While we didn’t stay long for these next couple cases, we were able to get the gist of what happened: a teenaged boy suffered trauma to the left side of his head close to his eye due to a bicycle accident. The cut was very deep and very close to his eye, but the surgeon said there were no concerns about his vision because neither the nerve nor the actual eyeball was damaged; there was also a little girl who was involved in an explosion and her face, hands and parts of her back were burned.

Today, we saw an orchiopexy on a two and a half year old. We then went to surgery clinic with Dr. Galindo. A mom came in with her 7 month old baby who has Down Syndrome and gallstones. While we typically think of gallstones being due to cholesterol, in this baby’s case it was due to hemolysis, as evidenced by her abnormal bloodwork. The mom was asking about surgery, but Dr. Galindo explained that because she’s so small and so young unless she starts becoming symptomatic (like becoming jaundiced), he won’t operate yet.

There was also another baby only a couple months old who has an imperforate anus (there’s no opening for feces to come out). She already had a colostomy put in (an opening in the side of the abdomen that allows feces to come out) and surgery is set for when she turns 6 months or weighs 7 kilos (about 15 pounds).

These past couple days have been filled with new learning and also refreshers which is great! We’re ending the week with a trip to Salar de Uyuni! More on that on the next blog 🙂

Highlights: getting to see some awesome cases; understanding Spanish better; Bible study last night; upcoming weekend trip!

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