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Wednesday, January 12, 2011

Hospital Stays: A Giant Biomedical Vocabulary Test and a Survey of Bioengineering!

Many people get sick to varying degrees and may require hospitalization. I just recently spent a week in the hospital in a lot of pain, ending in surgery. Not wanting to merely whine about the experience, I will use this opportunity to highlight the field of biomedical engineering and also use it to help you navigate the complex world of biomedical vocabulary. You might also learn a bit of anatomy, physiology, and chemistry as well.

Before I continue, I recently wrote an article for L’Oreal (yes the make-up and skin/hair care company) for their “For Women In Science” Foundation. Check out “The Heart of Collaboration: How Science and Engineering Go Hand-in-Hand”. My next one will be about Tissue Engineering.

Back to my story, but first, lets look at the accessory organs of digestion in the abdomen:

gummy/gallbladder_diagram.jpg

 The largest organ of the body is the liver (and when doctors and scientists talk about functions and parts of the liver, they usually include the prefix hepato-, or hepat-, “liver” from the Greek).  It is responsible for filtering the blood that comes from the small intestine. It helps to metabolize the components of your meal. It also produces a product called bile (chole- is the prefix used for bile. You might recognize this prefix in the words cholesterol and cholera). Bile helps to make fat from your meal in your intestine mix better in the watery secretions for digestion. Extra bile from the liver is stored in the gallbladder for easy release into the small intestine upon signals that food is in there. Bile has a yellowish color due to bilirubin, from the breakdown of erythrocytes  (erythro-, “red”, cyte-, “cell”) You might check out my Blood Cell Bakery video about red blood cells here. Bilirubin is what gives urine its yellowish color. It is what makes a very old bruise appear yellow as the blood that was under the skin breaks down. Too much bilirubin can cause a symptom called jaundice when levels are very high in the body in certain illnesses.

gummy/jaundice.jpg gummy/Bilirubin.jpg
 JaundiceBilirubin molecule

The pancreas (pan- "all" + kreas "flesh") is an absolutely critical organ. It has two portions that can be discerned microscopically. One is an EXOCRINE (exo-, “outside”, + krinein, “to secrete”) component. Digestive enzymes that are produced by the pancreas are sent through tubes called ducts into the small intestine. These enzymes help digest fats, starches and proteins. Recall that I filmed a gummy bear video to demonstrate the properties and the role of one protein digesting enzyme, trypsin.

Another component of the pancreas is the ENDOCRINE (endo- “internally” + krinein "to secrete”) portion. This part of the pancreas secretes, into the BLOODSTREAM, the important hormones insulin to help decreased blood sugar levels, and glucagon, which will help the liver raise low blood sugar.

The pancreas under a microscope. 

The pale area is the ENDOCRINE portion

gummy/pancreas.jpg

Darker pink is the EXOCRINE portion. 

NOTE: the pancreas and the gall bladder both have ducts that fuse to one duct called the COMMON BILE DUCT that drains into the first portion of the small intestine (the duodenum) This plays an important role in my story.

Lets step back to about eight years ago. I had a terrible pain, like a band around my midsection over a Memorial Day weekend. Turns out I was having a gallbladder attack. I was a bit young for it, but this would not be unheard of. Upon further diagnosis with ultrasound (high frequency sound waves used to create images, the same technique used to see babies during pregnancy, see this video of how ultrasound works), I was told I had numerous pigment stones; tiny, black stones in my gallbladder. Presence of stones in the gallbladder is referred to as cholelithiasis (from the Greek: chol-, "bile" + lith-, "stone" + iasis-, "process") and are usually made of three components: bilirubin, calcium, and cholesterol. My gallstones were a result of my body breaking down the pale, small, and less effective red blood cells I create due to a genetic disorder and tendency toward iron deficient anemia and were thus mostly comprised of bilirubin. Someone with cholesterol issues will most likely have the large cholesterol stones.

 Ultrasound of gallstones in a gallbladder

gummy/gallstone.jpg  

All imaging techniques used in medicine

are examples of bioengineering. 

Having my gallbladder removed surgically was not what I wanted to do at that time. I’d have an occasional attack, where a stone would travel down the bile duct with difficulty but endured the few hours of pain with a sense of resignation.

Mid-December 2010, I was not feeling well. I was having the classic symptoms of a gallbladder attack. It lasted for several hours, and by the evening I had some jaundice in the sclera (whites) of my eyes and dark urine. These are bad signs, I knew it, but wanted to go to the NCBI bioinformatics workshop the next day in Chicago. I attended the workshop during the day, checked into the hotel and in the middle of the night, experienced more pain. In the morning (I won’t say I slept), my skin was also slightly yellow, but I rationalized I was just to be sitting at a computer, so will get through the workshop and drive home, and if I still felt poorly, I’d go to the doctor. I did place a call to the nurse just to make sure I wasn’t being too foolish (oh, I was).

As soon as the very informative workshop finished, I drove back home with severe abdominal pain, but luckily never started vomiting, which is an even worse sign than the jaundice. Later, a nurse would say to me “You people with a high tolerance for pain do not do yourselves any favors!” Don’t bother scolding me, I have already been scolded several times.

I was checked into the ER in severe pain and welcomed a pain relieving opiod, a powerful type of painkiller. Would you like to learn more about painkillers? I really enjoyed this video from an organic chemist in the UK, Professor Dave at York.

 
I was subjected to a CAT scan. CAT stands for Computerized Axial Tomography. This is basically an Xray machine that moves around your body to capture full images. Here is a video about how CAT or CT scans work:

Depending on what is to be viewed in the body, the patient is usually given a CONTRAST AGENT. Generally they are given Iodine for blood vessels, and Barium for the GI tract.  If you want to know more about iodine and barium as chemical elements, click on the links and visit my favorite videos by Periodic Videos!

The doctors determined that I did indeed have gallstones that blocked my pancreatic duct. The pancreatic enzymes, unable to go into the small intestine, backed up and started to self-digest my pancreas! Ow! No wonder I was in pain. This created an inflammation, which is represented in vocabulary by the suffix –itis. I had pancreatitis.

One can have ACUTE or CHRONIC Pancreatitis. Mine was acute. 

What is the difference between Acute and Chronic? Let’s say you break open a rotten egg.

gummy/rottenegg.jpgBefore that incident, the house smelled just fine. Suddenly it didn’t. This is an acute situation. In this case, you clean it up, throw out the trash and things will return to normal fairly quickly. (An acute health situation does not always mean it will resolve quickly or at all).

 

gummy/messyroom.jpg

However, let’s say you walk into your older brother’s room. There is a strange odor in there, permeating everything. Perhaps it is a mixture of dirty clothes and left over food. This took a long time to accumulate and will be difficult to remedy. This is a chronic situation, probably lasting until he moves out.

 

I was admitted to the hospital, rested for the night, then underwent a procedure called an ERCP. This stands for Endoscopic Retrograde Cholangiopancreatography. Even I hesitate to pronounce the full phrase. Look at that phrase and see if you can recognize some word roots. Perhaps you know Endo- means “inside”. Traditionally, in medicine this means inside the digestive system.  Scop- is obviously a scope for viewing. An endoscope is used to view inside the digestive tract.

How about retrograde? This word comes from retro-, "backward" + gradi , "to go, step". The scope is a long tube

gummy/ampullavater.jpgplaced in the mouth (thank goodness I had a drug called Versed to help me relax and not remember this event!), snaked down the stomach and into the small intestine and then up into the common bile duct through an opening called the ampulla of Vater.

Let’s tackle the long last word. We have Chol- for “bile” or “gallbladder” + angio- “blood vessels”,  + Pancreato—“pancreas”  + “graph”-image. It seems they want to image the pancreas and gallbladder and the associated ducts. They did this with contrast agent (iodine) and an X-ray machine.

gummy/biliarystent.jpg

Lucky me, they found the stone had cleared and put a stent in my pancreatic duct! A stent is like a tiny scaffold that holds open the duct so in case a stone was trapped, it could pass back out. Stents are great little wonders of bioengineering. They are like a little wire scaffold that holds open the duct! Most of you have probably heard of them for holding open blocked arteries to the heart.

 

 

 

The next day I was imaged using MRI,  or Magnetic Resonance Imaging. Here is a video demonstrating the science behind the MRI.

 

I was given a contrast dye for the MRI, through my IV, made of Gadolinium. Again, you can visit Periodic Table of Videos to learn more.

So how was this acute case of pancreatitis treated?

Essentially, they gave my digestive system a rest for nearly

gummy/RHBH.jpga week so the pancreas would not be stimulated to work and send out more digestive enzymes. You rest your digestive system by not eating.  It took several days before I even cared about food. I was given painkillers that helped with the pain, but gave me nightmares and an inexplicable desire to watch The Real Housewives of Beverly Hills (my favorite is Lisa, fyi).

 

By the end of the week, I had my gallbladder removed in a procedure called a laparascopic cholecystectomy . You have been introduced to a few of the word roots, so I’ll just add the other ones. Lapara- is from the Greek for “flank” or “abdomen”. chole + kystis, bag, ektomē, “excision”. 

They removed the misbehaving gallbladder by making four small incisions in my abdominal wall where they inserted the scopes and other surgical tools used to cut and extract my gallbladder. No, I didn’t ask to save the gallbladder. Sorry folks. I have no attachment to it after the ordeal I experienced, and my curiosity to see it was not all that great, but like watching “Real Housewives”, I blame that on the drugs, too. 

One more cool thing…no stitches or staples, just amazing superglue was used to close my incisions. Wow. 

I am slowly regaining strength and I look forward to my fabulous time at Science Online 2011, my most favorite conference—an unconference for science communicators from around the world, trying to figure out how to best relay science information and learning in the online environment! I will be running a workshop on Video production with Dr. Carin Bondar, and also run a online science film fest with her as well. I will also be on panels to help describe how to explain science in blog posts as well as the perils of blogging as a woman under your own name. 

Until next time,

Kindly, Joanne 

Wed, January 12, 2011 | link 


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