Tuesday, March 20, 2007

FCM, Cholesterol Seminar, and Clinic

Our FCM session this morning was about the ethics of allocating organs like livers for people who need organ transplants. Like a lot of things in life, there is a supply and demand problem here. So there has to be some kind of system to allocate the organs fairly. There are a variety of factors taken into account, such as how sick the person is and how likely they are to be compliant with treatment and take care of their new organ. That's not a small issue, because liver transplant recipients have to take immunosuppressive drugs for the rest of their lives. They are also advised to avoid all alcohol and risky behavior that would increase their chances of contracting a hepatitis virus. We discussed whether the guy in our PBL case would qualify for a transplant under the guidelines, assuming he needs one. It doesn't look so hot for him.

Our seminar had two parts. We had been assigned to read two articles relating to cholesterol metabolism and bile acids. The faculty divided us into two groups of sixteen, and we went over each article for an hour. The articles were kind of detailed, but the group reviews were really helpful. One of the interesting things we learned is that there seem to be receptors for fatty acids and cholesterol on intestinal epithelial cells. Initially, people had assumed that nonpolar molecules like these could just diffuse passively into the cells. Maybe they do to some extent, but it looks like that's not the whole story.

I had a really good time in clinic today. One of my patients cancelled, so I only saw three people. But it was really fun and laid back because we didn't have any required exams to do this week. I just decided what exam to do myself based on what the patient's complaint was. One of them had loss of sensation in the torso and one arm, so I tested the patient's dermatomes to try to localize which spinal nerves were affected. (Dermatomes are areas of the skin that are innervated by the same spinal nerve. You can actually go down the patient's body dermatome by dermatome and test each nerve individually.) It was really neat, because I alternated from the normal side to the affected side for each dermatome, and the patient reported a difference for several of them.

There was a seminar over at Case that I had hoped to go to, but I got out of clinic too late to make it in time. So I just came home instead.

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