Shifting Dullness

This week we have been learning about the effects of radiation on the GI tract (not good) and congenital diseases of the GI tract. There are a surprisingly large number of babies who are born with some kind of GI malformation or malrotation. During embryology, the GI tract has to turn twice so that all of the intestines end up where they're supposed to be in the adult. If that doesn't happen correctly, it causes a malrotation. There can also be problems where the intestines don't return to the abdomen after they normally herniate out into the yolk sac during the second month of gestation, or where the neurons of the enteric nervous system don't migrate where they need to go. I hadn't realized that GI embryo was so complex.

Today I had my meeting with Dr. I about the OSCE. He had printed out all of my evals and read through them before I got there, and I got the impression he was kind of surprised that I had requested this meeting. I explained that I didn't feel I had done as well as I should have for the amount of time and effort that I spent preparing. He apparently didn't realize that my classmates and I were studying for the OSCE, because it was supposed to be something where you just kind of walked in and took it. He didn't think I had done badly at all, and he even wrote an email for me to put in my portfolio saying that I wasn't underperforming in clinical skills. Maybe part of the point of the exercise was to see how we'd adapt after we bumbled through the first station. But all I can say is that from a student perspective, it was a very frustrating experience.

My clinical correlation today was on performing abdominal exams. The GI fellow who was helping my group turned out to be one of my classmates from my Clinical Trials course last semester. We saw some interesting patients. One was so jaundiced that she was literally bright neon yellow. We also saw a patient who was positive for shifting dullness, which occurs when the patient has ascites (fluid in the abdomen). To test for shifting dullness, you percuss the patient's abdomen while he is lying on his back, then have him turn on his side and percuss his abdomen again. If the border between the dull and tympanic regions move, the test is positive. On an amusing side note, one of the attendings told us that when he was in med school, he and his classmates had to sit through boring lectures all day, five days per week. They used to call the lecturers "shifting dullness." :-D