Today we were assigned to the gastroenterology department with Dr. Tung, a GI attending. Dr. Tung is an MD/ PhD who trained in Vietnam and Japan. Before we ventured out into the wards and outpatient facility, he provided us a brief overview about the types of patients his hospital encounters. Gastrointestinal emergencies are serious conditions that develop suddenly requiring prompt attention. Upper GI bleeding accounts for over 50% of GI emergencies. Etiology is wide ranging and stem from chronic NSAIDs usage to vomiting. Portal hypertension predominantly due to liver cirrhosis accounts for 30% of GI emergencies. Gastric cancer, gastritis, and Mallory Weiss syndrome account for the remainder 20%.
Because the population of Vietnam has a high rate of people with Hepatitis B and chronic alcoholism, upper GI bleeding is a common occurrence at Hospital 108. With regards to Hepatitis B, the leading cause of death is portal hypertension secondary to ruptured varicose, hepatocellular carcinoma, and hepatic coma.
After the introduction, Dr. Tung brought us to the Outpatient GI Facility. At this facility, there were 2 endoscopes and one hybrid endoscope/ultrasound machine. The patient waiting room was packed to capacity with a mix of adult men and women and military officials. In order to see all the patients for the day, the endoscopic exams were performed very efficiently. Once the patients arrived into the procedure room, they were placed in the left lateral decubitus and quickly scoped. No sedation (local or general) was used because of the increased cost and increased length of procedure. The two physicians scoping the patients usually finish the whole procedure in 3 minutes. The sight of seeing patients endoscoped without sedation seemed at first disconcerting. The patients’ gag reflex was in full force but once the procedure was over the patients reported no pain. We were amazed to see how after the procedure, the patients nonchalantly walk out of the room as if it was a routine procedure.
We then continued to see some patients who mostly suffered from acute pancreatitis and cirrhosis. Dr. Tung discussed the widely used Transarterial oil chemoembolization (TOCE) procedure for hepatocellular carcinoma. TOCE is a minimally invasive procedure aimed to restrict the blood supply of hepatic tumors through minimally invasive angiography. Microsphere therapy, a method of using drug eluting particles to allow for slow, sustained release of loaded anti-cancer drugs locally with embolic effect leading to tumor ischemia is commonly used at Hospital 108 to treat patients who are not candidates for liver resection. We made our way to the cath lab and witnessed a couple TOCE procedures. The procedure lasted only approximately 30 minutes or less and patients were only under local anesthesia.
Overall, we had a wonderful experience shadowing in the GI department. Even when we were shadowing the cardiology and infection diseases departments, we encountered a fair amount of patients with hepatic disease. This department opened our eyes to not only the treatment and management of hepatic disorders, but also the public health issue of the high prevalence of Hepatitis B and alcoholism contributing to hepatic disease.
– Benjamin Nguyen