Church of the Flying Glomerulus

It's either this or all glory to the Hypnotoad. 

A friend was talking to me about the glomerular tuft and how the professors were using that term without exactly explaining what it was. I said that I think it's a name that refers to all the capillaries and other goodness within Bowman's capsule and that if this was so, the name is kind of fitting since the glomerular components do look a tuft of random stuff just thrown together.

But anyway, I'm not sure how many people are familiar with this, but the glomerulus to me looks a lot like the Spaghetti monster in the Church of the Flying Spaghetti Monster (which is a parody religious order). I think it was created to protest something about teaching Intelligent Design in schools along with evolution, but that's besides the point. The point is: if spaghetti were alive, I would want it to have eyes. 

NASH: Nonalcoholic Steatohepatitis

What is MASH even about?

My poor blog, I've neglected you for far too long! And I'll probably ignore you from here until the new year, so here's a quickie to make myself feel like I've been up to something useful.

Here's a play on the MASH TV show! I've never actually seen it, so I think it makes the reference so much better. NASH stands for nonalcoholic steatohepatitis. It's a liver disease that looks like alcoholic liver disease because you'll find all kinds of fatty change to the cellular architecture on the microscope. You'll likely see this in obese patients.

Hemochromatosis

More stolen chemistry humor!

Hemochromatosis is an iron overload disease.

It is a disease characterized by a defect in the HFE gene. This will negatively affect the cell's ability to produce hepcidin, a molecule that prevents cells from secreting iron into the blood. The cell cannot make hepcidin so iron will be continually secreted out of the cells and into the blood.

Hemochromatosis therefore = an insane load of iron in blood!

Vitamins The Body Can Make

This is Donkey Kong. I don't know why he looks like the Hamburglar.

I know we all love Flintstones vitamins, but did you know that the body is capable of making two fat soluble vitamins? One is Vitamin D (via UV light hitting the skin) and the other is Vitamin K (courtesy of bacteria in your gut). DK stands for Donkey Kong. Donkey Kong Country for the SNES is quite possibly one of the best Nintendo games ever. Another fun Nintendo game involving monkeys is Super Monkey Balls, for reasons I won't divulge.

Hello Kidney/Bladder

Rawr

OMG, I'm back online! Hope everyone had a good Thanksgiving!

We started the renal block yesterday and what better way to kick off some studying with something I'm absolutely obsessed with? It's been a while since I was a little kid and yet I still collect Hello Kitty things...

I kind of stole the Hello Kidney idea from someone else, but hopefully I put a little spin on things by adding the Hello Bladder. 

Destroying Angel Mushroom

Toad is practically Super Mario's slave.

Head's up: there won't be any new posts this week. Why? It's Thanksgiving week and I've convinced myself that I'm allowed to be lazy.

I'm never sure why people decide to go mushroom hunting. I know the organic craze has its merits, but I wouldn't want to die from eating so fresh from nature. The Destroying Angel is of the genus Amanita and contains a toxin that will shut down your liver and kidneys. I say: avoid white mushrooms. 

Toxic Megacolon

Also known as the Chernobyl Colon, Poisonous Poo-chute, Septic Shi...

Lactose Intolerance

"So give me coffee and TV" - Blur

You might remember the music video to "Coffee & TV" by Blur or you might not. If you do, you'll probably recall a milk carton walking around town trying to locate Graham Coxon (Blur's guitarist).

And speaking of milk, milk contains lactose, a disaccharide of glucose and galactose. People usually develop an intolerance to lactose because of the absence of the lactase persistence SNP (single nucleotide polymorphism). Lactose intolerance also becomes more common as we age, and can be secondary to a number of syndromes/diseases that disrupt the GI mucosa. Use the lactose-hydrogen breath test to diagnose!

Entamoeba Histolytica

Most people who collect vinyl wear scrotum-crushing tight jeans.

If you're from California, and like the music and independent scene, and are more often than not annoyingly pretentious, you've probably been to the Amoeba Music record store. The one in Hollywood is a bit of a dump, and I'm still bitter that I stood there futilely waiting to see a free Franz Ferdinand gig.

Anyway, onto real amoebas. Entamoeba histolytica is the type amoeba you want to get if you're interested in a getting dysentery (compare that to Entamoeba dispar which doesn't cause dysentery). Sometimes they might affect the liver, creating an abscess, which on aspiration supposedly looks like "anchovy paste". Their virulence factors lyse WBCs, so if you're digging around in the stool and place it under a microscope, you won't find white blood cells hanging around! 

Pancreas!

A tribute to Lichtenstein

I'm probably the only one who thinks the pancreas looks like a gun.

On dissection it looks like mush.

Salmonella

I asked for a Double Down and all I got was a drumstick with sprinkles.

Salmonella! A gram negative rod that can give you pretty bad inflammatory diarrhea. If like you like raw chicken, you'll love salmonella.

Hormones Implicating Obesity

Come along and sing a song and join the jamboree! M-I-C-K-E-Y-M-O-U-S-E.

First and foremost, sorry for the lack of posting. I was thinking of backtracking and fooling Blogger into thinking that I actually posted on the days I've missed out this week (which was practically every day), so if you see a post on Wednesday and the like... well, I cheated!

Anyway, what makes mice fat in experimental studies? Let me count the (hormonal) ways.

You could have a lack of anorixegenic peptides (CCK, PYY, oxyntomodulin, glucagon like peptide 1, pancreatic polypeptide). In class we concentrated on PYY. This rises after we eat and tells the pituitary/hypothalamus to STOP EATING. But man, do I love food.

You could also have too much ghrelin. Ghrelin levels are highest when we're in the fasting state ( = when I'm starving for a brownie). Fun clinical correlate: Prader-Willi (chromosome 15 paternal deletion, to jog your memory) patients have high levels of ghrelin. Ghrelin is also hard for me to pronounce and write.

Volvulus: Coffee Bean Sign

I'll have a venti triple shot half foam double whip cappuccino with non fat soy and 1/2 shot hazelnut, bitch.

In the previous Peeps post I talked about volvulus, a twisting of the colonic mesentery. Turns out you're more likely to see this huge bean looking thing on an X-ray to visualize this condition. Man I hate coffee.

Also, I drew this in two minutes.

Volvulus

Disgusting. Worst Easter treat ever.

I saw this CT with contrast for volvulus on one of the lectures and it totally looked like a Peep! Volvulus is a twisting of the mesentery (usually of the sigmoid colon or cecum) and also turns up as a "coffee bean" on a plain abdominal film. The beak of the Peep is the point where the twisting occurs.

Papillomatosis in Reflux Esophagitis

It was either this or the Jigsaw puppet from the Saw movies.

Acute changes in reflux esophagitis include the presence of intraepithelial segmented WBCs, basal cell hyperplasia, papillomatosis ( a saw tooth appearance), and erosions.

Chronic changes include fibrosis (manifesting as a stricture) and Barrett's esophagitis (where you see esophageal epithelium looking more like small intestinal epithelium).

Bacillus Cereus

Why so... cereus?

Bacillus cereus apparently causes diarrhea and can be found in fried rice. I still love Panda Express.

Pill Esophagitis

Pills > Suppositories

What are a couple of causes of pill esophagitis? What kinds of drugs will kind of give you a very painful feeling in the throat?

Tetracyclines are a known culprit... and also alendronate, quinidine, KCl, and a couple of chemotherapy drugs (daunorubicin, bleomycin, 5-FU).

Parietal Cell

Where my Rooty Tooty Fresh 'N Fruity at?!

This is a picture of what I ate for breakfast... or rather what I wish I ate for breakfast. I'm usually lucky enough to eat the bits of cereal left on the table. Anyway, the circles in the stomach cartoon are supposed to resemble fried eggs because that's what the parietal cells of the stomach are supposed to look like! They are the principal cells for acid secretion (HCl) and to me are the coolest looking.

It's also my birthday today! I'm going to have ice cream to celebrate. Now how are my gut organs supposed to handle all the fat/sugar after my ice cream binge... hmm...

Pepto Bismol MAX!

When you have nausea, heartburn, indigestion, upset stomach, diarrhea!

Pepto Bismol was my go-to OTC medication for diarrhea as a child, and it wasn't because of their really catchy jingle on the TV. I never knew how Pepto worked before though, and now I sort of do!

Also, this cartoon is a caricature of me. I'd love to be a door-to-door Pepto Bismol salesman.

Rugae Reggae

Ya mon!

Rugae are the ridges and folds in the stomach. I remember in anatomy class when I had to scrape out all the contents from the stomach to visualize the rugae. All that junk was green. I also helped scrape/scoop out all the feces from the large intestines out of the rectum. I'm a good scraper.

Chief Cell

Remember that song in Peter Pan? "What made the red man red"? Yeah, sorta racist.

Chief cells are found in the body of the stomach and are chiefly (hah?!) responsible for the secretion of pepsinogen, the zymogen to pepsin. The nucleus is located basally along with basophilic rough endoplasmic reticulum and on the apical surface you can see the graunules filled with eosinophilic pepsinogen.

P-ANCA

HULK!!!

Anti-neutrophil cytoplasmic antibodies and just about any antibody in general are helpful for immunological testing. p-ANCA will stain in a perinuclear fashion (around the nucleus - which is not shown well in the drawing) on a neutrophil and is anti-myeloperoxidase. Microscopic polyangiitis and Churg-Strauss patients will usually have p-ANCA positive neutrophils.

Happy Halloween!

What's this? What's this?

Jack Skellington looks cachexic and probably has COPD... or CHF... or cancer?

Aspergillus

Or is it ASSpergillus?

Small Cell Carcinoma

What a great show.

Small cell carcinoma: known for it's high N:C ratio and salt and pepper chromatin coloration!

DASH Diet

I actually HATE celery. Wait, that's broccoli. Fail. 

You're probably wondering why I'm acting as a public service announcement this week. Well, the answer is: without classes, I have no idea what to draw! I also like drawing pictures of fruits with smiley faces.

The DASH diet is recommended as one of the main components in the treatment for hypertension (BP >140/90). 

It pretty much consists of eating healthful foods: the whole nine yards of fruit/vegetables. I probably am not the best person to talk about healthful diets (if alcoholics use a drink as an "eye-opener" in the morning, I used to use ice cream as mine), but eating stuff other than only oil drenched cheese (which tastes good) really does wonders for the body. It's also much better to eat well than remember to take a pill everyday.

CAGE Assessment

It'd be kind of cool to get into a bar fight.

This is a picture of a liver. Livers do a lot for your body. Sometimes excessive alcohol consumption makes the liver cry.

Because of my genetics, even the slightest drop of alcohol makes my face turn a bright red color. Actually, it's not only my face that looks like it's terribly sunburned: I get red on my chest too, which is really embarrassing.

I share this story not because I'm trying to say that alcohol is terrible for you; I kind of need drunks around to laugh at on occasion. The purpose of this post is a reminder that binging a couple times of week isn't a good idea. 

So anyway... if you're assessing for an alcohol problem, use the CAGE questions:

C: Have you ever felt like you have to cut down on your drinking?

A: Have people told you that they are annoyed with your drinking?

G: Have you ever felt guilty for your drinking?

E: Do you drink right away in the morning as an "eye-opener"?

Smoking Cessation

There are probably more cigarette smokers in Las Vegas than hookers. That's a lot of smokers.

I don't have many pet peeves, and I do respect what people choose to do to their own bodies, but smoking is just bad. I've seen my grandpa go through lung cancer and it's not a pretty sight. I wouldn't say I'm advocate for smoking cessation per se, but I would love to see more people smoke free in the future. Alright, I'm off of my soapbox now.

Ventilation-Perfusion Ratio (V/Q)

"You have smoked yourself retarded." - Dave Chappelle from Half Baked

Is it just me or does the ventilation-perfusion ratio (V/Q) pictures in physiology books (BRS Physiology in particular) look like a bong?

I'm not an advocate of marijuana or any other mind-altering substance for the matter, but I can't help but place stoner comedies in my top three favorite movie genres. The best stoner films I've seen to date? 1. Half Baked 2. Pineapple Express 3. Harold and Kumar go to White Castle. 

As for actual learning points: when the V/Q ratio approaches 0, arterial blood gas numbers begin to look more like venous blood gas numbers. When the V/Q ratio approaches in infinity (WHO DIVIDES BY ZERO?! WHY WOULD YOU DO THAT?), alveolar blood gas numbers look like the gas numbers found in inspired air. 

More Halloween!

The best part of Disneyland's Haunted Mansion? The crystal ball room. 

Well, I had a line of drawings ready for posting but then I remembered that I care too little to get out and scan everything to the computer. I'm opting for the lazy man's out today.

Also, my coccyx probably broke from the skating last night. If you're wondering how I skate, I skate like I've just had a prolapse. 

1/3 Party

2/3 to go!

You know all those fun activities you were supposed to have accomplished as a child?: sleep-overs with friends, making snowmen, being able to properly use the monkey bars (ie: not flail around and just hang there), roller skate. Well, I've never really done any of them before. But today, everything changes! Well, somewhat.

Today we're going roller skating to celebrate our completion of 1/3 of med school and I'll have the opportunity to make a fool of myself on wheels rather than on foot. So anyway, congrats class of 2013, I'll see you at the rink!

Psittacosis (And Alcoholism)

"Calling all captains!"

In our recent lower respiratory infections lecture, I only remembered two things.

Firstly, having pneumonias with a history of bird exposure (eg. parrots, parakeets, turkeys - happy early Thanksgiving) makes it likely you have Pscittacosis. 

Second, alcoholics are likely to have pneumonias caused by Klebsiella, normal oral flora, S. aureus, or S. pneumoniae. 

And if you're exposed to both (a Captain Morgan-swigging pirate parrot for example)... who knows what caused your pneumonia!

Tension Pneumothorax

"It rubs the lotion on its skin or it gets the hose again." - Buffalo Bill (Silence of the Lambs)

Since all the pulmonologists here seem to go absolutely mental over the fact buffaloes have communicating lung pleura (which apparently made it really easy for Native Americans to ARROW them back in the day), here's a buffalo for your viewing pleasure. I know what you're thinking: it looks like an ox with a fro or an ox with its brains splattered out. Or maybe even a pig.

Anyway here's the fact of the day: a tension pneumothorax occurs where there is a penetrating tear to the pleura. This tear looks like a flap and acts as a check valve in that it allows air into the pleural cavity but not out. Thus with each breath, there is an increase in pleural cavity pressure.

Head Out Like A Fetus

Word up son!

Our class is trying to come up with a motto. This one was my favorite (courtesy of a really fun classmate).

Cri du Chat Syndrome

Sacre bleu!

Cri du chat is French for CRY OF THE CAT! But it's also the name of a genetic syndrome in which there is a congenital microdeletion on the short arm of chromosome 5. Findings include high-pitched crying that sounds much like a cat's mewing at birth, mental retardation, epicanthal folds, and cardiac abnormalities. 

This cat doesn't have a stripey shirt or mankerchief, but does have a beret and sleazy moustache. Stereotypes FTW.

Syphilis

Back then, having syphilis was the cool thing to do. 

Sorry I haven't had time to update the posts with information! I'll update all posts next weekend with relevant facts instead of silly cartoons.

But first off, syphilis can affect the dorsal (posterior) column of the spinal cord. It is also caused by a squiggly bacteria that is part of the group collectively known as spirochetes. 

Folate Deficiency

"Ah-gah-gah-gah-gah-gah" - Popeye

Hypersensitivity Pneumonitis

Watch Hitchcock's "The Birds"! Or North by Northwest. 

When I hear hypersensitivity pneumonitis, I think of bird fancier's disease. I also think of the time back in middle school when my school had a really bad seagull problem and I got bird poo splat all over me a frequent basis. They finally put wires across the buildings to keep the birds out, but not before putting fake owls on top of classrooms to "scare" off the gulls.

Primary Ciliary Dyskinesia

"You can learn a lot of things from the flowers..." - Alice in Wonderland

There are a couple of disorders resulting in bronchiectasis: cystic fibrosis, infections, bronchial obstruction, allergic bronchopulmonary aspergillosus, and also primary ciliary dyskinesia.

In primary ciliary dyskinesia, there is an absence of dynein arms in cilia. Dynein arms contain ATPase for the movement of cilia. As you might guess, the lack of dynein arms will impair the ability of the ciliated epithelial cells in the respiratory tree to clear up mucus and other respiratory secretions.

Kartagener's syndrome is a subset of primary ciliary dyskinesia. It features symptoms including bronchiectasis, situs invertus, and sinusitis. Situs invertus occurs when there's a mirror image of the major organs. CRAZY!

Usual Interstitial Pneumonia (UIP)

The really ugly mascot for Post's Honey Comb cereal!

Honey-combing is found in radiographic images of patients with Usual Interstitial Pneumonia.

Halloween Countdown!

"I am the who when you call who's there" - Nightmare Before Christmas

Using an online photo editing software is cheating but I couldn't be bothered to draw in the spider webs AND I didn't want to draw anything new (I believe in recycling... images).

Only a couple weeks to go until I get a reasonable excuse to gorge on candy.

Desquamative Interstitial Pneumonia (DIP)

Macrophages on the Fun Dip Stick!

Bronchiolitis Obliterans Organizing Pneumonia (BOOP)

Never really got the appeal to Betty Boop.

Bronchiolitis Obliterans Organizing Pneumonia (BOOP), also known as Cryptogenic Organizing Pneumonia (COP). 

I haven't studied this much yet... wait for some information tonight!

10-10-10

I know this deviates from the traditional format I've created for this site but watch this video in honor of 10-10-10. PREASE WATCH IT. 

Diphyllobothrium latum Sushi

itadakimasu!

TAPE WORMS: Diphyllobothrium latum. Ugh. I always found it kind of gross that these tape worm segments (proglottids) break off into your stools, releasing all those little eggs. We were told by our hematopathologist professor that you can get this tapeworm from eating raw fish. Because I really like sushi, this kind of disturbs me. It doesn't stop me from eating sushi though, just like how all the coronary artery disease lectures haven't stopped me from eating fried chicken and pizza.

The relevance behind Diphyllobothrium is its relationship to vitamin B12 deficiency (vitamin B12 is also known as cobalamin). This tape worm will end up absorbing all the body's B12, which will eventually lead to a vitamin B12 deficiency induced macrocytic anemia characterized by the presence of megaloblasts and hypersegmented neutrophils. Remember, B12 is an important for DNA synthesis and is needed in the enzymes L-methylmalonyl-CoA mutase and methionine synthase. You will see elevated levels of both L-methylmalonyl-CoA and homocysteine in a vitamin B12 deficient patient. 

Giardia lamblia Will Give You FATTY DIARRHEA

The Giardia trophozoite form kind of reminds me of the Sentinels in the Matrix. Kind of. Barely.

Protozoans! They're not bacteria, they're not viruses, and they're not fungi either. They're weird little organisms in Kingdom Protista, and they also cause a bunch of diseases.

Giardia lamblia is one of the coolest looking protozoans out there. These protozoans cause Giardiasis, which is characterized by greasy, foul-smelling stool and other GI disturbances. You get Giardiasis from drinking the cyst form in water. Mmm.

This is the trophozoite form of the organism that you can find in your stool if you happen to have Giardiasis. Treatment: Metronidazole, whose mechanism of action ultimately leads to the build-up of toxic metabolites.

Wikipedia also calls Giardiasis BEAVER FEVER?!

Right Upper Lobe Bronchus

Free Willy!

At the request of an awesome friend/classmate, here's an inaccurately drawn CT scan of the thorax (totally not going to be a radiologist) cutting through the right upper lobe bronchus at around the level just below the carina. The right upper bronchus looks like a whale!

Remember when Shamu at Sea World killed that trainer last year?!

The Black Lung

"What is this? A center for ants?"

Derek Zoolander after being in a coal mine for a day: "I think I'm getting the Black Lung, Pop. It's not very well ventilated down there."

I do realize this is a BAD drawing of Zoolander but I can't stop quoting from the movie. *high pitched cough*


Causes of nocturnal cough: GERD, bronchial asthma
Causes of productive cough: chronic bronchitis, bacterial pneumonia, bronchiectasis
Drugs causing cough: ACE inhibitors, aspirin

PEACOCK!

Teaching Point #1  

Without naming any particular names, I really enjoy the infectious disease doctors at the hospital.

Respiratory Epithelium: Goblet Cell

Harry Potter and the Goblet of Mucus.

Yesterday, no one came to microanatomy class. I did though, and this is what I kind of learned:

Respiratory epithelium differs based on where you are along the respiratory tract. In the nasal mucosa, you'll find pseudostratified columnar epithelium with the following cells: goblet cells, ciliated cells, and basal cells. Underneath this is a vascularized lamina propria with mucous/serous glands. 

Goblet cells secrete mucin, ciliated cells beat up all the junk in your airway towards the pharynx, and basal cells are stem cells. 

Down the respiratory tract you'll lose the goblet cells and then you'll see all the cool lung-y stuff. 

Also, I'M TIRED.

Pulmonary Fun Facts

It should really be Woo-Tang Clan. 

Just began studying the respiratory system and what better way to start it off than with a review of structures that pierce through the diaphragm?!

Level at which things pierce through the diaphragm:

T8: Inferior Vena Cava

T10: Esophagus 

T12: Aorta 

The lungs remind me of an upside down Wu-Tang Clan symbol. Word.