This week I rotated to work in the Gastrointestinal Department at Kazan Republic Hospital where I have seen many interesting gastrointestinal cases, as this hospital serves all villages within a one-hundred kilometers of Kazan. The most common condition I have seen is hepatitis. Conditions range from Nonalcoholic Steatohepatitis, Alcoholic hepatitis, and PBS to viral induced hepatitis. I have learned quite a good amount already. Dr. Diana hands us one article to read each day about a different disease. I was assigned to research how the West manages Helicobacter pylori and Clostridium difficile infections. I compared how the West prefers a triple therapy before initiating a Bismuth regiment, and treats H. Pylori on case-by-case bases.
The residents and I are having a great learning experience in this department. Dr. Diana chooses a patient case for us to investigate all the smallest details of, to analyze all the factors as in labs, physical exams, and imaging results to come up with a diagnosis. I had the opportunity to palpate large livers and an abnormal spleen. A forty-two- year-old patient presented with liver cirrhosis, elevated liver enzymes, and abdominal pain. After dissecting the case and ruling out nonalcoholic steatohepatitis and alcoholism induced hepatitis, we concluded that autoimmune was the cause. However, the autoantibodies test came back negative. In our reading, we learned that ten percent of autoimmune cases do not test positive for antibodies. The only option left was a liver biopsy of which we discussed the associated risks which include excessive bleeding and infection.
Another interesting case was a patient in his early fifties presenting with with twenty-liter ascites. I was amazed to see such a big abdomen with such prominent veins. I quickly asked why we cannot drain the fluid all at once. After reading the management of ascites, I learned about the associated risks of draining more than half a liter per day: electrolyte imbalance leading to cardiac damage and a hypovolemic shock that could be lethal. It seemed as if the patient is going to be staying here for a while.
Apparently the hospital stays for patients in Russia are much longer because a bed costs much less than one in the United States. Additionally, the Russian government pays for costs incurred while at government hospitals. One patient waited in a bed for a week to get a colonoscopy. I do not see how this could happen in the United States, where medical services offered free for the public is something yet to be achieved.