Fourth-year UMHS student Laura Tafuri gave a poster presentation at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Scientific Session and Postgraduate Course in Seattle back in April.
The UMHS Endeavour spoke to Ms. Tafuri about the presentation on “Portal Vein Thrombosis [PVT] After Elective Laparoscopic Right Hemicolectomy for Recurrent Diverticulitis.” We discussed how she got the opportunity to work on this important research, how PVT affects patients, what medical students should know about it, why it is vital to show interest in all areas of medicine during clinical rotations, and more.
While working at St. Mary’s Hospital in Waterbury, Connecticut on a Surgery clerkship as part of the UMHS Clinical Science program, Ms. Tafuri’s chief resident asked if she would like to write a case report on a patient with a rare complication.
“From there we submitted it to the Waterbury Research Day 2017 with surrounding surgical programs in the area, and it was chosen for a poster presentation,” she said. “I kept in close contact with my chief resident and later in the year he reached out to me when he got an email from SAGES, asking for submission for their national conference.”
Poster Presentation in Seattle
They submitted and were chosen to be a poster presentation (done as an actual e-poster on a touch-screen monitor) in Seattle. Ms. Tafuri said she worked closely with the second-year Surgery resident who was an author on the original case report. They updated it with new literature findings for 2018.
“We worked on updating it online, emailing back and forth as she was in Connecticut and I was in Augusta, Georgia in rotations,” she said. “We met up in Seattle and presented this alongside surgeons from around the world in a four-day conference.”
What is PVT?
What is PVT in layman’s terms? “A PVT is a clot that occurs in one of the main vessels going toward your liver. This has been seen in other upper GI surgeries but it is rare after colon surgeries.”
Ms. Tafuri said there are numerous factors contributing to this, including such infectious states as “diverticulitis, inflammatory bowel disease; inherited ‘clotting’ states if someone is deficient in a factor that would normal keep their blood thin, medications like those used for hormone replacement therapy, malignancies, cirrhosis, or even an increase in the CO2 or position used during laparoscopic surgery that can create an increased pressure and releases clotting factors from the cells that line those veins.”
How did PVT affect the patient studied?
“In our case our patient had a history of diverticulitis (although not in active infection state), had a laparoscopic procedure to remove part of her colon which used CO2 insufflation, and was later found to have an inherited anti-thrombin mutation, something that genetically predisposed her to this complication, but is not regularly tested until someone presents with a suspected clot.”
Medical students need to be aware of possible PVT in patients.
“Although it is rare, it is being seen more often in colon surgeries, and is an important differential diagnosis to keep in mind in a post-op patient who might come back to the hospital complaining of severe abdominal or back pain, nausea or vomiting, symptoms that might seem vague,” Ms. Tafuri said.
Much can be done for a patient if PVT is suspected.
“ It is important to get imaging using a CT with contrast (90% sensitivity) to identify this quickly so the patient can be started on anticoagulation with a heparin or low molecular weight heparin, bridged to Coumadin, for 6-12 months, possibly life long, depending on genetic hypercoaguable mutation they might have, as well as testing for some of these genetic ‘clotting’ states to determine how long to anti-coagulate.”
Interest in Gastroenterology
Ms. Tafuri said she is applying to OB-GYN this fall but has always been interested in in GI (Gastro Intestinal) medicine. What interests her the most about Gastroenterology?
“The pathology of different GI conditions is very interesting to me and GI problems are so very common and most people will visit a gastroenterologist in their lifetime outside of colonoscopy screenings,” she said. “I think it is something that all students and professionals in all fields should be educated on because the chances that you will be treating someone with some type of GI issue is 100%, and doesn’t matter if you are in OB, Peds, Internal Medicine, Dermatology, etc.; it is all intertwined.”
She remains grateful to the residents with whom she worked on the presentation.
“I was lucky to have such involved residents who wanted to include me in these presentations and papers early on and formed a great friendship with them, such that we speak regularly even over a year later,” she said. “They have been instrumental in guiding through my 3rd and 4th year as I approach application season. My chief resident, who is now a Vascular Surgery fellow in Maryland, actually spoke to his old medical student who is now the chief resident of OB-GYN at Bridgeport Hospital-Yale New Haven Heath, and got me this Sub-I I just completed, loved and hope to match into.”
Show Interest in All Areas of Medicine
Ms. Tafuri said she knows she was extremely fortunate to work on such a prestigious poster presentation. It is important for medical students to show interest in all areas of medicine, even if it is not one in which one hopes to specialize.
“Working hard during my clerkship and with these presentations showed them I was a dedicated student,” she said. “The other students in my rotation were not given this opportunity so it is always important, no matter what field you are applying to, to act very interested, be proactive, study hard and show you are dedicated to doing well in the short time you are there because someone is always watching and noticing even if you don’t think so.”
Med students should take any opportunity to work on research and presentations in all areas of medicine.
“It is great exposure and you should take all the opportunities presented to you, to build your CV, make connections and work hard toward whatever your end goal is,” she said. “Research and case reports like this are also something that is expected to be done when you are in your residency, whatever specialty you choose, so I was happy I got this exposure early on so I would know how to better go about this when I am a resident.”
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