hye,Assalamualaikum! :)
This is weekend!time to rest after through hectic weekday. hehe.sape x suke weekend kan.dahla cuti krismas,selasa bru ade kelas.bahagia je rasa. hari tu pegi melawat ikram kat Pusat Kusta Negara ngan pok kem. Alhamdulillah.he look more better than before. dah boleh duduk ats wheelchair.compare dengan hari tu terbaring je. x boleh nak gerak kan kaki pun. ikram kena stay kt PKKN tu about 2 month. sabrla ikram.dugaan hidup untuk ikram. borak punya borak ngan mak ikram baru tau he was my junior at MRSM PC.aigooo.*ni tetiba masuk mood korea plak kan.tp....x kenal la junior2 ni.huhu.ikram dulu naib presiden timbalan 1.wah,wah.orang hebat PC ni.BWP tu.pastu agak2 maghrib gerak pegi Kg Melayu for dinner ngan pok kem dan member dy sorang.hafiz.sempat borak kejap je sebb nak kejar waktu maghrib.sob3x.lame x jumpa tpi bila jumpa x sempt borak panjng pown.xpela.lain kali ye pok kem
.ingt secret recipe tu.hahaha
semalam(jumaat) ade bedside dengan DR ADLI.wah,cuak,cuak.sebbnya dgr dr adli ni suke tnya differential diagnosis.part ni yag rase susah ni.must think creatively. my patient was hypoglycemic secondary to diabetic.mcam case ward medical je kan.last2 hady yg present.case cholecystitis secondary to cholelithiasis.time dr tanya what
are differential diagnosis tu haa sudah.memang gelabah la. tp cool,cool.this ptient had abdominal pain and jaundice. bila my turn sampai,laju je keluar dr mulut malaria!amek ko.malaria terus.pastu dr cakap nk surgery punye differential diagnosis.tp kan..tetiba sy terpk. kalau saya is the first dr yg jumpa that patient dulu,malaria mestila termasuk dalm kepala sy gak kan. Mala
ria,leptospirosis,hepatitis. all of this can coz jaundice. tp xpela.pastu blurr dah nk bg jawapan ape.
pastu lepas dr tanya sume orang.this was the differential diagnosis for the patient that had abdominal pain at upper abdomen,jaundice,nausea,vomiting and fever:
i) hepatitis
ii) acute pancreatitis
iii) cholelithiasis(
iv) choledocholithiasis
v) cholangicarcinoma
Important point to ask when the patient come with us with jaundice(5 things):
1)tea coloured urine
sebab nak tau patient ni pre-hepatic,hepatic or post-he
patic(obstructive) jaundice ke.
kalau pre-hepatic was unconjugated bilirubin.kalau hep
atic conjugated bilirubin+unconjugated bilirubin.if post hepatic(obstructive) conjugated bilirubin.
normal urine,urobilin akn present(yellow colorr urine la)
kalau patient kita ade tea colured urine,tu maksudnya urobilin kurang,conjugated bilirubin high.selalunya jadi camni if the ptient had obstructive jaundic
e. if obstructive jaundice occur,high amount of soluble conjugated bilirubin enter the kidney. these are the mechanism why the patient had tea coloured urine which is due to low urobilin,high conjugated bilirubin.
2)pale stool
in obstructive jaundice,urobilinogen will reduce.so urobi
linogen cannot convert into stercobilinogen kat intestine. as we know,stercobilinogen give colour to aur feces. so,that why this patient had pale stool sebb stercobilinogen kurang dalm feces.
3)about the jaundice
jaundice is cause by the bilirubin.in obstructive jaundice the level of bilirubin increase. this will manifest as jaundice due to presence of the bilirubin in the bl
ood.taw x bilirubin ni datang dr mane?bilirubin come from th
e hemolysis of RBC yang life span dy dah expired. :)
4)itchiness(pruritus)
indirect hyperbilirubinemia does not induce pruritus.so dalam obstrtuctive jaundice,patient will have pruritus sebb obstructive juandice is conjugated bilirubin present in the blood.this sonjugated bilirubin seposited in the skin and cause the pruritogenic substance release.sebb tu gatal-gatal. :)
5)bleeding manifestation
ni sebb ade disturbance for the vit k when obstructive jaundice present
..
causes of gallstone:
female,40,fat,estrogen,TPN(total peripheral nutrition),OCP(oral contraceptive pills)
hari ni banyak benda belajar ngan dr Adli.
list things to learn:
1)find out about ERCP(Endoscopic Retrograde Cholangiopancreatography) *sila sebut dengan lidah tergeliat
2)staging and pathophysiology clubbing of finger
3)portal hypertension
4)SVC obstruction
5)Murphy's sign
6)find out right or left testis more descending?
7)type of tumor marker
8)tyhroid cancer
*has 4 type: papillary,medullary,follicular,endoplastic.
yg papillary is common while endoplastic plak was invasive and invade vigorously.
banyaknya nak kena stdy.. T_____T
tp bila weekend datang,mood nak stdy tu cket sebanyak terbantut..aiyooooo.
*mood: nak balik rumah.rindu rumah.rindu family.rindu nak tido atas katil sendiri.rindu nak jumpa aina.rindu kucing.rindu nak pegi pantai.senang cite,rindu nak balik besut and do all sort of things that i want to do.
