Clerked a paraplegic female patient in the orthopaedic ward today. She sustained multi-level fractures of the vetebral column due to a fall from a 2-storey building. She's paralysed from the waist down. Besides urinary and faecal incontinence, she can't walk. Can't stand. And no more sensation.
My heart was deeply touched by her optimism. She answered our questions (even silly ones) very patiently, with a broad smile, making our history taking very smooth-sailing. And she allowed our untrained hands to examine her.
She's just 30. A very jovial and chatty young lady, despite the situation she's in. And yet she's bed-ridden. I could see from her eyes that she missed her home, her family, her siblings. I don't know if she'll be able to recover from her injury. My heart felt sour. Before leaving, I said a prayer to God, hoping that she'll regain the ability to walk.
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I had a bad dream. Dreamt that my father was diagnosed with hepatocellular carcinoma (liver cancer). It woke me up at 3.30am. Ha. What a relief! It's only a dream.
Monday, June 23, 2008
Sunday, June 22, 2008
Exams
schI'll be sitting for an OSCE (observed standardized clinical examination), a written test and viva voce at this end of this week, which'll mark the end of my first posting (Introduction to Clinical Medicine and Radiology) in third year.
Tests. Tests. Tests. I don't know how many tests or papers I've sat for since I was in kindergarten. I have a phobia about tests. And I got myself into an undergraduate program in which doing well in examinations is almost everything. Passion and interest alone would definitely not suffice.
The day before a test (even a minor one) is always a nightmare. I experience dyspnoea and palpitations. I feel drowned in helplessness and suffocated by tension. It feels like I've studied everything within the scope, and forgotten 90% of it. That's the scariest part. I panic. I call my mom to ask her to pray for me. I sms my close friends for solace and comfort. And I wish I had a boyfriend to talk to. Sigh.
Nevertheless, third year is quite fun. Less lectures. Lots of ward work. At least, I don't fall asleep during ward work.
I'd better get back to studying. Hope things will be fine. Look forward to my next posting, which'll either be medicine, surgery or Obstetrics & Gynaecology.
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The juniors will be coming in soon. Heard that one of them is gonna occupy my room, which is still short of one occupant. I'm keeping my fingers crossed that he'll turn out to be a cute twink, and gay. LOL. I've been feeling quite lonely lately. I seriously need some accompaniment (in any form). Heh.
Tests. Tests. Tests. I don't know how many tests or papers I've sat for since I was in kindergarten. I have a phobia about tests. And I got myself into an undergraduate program in which doing well in examinations is almost everything. Passion and interest alone would definitely not suffice.
The day before a test (even a minor one) is always a nightmare. I experience dyspnoea and palpitations. I feel drowned in helplessness and suffocated by tension. It feels like I've studied everything within the scope, and forgotten 90% of it. That's the scariest part. I panic. I call my mom to ask her to pray for me. I sms my close friends for solace and comfort. And I wish I had a boyfriend to talk to. Sigh.
Nevertheless, third year is quite fun. Less lectures. Lots of ward work. At least, I don't fall asleep during ward work.
I'd better get back to studying. Hope things will be fine. Look forward to my next posting, which'll either be medicine, surgery or Obstetrics & Gynaecology.
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The juniors will be coming in soon. Heard that one of them is gonna occupy my room, which is still short of one occupant. I'm keeping my fingers crossed that he'll turn out to be a cute twink, and gay. LOL. I've been feeling quite lonely lately. I seriously need some accompaniment (in any form). Heh.
Wednesday, June 18, 2008
Oesophageal varices
Portal hypertension, a state where the pressure within the portal hepatic vein is increased, causes dilated veins (varices) of the portosystemic anastomosis. Varices most commonly occur in the lower oesophagus and hence are called oesophageal varices. The enlarged veins may rupture, leading to severe upper gastro-intestinal bleeding (UGIB).
Clerked a patient, who's a chronic alchoholic and smoker of more than a decade, who'd been diagnosed with oesophageal varices.
There's hepatomegaly. I could palpate the lower border of the liver about 3.5 cm below the costal margin. And the percussion note was dull in the 4th right intercostal space. The consistency was hard and there was no tenderness. The yellow discoloration of his sclerae revealed the presence of jaundice. I thought of liver cirrhosis as the underlying cause of the varices in this particular patient. Yet, of course, I couldn't be sure. It was a mere guess, but a logical one. Am still far from being qualified to make a diagnosis anyway.
Causes of portal hypertension:-
prehepatic:portal vein thrombosis, splenic vein thrombosis
intrahepatic: cirrhosis, schistosomiasis,sarcoidosis
post-hepatic: right heart failure, constrictive pericarditis.
- - - - - - - - - - - - - - - - - - ... .....--------
I bumped into Dr. Aaron twice today!! My heart missed a few beats. The first encouter was in the male medical ward when I was doing history taking ( my history taking became very disorganized in the end) and the second on the staircase.
Clerked a patient, who's a chronic alchoholic and smoker of more than a decade, who'd been diagnosed with oesophageal varices.
There's hepatomegaly. I could palpate the lower border of the liver about 3.5 cm below the costal margin. And the percussion note was dull in the 4th right intercostal space. The consistency was hard and there was no tenderness. The yellow discoloration of his sclerae revealed the presence of jaundice. I thought of liver cirrhosis as the underlying cause of the varices in this particular patient. Yet, of course, I couldn't be sure. It was a mere guess, but a logical one. Am still far from being qualified to make a diagnosis anyway.
Causes of portal hypertension:-
prehepatic:portal vein thrombosis, splenic vein thrombosis
intrahepatic: cirrhosis, schistosomiasis,sarcoidosis
post-hepatic: right heart failure, constrictive pericarditis.
- - - - - - - - - - - - - - - - - - ... .....--------
I bumped into Dr. Aaron twice today!! My heart missed a few beats. The first encouter was in the male medical ward when I was doing history taking ( my history taking became very disorganized in the end) and the second on the staircase.
Tuesday, June 17, 2008
Cholecystitis
Chronic cholecystitis with cholelithiasis
Rushed to the male surgical ward right after a boring lecture on bedside manners and decorum. Haih. The environment has forced me to become 'kiasu' these days. I can't help it. I just want to survivie.
Found a case on cholecystitis (inflammation of the gall bladder) caused by cholelithiasis.
Acute cholecystitis follows stone or sludge impaction in the neck of the gall bladder (GB), which may cause continuous epigastric or RUQ pain referred to the right shoulder, vomiting, fever, local peritonism or a GB mass. If the stone moves to the common bile duct, obstructive jaundice and cholangitis may occur.
I was able to palpate a mass in the epigastrium of this particular patient. Tried to elicit the Murphy's sign too. I laid 2 fingers over his RUQ, asked him to take a breath, which I knew would cause pain and arrest of inspiration as his inflammed GB impinged on my fingers. Well, his face did crumple up. Yet, I wasn't sure if what I saw was a Murphy's sign.
Gallstones are the notorius cause acute and chronic cholecystitis. Other complications of gallstones in the GB include biliary colic ( occurs when gallstones become symptomatic with cystic duct obstruction or by passing into the common bile duct), empyema, mucocoele and carcinoma. Whereas, gallstones located in the bile ducts may lead to obstructive (acholuric) jaundice, pancreatitis and cholangitis.
Monday, June 16, 2008
Inguinal hernias and cute MO
SureClerked a patient with right-sided reducible inguinal hernia today.
Basically, hernia refers to any structure passing through another and ending up in the wrong place. Indirect inguinal hernias pass through the internal inguinal ring and if large, out through the external ring. During the embryonic development, the testis is led down from its original position in the posterior abdominal wall into the scrotum by the gubernaculum. Hence, if the connection between the peritoneal cavity and the tunica vaginalis fails to close behind the testis, there'll be a patent processus vaginalis. It's through this that an inguinal hernia occurs. Indirect hernias are more common (80%) and chances of strangulation are high as the external inguinal ring is very narrow.
Whereas, direct hernias push their way directly forward through the posterior wall of the inguinal canal, into a defect in the abdominal wall. Predisposing conditions include chronic cough, constipation, urinary obstruction, heavy lifting, ascites and previous abdominal surgery ( damage to the iliohypogastric nerve during appendectomy).
To distinguish a direct from an indirect inguinal hernia, reduce it and occlude the internal inguinal ring (mid-point of inguinal ligament) with 2 fingers. Then, ask the patient to cough or stand -- if the hernia is restrained, it is indirect. If it pops out, it is direct.
Hmm. A medical officer talked to me in the surgical ward. Dr. Aarron. A pleasant surprise. He's kind of cute. I'm not sure of his race. He took the first move to talk to me thrice. I literally tagged along him while he was doing his ward round. I'm gonna linger in the surgical ward tomorrow!!!
Basically, hernia refers to any structure passing through another and ending up in the wrong place. Indirect inguinal hernias pass through the internal inguinal ring and if large, out through the external ring. During the embryonic development, the testis is led down from its original position in the posterior abdominal wall into the scrotum by the gubernaculum. Hence, if the connection between the peritoneal cavity and the tunica vaginalis fails to close behind the testis, there'll be a patent processus vaginalis. It's through this that an inguinal hernia occurs. Indirect hernias are more common (80%) and chances of strangulation are high as the external inguinal ring is very narrow.
Whereas, direct hernias push their way directly forward through the posterior wall of the inguinal canal, into a defect in the abdominal wall. Predisposing conditions include chronic cough, constipation, urinary obstruction, heavy lifting, ascites and previous abdominal surgery ( damage to the iliohypogastric nerve during appendectomy).
To distinguish a direct from an indirect inguinal hernia, reduce it and occlude the internal inguinal ring (mid-point of inguinal ligament) with 2 fingers. Then, ask the patient to cough or stand -- if the hernia is restrained, it is indirect. If it pops out, it is direct.
Hmm. A medical officer talked to me in the surgical ward. Dr. Aarron. A pleasant surprise. He's kind of cute. I'm not sure of his race. He took the first move to talk to me thrice. I literally tagged along him while he was doing his ward round. I'm gonna linger in the surgical ward tomorrow!!!
Sunday, June 15, 2008
When'll you come back?
Gor has gone to Singapore to meet his boyfriend. So, obviously he's not replying to my sms-es.
We've been sms-ing each other a lot since March 2008. He's probably the only person who's willing to listen to all my craps. Haha. Really appreciate him for his patience.
It feels weird not receive his sms-es these few days. My phone rarely rings. And when it does, I wish it's him.
Gor, when'll you come back?
We've been sms-ing each other a lot since March 2008. He's probably the only person who's willing to listen to all my craps. Haha. Really appreciate him for his patience.
It feels weird not receive his sms-es these few days. My phone rarely rings. And when it does, I wish it's him.
Gor, when'll you come back?
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