Wednesday

My Second Patient ::Clinical teaching 2

Assalamualaykum... hai semua..!!! haha mood sangat baik sekarang..alhamdulillah sudah selesai pun 1st exam paper-TITAS. Now boleh focus untuk exam medic pulak. not so sikit..aduii laaa.. OOh yea, sudah pun selesai clinical teaching yg kedua~ haha.. meaning, student medic belum lagi kecutian yea. Doakanlah kami banyak-banyak yea..ameen!


So, nak oyak lah sikit-mikit pasal my second patient neh.. is a sharing what...this time i did history taking,not physical examination ..(tetibe rase malas nk belatih PE GIT huhuu....)

A 80 years old Malay Female, was diagnosed gastritis about 30 years ago, and has been known to be hypertensive on past 4 years, came to HUSM ,presented with localised right iliac fossa pain,11 hours prior to admission..

if talking about 'right iliac fossa pain' probably, doc will think of something may related to appendix, ovary. more specifically acute appendicitis or ectopic pregnancy or any tumor at organ in that region. but the thing is, actually, provisional diagnosis is intestinal obstruction.must be pain at lumbar or umbilical region. so, i think the patient maybe wrongly pointed her finger when i asked her which part of her abdomen  did she really  felt the pain? (hahaha ..sebenanye agak challenging tau nak ambil history disease dri patient kelantan yang agak terherot telinga Aena cuba faham dialek perkataan diorang..hoho..banyak ngomel tul budak neh.)


ok.knowing the disease:
intestinal obstruction(halangan pada usus) is a blockage of your small intestine or colon that prevents food and fluid from passing through. Intestinal obstruction can be caused by many conditions, but it's most often the result of fibrous bands of tissue in the intestine (adhesions), hernias or tumors.





Intestinal obstruction can result in an array of uncomfortable signs and symptoms, including abdominal pain and swelling, nausea, and vomiting. 


If left untreated, intestinal obstruction can cause the blocked parts of your intestine to die (become necrotic). This tissue death can lead to perforation of the intestine, severe infection and shock. However, with prompt medical care, intestinal obstruction can often be successfully treated.




Signs and symptoms of intestinal obstruction include:( Aena kasi sikit terjemahan lah sebab nak pembaca blog boleh ngerti n alert,kot-kot ada alami simptom/sign disease ni.learn the knowledge sama2 k!!!)
  • Crampy abdominal pain that comes and goes (intermittent)--(sakit kat abdomen kejap ada,kejap hilang,kejap rasa balik)
  • Nausea(pening2 rase macam nak muntah,tapi belum muntah..)
  • Vomiting or diarrhea(muntah2/cirit birit)
  • Inability to have a bowel movement or pass gas( tak boleh kentut!!)
  • Swelling of the abdomen (distention)-(ada kembung2/bengkak  kat kawasan perut/bawah perut)
  • Abdominal tenderness(rasa sakit kat kawasan abdomen)
  • Fever(demam laa..apa lagi maksudnye kan..)
ok , mesti ada yang keliru lagi kot, what actually abdomen really is???ok see this pic. bahagian tanda '+' tu lah abdomen yea..




so, When to see a doctor???? 
Because of the serious complications that can develop from intestinal obstruction, you should seek immediate medical care if you develop the signs or symptoms listed above...
note: dengan penuh ketar-ketar pukul 9.55 lari marathon ke HUSM(hosp USM), pergi naik lift untuk ke wad 7. bengang ramai gak. then,kat tingkat 3 ada orang masuk sembang2 menambahkan lagi ke'blurr'an daku. sampai2 dlm bilik kat wad 7, ohhh then doc came in. Oh my GOD!! he was in the lift just nw! dia sengih2 aja,n me lagi la sengih2..present macam ayam berak kapur je..ahahaaaa..

tata lah k~