Friday, June 28, 2013

OT Time

Okay. So lets recall about yesterday.

1. We had bedside teaching with Mr.Islah yesterday at 2pm. We discussed on Ureteric stone. The patient presented with lumbar pain radiated to back, fever, as well as hematuria for 6 days. In this case, you have to rule out bladder carcinoma or renal cell carcinoma. Hematuria is a very alarming symptom in urology, so you have to do hematuria workout. Check the UFEME, Urine C&S and Cytology.

When you examine abdomen, you have to complete it by examining his back (scar, sacral edema, renal punch, spine abnormalities), inguinal (hernia) and groin region (scrotal swelling, hydrocele).

My friend who presented the case got 21/25 marks, even though he left a few points in history, and his chief complaints were inaccurate. Anyone who get Mr.Islah in exam would be so lucky!!

2. We watched four operations in the OT yesterday. First, the Cholecystectomy case where the gallbladder of the patient was removed due to stones. We saw Mr.Faizal hold the excised gallbladder and we saw several small black stones in it.

Secondly, the Upper Back Lipoma case, where surgeons excised the mass to get it out. I did palpate the lipoma, it was soft, rubbery, non-tender with well-defined margin and smooth surface, round in shape at the upper back of the patient. The size was about 8x8cm.

Thirdly, in the evening, we went to OT again to see Mr.Ahmad Faidzal operate on a patient who was electively admitted for Vascular Graft insertion. We didnt manage to see the entire operation, so we asked Mr.Faidzal about it. He drew us pictures and explained. Basically, you connect the loop graft with axillary vein and brachial artery. With artery, you have to connect it end-to-side, but you can do end-to-end connection with vein. You can use the graft to do dialysis. 

I clerked this pakcik Alias in the ward before his op. He was diagnosed to have End Stage Renal Failure in 1993, and he had made many fistulas on his arms, I think about four times. If you look at his left forearm, you can see scars (from fistula operation) and bumps (from the non-functioning fistula). And his right forearm, there were bumps too. It was sad to see so many scars there :(

And he had undergone parathyroidectomy years ago. Three of his parathyroid glands were removed and one was implanted under the skin of his left forearm! You cannot feel the gland but there was a small scar there. Parathyroid gland at your forearm, how cool is that!!

Then the last operation was Mayo repair on umbilical hernia. Yeah, we examined the patient too. The mass was felt inside the umbilicus, about 2x2 cm and it was soft (omentum).

It was our turn for on-call last night so we stayed after 5 and followed night round with Mr.Rudy. The most interesting cases were  of Infected Urachal Cyst and Orchiepididymitis.

I reached home at 11pm, took shower and slept like a baby. Hehe.

No comments:

Post a Comment