Thursday, January 29, 2009

Just an AGE? Not Really!

Weekend tagging is not easy. Have to do rounds of 2 wards, but on-call is even worse, covering the rounds of 4 wards. But luckily this tagging is coming to an end...31st is gonna be my last-day tagging!

I remember there's this case during weekend round, my houseman presented to me, "This patient just came in this morning, complaining of vomiting and diarrhea for 1 day. Currently treated as acute gastroenteritis (AGE) with mild dehydration. Otherwise he's stable." I think if I were really in rush, and fully trusted him, I'd have missed something big.

Luckily I didn't. I took a look at the abdominal Xrays and ya, you know what it is.

Multiple fluid-levels seen.

And really dilated small bowels!
Just an AGE? He's having intestinal obstruction! A surgical referral was made and patient's planned for emergency op.
So the moral of the story, must see the patient by yourself!

Wednesday, January 14, 2009

Chronic Symptoms...Don't Overlook!

Sorry for the lack of updates. Tagging period is really tiring!
Just to share some thoughts...from the cases that I came across recently:

A lady who had an appendicectomy done, having recurrent admissions for abdominal pain, treated as adhesion colic but symptoms never really improves despite adhesiolysis done twice and analgesic treatment over 2 years. Somehow she got to be admitted to medical ward. You wanna know what's the diagnosis? Porphyria. Solved the myth of her chronic abdominal pain!

A young female with history of bronchial asthma, having multiple episodes of exacerbations (with a normal-looking chest Xray) despite stepping-up of treatment. Finally someone sent the sputum for acid-fast bacilli. She's got pulmonary tuberculosis!

This man with chronic right hypochondriac pain, admitted before and ultrasound abdomen showed no abnormality. Not much of respiratory symptoms though. But when he came again, a simple chest Xray was done:

Multiple right lung abscess! And it's the right basal one which causes the diaphragm irritation hence the RHC pain.

There are many more instances. The simple message is, there are always atypical presentations of diseases. So, do not overlook chronic symptoms!

Saturday, January 03, 2009

Why Hypoglycemia?

A 70 yr-old man was admitted for hypoglycemic attack. So I was asking his wife the history.

Me: "Is he on insulin or oral medication?"

Pt's wife: "He's on insulin. I'm the one who give him injection coz he can't see."

Me: "Then what happened actually?"

Pt's wife: "I also dunno la...yesterday he didn't take his dinner coz he said no appetite, then at night after I gave the insulin injection, this morning he's unresponsive!"

Me: "Did you do anything then?"

Pt's wife: "He usually wakes up early at 6am. Today he slept until 9am! I just let him sleep...waiting for him to wake up..."

Me: "Then he regained consciousness at 9am...then what did you do?"

Pt's wife: "Oh I scolded him, aiya why today you slept until so late? I'm waiting for you to wake up ah! You're late for your morning insulin injection already!"

Me: "THEN?"

Pt's wife: "Then I injected him the morning insulin...then he fainted again!"

Me: "......"

Diagnosis: Hypoglycemic attack secondary to...his wife! ;)

See this is a real example of diabetic patient with inadequate education on insulin use.
The patient probably suffered a hypoglycemic attack since last night due to missed meal, so long only he regained consciousness this morning and he was "induced" another hypoglycemic attack! I really pity the old man.

p/s: Certainly I'm not blaming the's us who didn't give enough patient education!

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