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:

#1
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!

#2
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!

#3
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!

8 comments:

eelainee said...

wow!!! interesting interesting!!! someone really enjoy medical huh...

ps: yes, he can fetch u... :p

Zzzyun said...

wow really interesting le.. they say uncommon presentations of common diseases are more than the common presentations of rare diseases haha..

ps: just wondering, abt the chest xray, can i ask why the left lung field is totally white? looks kinda weird..

Darren Lee said...

elaine: Ya medical is where I belong to..hehe

zzzyun: It seems that the left lung has collapsed. But believe it or not, this man doesn't complain of dyspnea, despite a collapsed lung and multiple cavitative lesions at the other. Really surprising.

Yew TW said...

siao! porphyria!! not sure whether i'll c one in my whole life.

Darren Lee said...

Yew: Huh? This is already the 2nd one I saw in Taiping..hehe

fooji said...

porphyria - actually got plenty one... but very few are true diagnosis. I've seen one patient who was treated as porphyria but hardly got better.

Thank you for the tips, Darren!

said...

hmmm...
keep in on..

Kelly said...

Porphyria!!! Never seen one and don't think i'd ever pick one

good to see u r enjoying Med!

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