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!

14 comments:

Zzzyun said...

hey, havent been commenting for a long time. been really busy trying to settle down in perth and finding a place to stay!

anyway just wondering, did the houseman made that AGE diagnosis after seeing that Xray? coz it does look pretty abnormal to me...

Darren Lee said...

zzzyun: Oh actually he didn't. So we both got a shock when look at the Xrays..hehe.

Oh you started you new sem! How's life in Perth?

Liam said...

the moral of story should be, never trust ur houseman, their eyes only see what contain in their brain(usually houseman brain is blank), so, u need to train them well...

peanut said...

i thought xrays should be the favourite thing to look at when inside the wards.. the gas is obvious. =P

Jing said...

liam... i dont think all housemen are that brainless mmm... anyways... that's a damn nice xray of small IO...

Darren Lee said...

My that HO is actually quite ok..(considered better than others)..so i think he just missed the Xrays.

But anyway, ya the Xrays are so classical! In fact i've not come across such images even when I did my surgical posting. Really like those in the textbook!^^

Anonymous said...

Everyone starts from somewhere at the base, and it is from experiences & mistakes that we learn & gain more. I am very sure the houseman will be extra cautious when he/she is dealing with cases the next time =) It's a good one, Darren.

Zzzyun said...

hey Darren, yeah tmr will be my 2nd week here in Perth ade. Still trying to adjust, so many things tat are different compared to msia.. we hv like 2 weeks of preparations for clinicals sort of classes b4 we start actual rotations. oh no! haha

PS: yeah i wud say the xrays are rather typical...i used to wonder where are the air-fluid levels they always talk abt haha..

Darren Lee said...

Anonymous: Ya what you said is certainly true. Everyone learns by experiences and mistakes! and ya I think the HO learnt from this case too;)

zzzyun: Oh i'm sure you have no prob adjusting to it..all the best in your study and enjoy your clinical years!

ANNE said...

doctor into the rescue!!

MedicBoyz said...

just onr query, y dun any MO seen the case before?
did they also miss the big picture?

Darren Lee said...

Medicboyz: Oh hmm it's seen by a MO before..but then only the Xrays were done..so not considered missed i think..

kucau said...

ermmm, was there any particular reason for the xray done despite the AGE diagnosis? What was the reason for IO

Darren Lee said...

kucau: The IO is secondary to an obstructed inguinal hernia.

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