Alhamdulillah....

Assalamualaikum hamba2 Allah sekalian...

Alhamdulillah, bersyukur ke hadrat Ilahi, kerana dgn limpah kurniaNya, pd 21/12/2011, hari Rabu yg lalu, maka berakhirlah posting SURGERY I dlm thn ni...myb dengan izin Allah, sy akan berjumpa posting itu lg di thn 5...
post kali ni nak ceritakan psl exam yg lps...
exam posting surgery start 19hb dgn paper PBQ (problem-based question) n OSCE..that was not the thing i worried about...
clinical exm was held on 20th n 21st but bcoz of i was in the last cycle, so my turn was on 21st...
sgt jeles ok tgk org lain dah hbes exm, sy terkontang-kanting-kebingungan dlm bilik bukak buku..(ke mukabuku??hehehe~~)
sgt berdebar n sgt mendoakan yg kes yg sy akan dpt adalah kes yg boleh sy present dgn baik n jawab dgn bagus...
but Allah is the best Planner...
He Knows everything behind of sumtg bcoz He created it...


Firman Allah dalam surah Al-Baqarah ayat 216 :

...boleh jadi kamu benci kepada sesuatu padahal ia baik bagi kamu dan boleh jadi kamu suka kepada sesuatu padahal ia buruk bagi kamu dan (ingatlah), Allah jualah yang mengetahui (semuanya itu), sedang kamu tidak mengetahuinya.

pd hari tu, sy dpt case "A 39-year-old gentleman with ABDOMINAL DISTENSION fot the past 9 month"...
mcm ni la ley kurang keadaannya...

~jgn ckp pregnant plak erkk..~

we call it ASCITES (ES-SAI-TIS) --> siap bg cara nak pronounce lg..huhuhu~~

org yg ada ascites ni selalunya dia ada underlying disease such as Liver cirrhosis, Chronic Liver Failure, Hepatocellular Carcinoma, TB, Pancreatitis, Heart problem, Peritoneal Carcinomatosis and etc...

But ditaqdirkan, my case was a lil bit hard for me (i said it again FOR ME) bcause my patient had no any signS n symptomS of the diseases such as jaundice, flapping tremor, scratch mark, spider naevi, chest pain, gynaecomastia, grey-turney sign, caput medusa and so on...

i suspected he had either TB or hepatocellular Ca..
i said it TB point for he had history of contact with TB patient which is his aunt n his aunt currently had the same problem like him...Hepatocellular Ca bcoz he had loss of appetite and loss of weight but points against are no signs of liver disease...

there were so many questions have been asked from the surgeons, Miss H n Dato' J..

n i dunt think i gave them good answers though..hahahaha~~~

some of the questions had never across my mind before..

~ibarat lautan question marks la time tuhh~

such as :

1- how do you know the blood flow of the dilated vessels are going up or down?what test would u like to do??? (blurrrr................) i just replied : i think it's going up because a vein will drain up to the heart...(gelak sendirian..) then they replied back : ok, what kind of test to confirm your answer?? (blurrrr lg...amek kau!!)

2- how do you know this patient is cachexic? i replied : prominent ribs, mucle wasting (muscle kat muka tp x igt nama muscle..sengal, dulu selalu ja sebut...TEMPORALIS MUSCLE ceqq oiii...) then stop....blurrrr lg..

asked again : what muscle??? alamak...nsib baik urethral sphincter masih kukuh..kalau x... siap tya intrinsic muscle kt tgn lg ok.......(suram-sunyi-sepi..................................)

3- masalah position of umbilicus pon menjadi kontroversi sekejap di situ....malas nak tulis...hahaha~~

4- stoma bag sy cakap tapping bag..bertambah lg kontroversi di situ....stoma bag ada fluid + blood ja...kalau ada feces bley la sy hentam stoma kann even x penah tgk...hahahahaha~~~ 

5- Mcm mana kalau u nak expalain kt superior u yg ini adalah ascites yg teruk? i replied : he had gross ascites, with SOB bla3....(menggoreng adalah kepakaranku...) Dato' J : ok.then??anythg else?? i replied : errrr....??? jwpn yg dato bg : gross ascites, SOB, tensed skin, SHINY SKIN.......

6- dan BANYAK LAGI...SEKIAN..............................

~ok x la sehodoh seteruk ini...~

tapi, bila difikirkan balik, Allah tu Maha Mengetahui...
Dia tahu sy x pernah clerk case Ascites so Dia bg sy kes nih...

mmg sy sgt appreciate bnda nihh...

bnda baru yg sy dpt :

1- positive fluid thrill... yg dulu selalu practice tipu2 ng kwn2, akhirnya, dpt buat btul2...susah nak ada kat ward...seriously, sgt2 Alhamdulillah...

2- HARVE'S SIGN (i dunno how to spell it even i've googled it...) bnda ni diajar oleh miss H setelah hbes exm sy..sgt menakjubkan subhanallah...ini la test yg nak confirm blood flow tu...aiiyyoooo...hahaha~~

3- dpt tgk stoma cmna...

4- dpt tau how displaced umbilicus is...

5- dpt tgk GROSS ASCITES itself....

6- dpt tahu how to describe the severity of the ascites when it comes to explain to the superiors...

7- byk lg utk disenaraikan di sini...

Mak selalu pesan, kalau sakit baca doa ni...Doa Nabi Ayyub ketika jatuh sakit dalam surah Al-Anbiyaa ayat 83...siap suruh hafal la2 tu jugak...comel la mak i nihh...huhu~~Insyaallah dikurangkan kesakitan tu...

Al Anbiya : 83 : (Ya Tuhanku), aku ini tengah ditimpa malapetaka (penyakit) dan Engkau adalah Tuhan yang Maha Penyayang diantara semua penyayang.

May Allah grants us a good result for this posting...amin ya Rab....

ppssttt...currently, dah jumpa mak abah..hoooraayyy!!!rindu sudah terlerai..kott???nak lama lg plzzzz....surprise menjadi!!nnt sy cerita lain..(mcm org lain kesah sgt kan??perasan..hahaha~~)