20/03/09 Fri Week 6 of GI

Morning:
-2 cannulations---remember to adjust the position of the hand on 22G needle so that the flush back can be seen, remember to press at the end of the cannula after inserting! (today I pressed on the head and made a mess! :p )
-saw a patient with advanced Rheumatoid arthritis --＞ should revise RA...and hand exam, the patient also has a Ganglion cyst (the Bible bump).
-examine a VRE patient with decompensated chronic liver disease and chronic renal failure due to type II hepatorenal syndrome. He is not feeling very well but kindly let us had a look.

-Tute with Le Page:
1. DDx for painless jaundice---malignancy of the head of the pancreas
2. inguinalscrotal swelling: chronic---testicle(testicular tumour), epididymas( cysts of the epididymis, epididymo-orchitis), tunica vaginalis (hydrocoele, haematocoele), spermatic cord(hydrocoele of the spermatic cord)

-Examine a patient with swollen testis....this is the first time for me to examine a testis. There's a 2 cm firm mass and I couldn't appreciate the the underlying structure. The patient is very kind and willing to let us have a feel.

-GI meeting with lunch~ Thank God and GI department for the great food!
hepatorenal syndrome: Type I acute(rapidly rising serum creatinine and very poor prognosis) and type II chronic(slowly progressive deterioration). It's a functional renal failure due to extensive vasodilatation from advanced liver disease on a setting of ascites and hyponatraemia. It may be precipitated by infection (esp spontaneous bacterial peritonitis), diuretics, nephrotoxic drugs, GI bleeding or large-volume paracentesis.
Mx: monitor diuretic use and stop if hyponatraemia or renal impairment develops. IV albumin if undergoing large-volume paracentesis. Cirrhotic patients with GI bleed should be given prophylactic antibiotics. Nephrotoxic drugs(aminoglycosides, NSAID) should be avoided
-correct hypovolaemia and precipitants.
-if fail to improve---terlipressin(vasopressin analog which insert more aquaporin to reabsorb more water) AND albumin

Afternoon:
PBL-colorectal cancer and haemorroids
ECG tute-may need to revise the basic again and go the lecture nxt see whether I can do thoses correctly
Renal revision-acute and chronic renal failure! great revision

End of block party---great to relax and play table tennis!!! so fun!

Plan for the weekend:
1. revise RA
2. FBE, coag, U/E, LFT, TFT
3. AF, CCF, IHD, Cholesterol and obesity as topics!
4. GI final revision
5. Sunday---long case presentation, do another case. Print revision notes for neuro, renal
6. Neuro Exam!!!!! Neuro basic knowledge revision.
7. Last week respiratory topics: Asthma, COPD, DVT/PE
(sounds a bit ambitious, let's see how many can be achieved)