An Emergency Exploratory Laparotomy

>> Sunday, November 30, 2008

Yesterday we had a stat exploratory laparotomy on one of the in patients who underwent an elective "Ex-Lap" for a take down colostomy around 4 to 5 days ago. She was a high risk patient because around 2 to 3 days post operatively she suffered a myocardial infarction at the wards. She was then eventually transferred to the ICU.

The reason for the stat exploratory laparotomy was she was noted to have a wound dehiscense and aside from that her bowels were noted to be dilated. She was then brought to the OR for the procedure. Upon opening her up, I noted her bowels to be really dilated from the small intestine down to the large intestine. Adhesions were noted all over the place. Eventually decompression was done and closure of the wound dehiscense was done. After the operation she was eventually brought back to the ICU were close monitoring was done. This morning prior to me going home, I passed by the ICU to check his condition, she was eventually awake and would just communicate by nodding to some of my questions. Hopefully she would improve in the coming days. Pleasant Day


An Emergency Craniotomy

>> Friday, November 28, 2008

This morning I was supposed to be assigned to assist on a cholecystectomy case. Unfortunately I arrive in late, and someone already was put in my place. I went back to our quarters to return my scrubs, one other intern then informed that the was a cranial bleed case in the ER and my residents are already there. So I jumped and went to the ER. Upon reaching the ER, I noted that the patient intubated in the ER was just discharged from the hospital yesterday.

He was a 23 year old male who was previously admitted at our institution due to a vehicular accident around 2 weeks ago. He was hit by a dump truck and was immediately brought to the ER. During his stay at the hospital, he underwent a craniostomy due to a bleed in his brain. Yesterday, he was doing ok with stable vital signs and was already discharged. Unfortunately around 2 in the morning, according to his relatives, he started to complain of severe headache and his condition continued to detoriorate and he was immediately rushed to the ER. At the ER, a repeat CT scan was done reveling an intracranial hemorrhage and a stat craniotomy for evacuation of hematoma was done.

I again rushed to our bed quarters and grabbed my scrubs then went directly to the OR. Patient was immediately brought to the OR and his brain was cut opened. Intraoperatively around 5 to 6 big clots were noted on the right side of his brain and was immediately removed. A part of his skull was removed and was scheduled to placed again some other time to relieve brain pressure. After the operation he was then admitted to the ICU. Hopefully his status will improve in the coming days. Pleasant Day.

The CT scan above was somewhat the same as the repeat CT scan of the patient mentioned above.


Infected BIG Toe

>> Tuesday, November 25, 2008

I m assigned to the OPD today since I m just on pre duty status. We only met a couple of patients, most were follow ups. I grabed one folder and the chief complaint labeled as swelling of the big toe. Then I called out on the patient, then there was this little boy who went towards me. Then I asked the parent what happened, she said the a week ago, her child accidentally stepped on a broken piece of glass which caused a puncture wound on his right big toe.

Unfortunately, after being punctured the boy was not brought to a hospital for tetanus shots and a simple cleaning of the wound was done. Yesterday, according to the mother, the big toe started to swell and started to turn red. Pain was also noted upon touching the affected part. Upon careful examination, a pus was already noted aroung the wound site. Incision and drainage was then advised to the patient which the patient, crying, complied. A 2 cm incision was done which produced outflow of the pus inside. Patient was then prescribed with antibiotics and daily wound care was instructed. He is to come back next week and hopefully his big toe wont be that engorged due to infection so that he can walk straight. So guys be careful of little pieces that causes a break in your skin, who knows they might caught a local inflammation and eventually an infection. Pleasant Day

The picture above was somewhat the replica of the patient's big toe.


Bone Flap Placement

>> Monday, November 24, 2008

Another tour of duty in surgery has ended and we had a total of 4 admissions yesterday. We had a 25 year old male who underwent craniotomy (removal of a part of the skull) 5 weeks ago due to a bleed in the brain secondary to a vehicular accident. He was admitted for placement of the part of the skull which was earlier removed.

When we visited the patient, he was currently eating and was doing ok. No signs of any deficits were noted and he was even speaking well. The only striking part in him is that the right side of his head is somehow deformed due to the absene of a skull part in that region. He is scheduled this afternoon and hopefully by tomorrow when I see him again hopefully his head won't be deformed anymore. Pleasant Day


Mesothelioma - A Deadly Occupational Disease

>> Friday, November 21, 2008

Mesothelioma is a type of cancer which is caused when a person is expose to the chemical asbestos. It affects the mesothelium which is a protective lining of the pleural cavity. People affected or people who harbor this deadly disease are people who work or are exposed to asbestos in their workplace. Symptoms are usually chest pain, shortness of breath and other systemic manifestations. More information regarding mesothelioma can be viewed at Mesothelioma Information

Compensation among workers exposed to asbestos is an important issue in mesothelioma. Families of affected workers should be educated and should be properly instructed on how to file for compensation. Mesothelioma is a group of lawyers dedicated in handling mesothelioma cases. They provide important details not just for mesothelioma cases but also important details on the disease itself. They have a wide range of lawyers for you to choose from in whom you think will best represent you in your case. For a more detailed information visit Mesothelioma


A Morning of Mourning

>> Thursday, November 20, 2008

Prior to ending my last tour of duty in Surgery, we had 2 mortalities. Both of them died at the ICU and both of them almost expired at the same time, maybe just seconds in between.

The first to expire was a 70 year old female who underwent right sided hemicolectomy (removal of the ascending colon) due to a mass. During the previous afternoon, her lung finding were starting to get congested with note of crackles all over the lung field. Patient was intubated in the ward and was eventually transferred to the ICU. She was there the whole night closely monitored, until around 5 in the morning, she arrested. She was initially resuscitated but to no avail and eventually expired after an hour.

The second mortality we had that day was a 9 month old baby boy who suffered from severe pneumonia. He was admitted the night prior and he was referred to our service for CTT (chest tube thoracostomy) insertion due to a pneumothorax. CTT was eventually inserted at the ER and he was also admitted into the ICU. He was also closely monitored through out the night until aroung 5 to 5:30 in the morning his vital signs started to fall. Resuscitation was done but to no avail and was pronounce dead just after a few seconds after the first patient died.

Today I m on duty again and I dont want to see any mortalities today. Hopefully there would be none. Pleasant Day


Fusion Of The Spine

>> Tuesday, November 18, 2008

Yesterday I was assisted in a spinal surgery because of a fracture located at the level of the lumbar spine (L2 - L4). The patient was a 23 year old female who suffered a vehicular accident 3 days ago and she was hit by a car on her hip area. X ray and CT scan done revealing a fracture in the lumbar area of her spine.

Our spine or vertebral column is composed of 5 parts namely the cervical, thoracic, lumbar, sacral and the cocyx. The lumbar area is located just below the level of our navel. For our patient she suffered a burst fracture at that area. The surgery lasted for 2 hourr. After opening the patient, the lumbar spine affected was identified and 4 screws were inserted into the 4 corners then it was connected by a titanium rod and was eventually locked. The screws inserted really looked good on xray. Hopefully the patient will be back being able to do his normal routine activites and forget the nightmare of the accident. Pleasant Day

The above picture is an example of what was done to the patient at yesterday's operation


Appendicitis - An Acute Stomach Pain

>> Saturday, November 15, 2008

Another tour of duty ended and we only had 1 admission yesterday. She was a 28 year old female who came in with a chief complaint of right lower quadrant pain of the abdomen. So I interviewed the patient for her medical history and did a physical exam on her. On palpation of the abdomen, you could really see her face distorted whenever the right lower quadrant part of the abdomen was palpated. She was eventually admitted with and impression of Acute Appendicitis and was scheduled for a stat appendectomy. True enough, the appendix was noted in its suppurative stage upon opening the patient. The operation run smoothly

The appendix is a blind ended tube located in the transition from the small intestine into the large intestine. Apparently the appendix has no function in the body but some sources say that it is a lymphoid organ early in life. For patient's with acute appendicitis the only cure is to go for surgery. Surgery should be done to avoid complications like a ruptured appendix which could contaminate the gastrointestinal tract and create peritonitis.

The patient this morning was all smiles, her abdominal pain remove, maybe she would be out of the hospital by tomorrow. Pleasant Day.


Eroding Your Anal Canal

>> Thursday, November 13, 2008

I just came home from the hospital and from attending a pre-operative case presentation. The case presented was a 65 year old female presenting with a rectovaginal fistula. She was complaining that some feces are passing out of her vagina. She had noted a mass in her anus for quite a long time. On physical inspection her anal canal is really eroded to the point she hasn't any bowel control.

She was eventually admitted at our institution and a 4 quadrant biopsy was done. The biopsy done revealed anal carcinoma. The surgery team is currently preparing the patient for a major operation (abdominopelvic surgery). Hopefully she will improve after surgery. I was looking at the picture of the patient's anal area and it was a major devastation. Just wondering how she was on her daily life, I mean doing her regular things like eating, taking a bath, going to the comfort room etc. It should really be hard for her having an eroded anal canal, even doing the daily routine stuff. Hopefully after surgery life would be better for her.

It was also mentioned that low grade tumors have a good prognosis, that you can sometimes go for cure. Good prognosis is noted if the cancer is detected early and you can even opt for cure if the needed intervention is given early. So if you think you have some not normal symptoms, visit your friendly doctor, you might save a lot of difficulties in the future. Pleasant Day


Stab Wound Patient

>> Wednesday, November 12, 2008

Yesterday we met a sixteen year old male patient who came in due to a stabbed wound on his left flank area. He came in the ER limping in his school uniform with no signs of any blood in his clothing, so I taught he had just another injury probably from playing basketball from school. So I approached him and asked what happen, then he told me, he was stabbed by a kitchen knife. After hearing this, my eyes somewhat enlarged, I told the ER resident that we have a stabbed wound patient and the patient was eventually hooked to IV fluids.

Although he was stabbed, his vital signs were stable, so I started to ask for his history. He came out of his school campus for a break but someone from another school attacked him and stabbed him from the back with a kitchen knife. The assailant was eventually captured and brought to the police authorities. I asked him what prompted the other guy to stabbed him, and he gave me a smile telling me that its because of a girl he was courting. It made me laugh, somehow, people really do crazy things for love.

On physical examination, aside from the stabbed wound, he has a big hematoma surrounding the wound. An xray and ultrasound was done to rule out any injury or bleeding inside. After that, my residents did wound suturing and evacuation and exploration of hematoma. The patient was eventually admitted. Before going home, I check out his chart and noted that he was doing ok with stable vital signs. People really could kill because of love. Pleasant Day.


Crohn's Disease: Your Bowel Is All Inflammed

>> Monday, November 10, 2008

One of the disease which I discussed during my presentation of the colon was the inflammatory bowel disease, Crohn's Disease. Crohn's Disease is an inflammatory disease which can involved any part of your digestive tract from the mouth down to your anus compared to Ulcerative Colitis (another inflammatory disease) which only affects your colon and your rectum.

Crohn's disease is a type of disease which is very nasty and can really make your life hard. This type of disease causes the lining of your digestive tract to be inflammed which could cause you to have severe diarrhea or severe abdominal pain. This involves the whole thickness of the digestive tract unlike the other inflammatory disease which only involves the upper 2 layers. Other symptoms aside from the two mentioned above include weight loss, bloody stool, ulcer formation, and fistula formation.

Currently, medications are targeted on the different symptoms presented by the disease and currently there is no medical cure for the disease. With advances in technology, treatment is targeted on relief of symptoms and usually they could also give life time remissions that people with this disease could continue with their normal life. When presented with the aboved mentioned symptoms, don't hesitate to consult your friendly doctor, who knows you might have the dreaded Crohn's Disease. Pleasant Day.

The above picture in an endoscopic view of a colon with Crohn's Disease.


Poor Baby Got Bleed

>> Sunday, November 9, 2008

Yesterday's tour of duty was somewhat a little benign inspite of the fact that I don't have my clinical clerks. I had a total of 3 admissions with 2 referrals. One of my admissions suffered a ruptured abdominal aneurysm, a stat abdominal aneurysm repair was done, unfortunately during the operation, no blood was available and the patient eventually suffered a cardiac arrest on the operating table and eventually expired.

My last admission was a bouncing 3 year old boy who suffered a lacerated wound on his parieto-occipital area due to a fall. He was playing with his older sister when he slipped and fell hitting the cabinet which cause the laceration. In the ER, he was bleeding profusely at the back of his head. He was for wound suturing unfortunately he was agitated and resisted. Because of this the patient was eventually admitted for wound suturing under IV sedation. Poor baby, aside from being irritable all night, some blood was still gushing out of his lacerated wound at the back of his head.

After this admission, I had a dose of 2 hours of sleep, woke up had breakfast and I am homeward bound again. Pleasant Day.


Pain: The 5th Vital Sign

>> Friday, November 7, 2008

I saw this poster at one of the clinics at the medical arts building saying that pain is the 5th vital sign. It made me smile and told myself there is truth on what the poster says.

When a patient arrives in the ER, vital signs are usually taken and recorded. This includes blood pressure, temperature, cardiac rate, and respiratory rate. One can add pain to this 4 signs. In my current rotation which is Surgery, we receive ER referrals regarding patients suffering from abdominal pain. They usually want it evaluated by the Surgery resident before sending someone home. In dealing with a patient presenting with abdominal pain, pain is the most significant guide on whether you would operate on the patient immediately or you can still have room for observation. Usually, patients are recommended to be admitted for the sake of observing if the pain would progress or if it would resolve on its own.

Whether dealing with acute appendicitis, cholecystitis or other pain causing conditions, aside from the 4 vital signs mentioned above, one can add the vital sign “Pain” to be included in one’s monitoring of a patient.


Milking the Colon

>> Wednesday, November 5, 2008

We have another patient for daily colonic irrigation. He is a 4 year old likely to have Hirschsprung's disease. The attending ordered daily colonic irrigation prior to his rectal biopsy by tomorrow. The irrigation was done prior to lunch and it somewhat took away my appetite, seeing all those feces go out of a red tube.

Hirschspurng's disease is a condition wherein ones colon or large intestine is devoid of ganglion cells (a type of nerve cell). The patient would usually present with chronic constipation and their bellies eventually enlarged. The stools stored in the colon don't move towardd the anal canal because the colon is not doing its peristalsis thing because its devoid of the above mentioned cells. That's why sometimes you have to do manual evacuation of the feces to relieve symptoms

Hopefully his rectal biopsy tomorrow would turn out to be negative so no surgical intervention may be needed. Hirschsprung's Diseas is a congential condition which is needed to be address as soon as possible. Pleasant Day.

The above picture shows that patient's with Hirschsprung, usually present with a bloated abdomen due to accumulation of feces.


Colorectal Carcinoma – Bowel Habits Won’t Be The Same Again

>> Tuesday, November 4, 2008

Currently in my rotation in the department of Surgery, I was assigned by a surgery consultant to do a report on the topic of Colon, Rectum and the Anus. Actually I already presented half of my report. Now let’s take a look at the malignancy which involves the topic assign to me.

Colorectal Carcinoma is the most common malignancy of the gastrointestinal tract. The incidence among men and women has stayed the same over the past 20 years. Early detection along with improvements in medical and surgical care are thought to be responsible for the decreasing mortality of colorectal cancer observed in recent years.

Symptoms of the above carcinoma usually includes abdominal pain, pelvic pain, anorectal pain (painful bowel movement), fecal incontinence, constipation, diarrhea and lower gastrointestinal bleeding which usually present as black tarry stools. With persistence of the above mentioned symptoms, one should usually seek consult and undergo different screening modalities to be able to catch any disease entity early especially if it is cancer. Risk factors for having colorectal carcinoma includes aging (risk increases among those 50 years and above), history in the family, dietary habits (people who eat less fiber or those having a diet high in saturated fats), environmental (exposure to any carcinogens), inflammatory bowel disease and smoking. If one is a high risk candidate don’t hesitate to seek consult just to be sure your ok.

Treatment for the above carcinoma both includes surgical and medical therapies. Treatment usually depends on what stage the carcinoma is. After undergoing treatment, surveillance is highly recommended to detect early recurrence at the same time surveillance is also highly recommended among people who are high risk for having the disease. You could always go for cure when you catch cancer early. Pleasant Day.


Another Lacerated Wound

>> Monday, November 3, 2008

Yesterday, I again met up with a drunk patient who suffered a lacerated wound. He was evenutally on his way to be when he slipped causing to fall down and extend his arm which then hit a the glass door of the their cabinet. The hit caused a lacerated wound around 6 cm in length and around 2 cm in width. Whew this is much bigger than the previous lacerated wound I encountered at the ER.

Suturing materials where prepared, the wound was cleaned and eventually I did suturing. Aside from the big lacerated wound, there was anohter one around 1 cm in lenght just below the above mentioned wound. I gave it one bite of suture and it eventually closed. The suturing of the wound looked ok and no opening was noted. Hopefully it wont get infected. Drunk people should be a little more careful when they drink the next time, they always end in the hospital if they get clumsy. Pleasant Day

The wound above was somewhat the same as last night's


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