Gerak Khas Attachment: Day 9

*Please refer glossary below*

Today, I came a little bit early. As yesterday, there's no blood sampling to be done. I just followed the HO doing morning rounds. He is a good doctor actually, and very friendly. We stroll through his cubicle, seeing patients' progress. Then, I was joining MO rounds. She asked me, "Kau berapa lama attachment, dik?". I answered 3 weeks which she replied, "lama eh macam posting houseman pulak". Well, after that, the specialist came and we followed her.

She reminds all of us, that patient with RVD may come with opportunistic pneumonia. But, if the opportunistic pneumonia worsening, consider covering the patient with appropriate ABx to cover HAP. Also, it is very important for us doctor to know each drug side effects especially in treating elderly. Charcot's triad, a diagnostic triad for ascending cholangitis and biliary sepsis. It includes;

i) Fever

ii) Jaundice

iii) Hypochondral/ abdominal pain

We were also asked to read about Child-Pugh grading for cirrhosis and King's College hospital criterion for liver transplantation.

Child-Pugh grading for cirrhosis

	1	2	3
Serum bilirubin	<34 μmol/L (<2.0mg/dL)	34-51 μmol/L (2.0-3.0 mg/dL)	>51 μmol/L (>3.o mg/dL)
Serum albumin	>35 g/L	30-35 g/L	<39 g/L
Ascites	None	Easily controlled	Poorly controlled
Neurologic disorder	None	Minimal encephalopathy	Advanced coma
Clotting properties	PT prolonged 0-4 s (INR < 1.7)	Prolonged 4-6 s (INR 1.7-2.3)	Prolonged > 6 (INR >2.3)

It is scored from 5-15. Which 5-6 is Class A, 7-9 is class B, 10-15 class C. For more info, please refer Kumar and Clark's Clinical Medicine 7th Edition, page 347, box 7.3.

King's College Hospital criteria for liver transplantation

Paracetamol induced toxicity

blood pH less than 7.3 24h after paracetamol ingestion

or All of the following

PT > 100s

Creatinine > 300 μmol/L

Grade III/IV Encephalopathy

Non-Paracetamol

PT > 100s

or 3 out of 5 of the following

Drug induced liver failure

Age <10 or >40

> 1 week from jaundice to encephalopathy

PT> 50s

Bilirubin > 300 μmol/L

Ok, too much isn't it?

Glossary

RVD- retro-viral disease

ABx- antibiotic

HAP- hospital acquired pneumonia

PT- prothrombin time

INR- International Normalized Ratio