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Thursday, August 18

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


2 comments:

DrSurialiNadiah said...

baem

1. you made me feel like im the one doing this in your every grak khas day. :D except that i dun actually go thru this and so no panic/anxiety. :P

2. kat sane byk SLE macam so MYS mmg byk SLE jugaklah ye?

3. in4 abt paracetamol and non-paracetamol tu from books ke or baem really2 hafal? =.=''

ibrahemazamanzain said...

ok..nad, first thanks. kita kongsi2 ilmu kan..
2) takdela sgt. biasa cm sorg je sebulan yang admit pasal sle. x adela ramai sgt.
3)ouh yang paracetamol dah hafal, yang non paracetamol belum lagi..hehehe tp kena hafal la jugak tau