Salam sahabat2 semua selamat menyiapkan diri dalam menghadapi bulan Ramadhan Moga kita diberi kekuatan dan

kesihatan oleh Allah swt utk moptimum ibadat di bulan ini Alhamdulillah selesai Surgical posting di Hosp Taiping; banyak yg nak kongsikan dgn sahabat2 semua moga dapat mengambil sedikit sebanyak manfaat Pertama; antara case2 yg kerap di Hosp Taiping adalah I/O, UGIB, Gastritis, appendicitis, Abscess & Carbuncle, PGU, Acute pancreatitis, AUR (stricture/BPH), HBS disease ( cholecyctitis, cholelithiasis, choledocholithiasis, cholangitis), Renal colic, MVA with Head Injury, Hernia, Hematuria, DVT, Breast Ca, Rectalsigmoid ca, Thyroid Ca. So rasanya tak berapa banyak kan.. hehe, Cuma perlu tahu apa yg penting2 dan practical utk setiap disease tersebut Ok roughly about every disease above yg ini apa yg MO/S Hosp Taiping selalu Tanya dan espect HO tahu

1) I/O (intestinal obstruction); kita kena tahu bezakan subacute/acute I/O. pt p/w generalize abd pain, NBO x3/7, not passing flatus x3/7, vomiting x 5 food materials, P/A mild distended, BS sluggish, AXR: dilated small bowel, h/o TAHBSO done 3 years ago. So biasanya dorang akan tanya acute/subacute; esp bila oncall sorang2 waktu malam, time tu dilemma nak call mo ke tak.. hehe.. yg penting tahu nak buat apa Insert RT free flow, hydrate pt (3rt space lost), give analgesic, do PR, watchout any feacal materials from the RT (indicator for emergency intervention), if AXR has dilated large bowel, think if possible to give Ravin enema stat and rectal washout. 2) UGIB: p/w coffee ground vomiting, h/o using NSAID/traditional medicine, claims blackish stools. Yg biasa ditanya cause of UGIB. Clearkan variceal cause dulu, sbb mt sgt berbeza, then check any sign hematemesis / melena. So kita kena tahu bezakan PR finding sama ada fresh/stale/hematinic. Then Monitor Hb, Coag. First management, make sure vital stable (BP/HR/Hb); level HO boleh kasi IV pantoprazole 80mg stat,then 40mg BD. Biasanya kalau suspect active bleeding, MO akan start IVI panto 8mg/H for 72H. dan dorang akan order OGDS stat. so kita kena tahu bezakan finding dia: Forrest 1a,1b, 2a,2b,2c,3; RUT positive ke tak utk eradication therapy. Ehm utk gastritis pun kurang lebih sama juga, end up with OGDS. 3) PGU (Perforated gastric ulcer): selalunya memang acute abdomen r, ada h/o gastritis n NSAID, kena suspect bila kasi syrp MMT or PPI pain still not resolving. So kena order erect CXR with inflate 200cc air through RT to see any air under diaphragm. Selain tu check se amylase, biasanya tinggi 4) Acute Pancreatitis: Kena tahu pasal IMRIEs Score; bila more than 3 dah severe. Hydrate pt, check se amylase and urine diastase, cari possible cause(kena tahu semua cause , selalunya disebabkan biliary stone r, so order U/S HBS urgent. KIV to start antibiotic. Seminggu tak resolve gak maybe blh order CECT Abdomen to see any necrotic pancreas, sbb bila ada necrotic perlu surgical intervention, kena letak drain. 5) Abscess & Carbuncle: Biasanya kena check pt ada DM ke tak, takut blh DKA. Kalau suspect ambil VBG and refer medical.. haha. Then check abscess tu.. fluctuant ke tak carbuncle pun sama then put KIV for I&D utk abscess or saucerization utk carbuncle. Post Op kena plan dressing;

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sama ada povidone/NS/Solcoceryl/Aquacel silver (tah r byk sgt huhu ortho nnt lebih power bab ni). AUR (acute urinary retention) : Biasanya BPH or urethra stricture. So cuba dulu insert CBD, klu tak blh gak baru SPC (kena insert sendiri!). aku dulu buat2 tahu je, nasib baik masuk.. klu bladder not palpable ambil U/S je r.. ok Bab BPH yg penting IPSS score, then PR assessment: 3-4 FB, medial sulcus, smooth. Pastu baru decide obat dia: Xatral, Avodart, proscar, Tamsulosin.. then refer Uro Penang for further management sorry r kat hosp aku tak da urologist hehe. HBS (hepatobillier system): p/w jaundice, tea colour urine, pale stools; ada charcots triad. So biasanya U/S HBS urgent, start IV Rocephine 2g stat then 1g BD. Send r FBC, RP, Coag, LFT, bil direct/indirect, se amylase. After resolved biasanya kena prepare pt for ERCP.. again kena refer Hosp Alor setar; kena tahu pre-med utk ERCP, prepare referral letter. MVA with cerebral concussion: first GCS n pupil charting, kena tahu define mild, moderate n severe head injury, GCS <9 SHI; kena intubate and sedated, ada midline shift start manitol and refer neuro Ipoh!. Kalau mild GCS 14-15 monitor dlm ward at lease 24 hours. KNBM, IVD NS shj. After 6H post trauma allow orally. Utk MVA case, clerking mcm biasa; MB Vs Car, pukul brp, post trauma ada LOC ?, retrograde amnesia?, regained consciousness bila, vomiting? Headeache? Blurring of vision? ENT bleeding? Chest / pelvic spring? Hernia: kena tahu reducible / irreducible hernia (inguinal, para umbilical, incisional), any sign or obstruction incarcerated dll. Op plan: open/laparoscopic hernioplasty, kena tahu mesh dia apa.. Hematuria: Insert 3 ways CBD, bladder irrigation until clear urine, then for cystoscopy later.. hehe. DVT: adui yg ni paling aku pening.. U/S Doppler, D-dimer, Coag.. Heparin infusion, warfarin, monitor INR, aPTT, ujung2nya suruh refer vascular Penang gak.. haha. Ok lastly Bab Ca: Breast, Prostate, Colon, Gastric, Thyroid.. byk yg dah mets ke lungs, liver, bone so kena tahu Op apa je, Wide local excision and level II axillary clearance, Total mastectomy, Total thyroidectomy, Hartman Procedure, Hemicolectomy with primary anastomosis, Gastrojejunustomy. Investigation kena tahu tentang tru cut biopsy HPE, Mammogram Birads I-IV. IDL before thyroidectomy, CEA, CA 19.9, AFP, Ca 125. Post Op kena tahu pasal TPN (Total perenteral Nutrition) peri or central line, monitor electrolyte n I/O bila start TPN Kena tahu gak pasal Chemotherapy: adjuvant/neoadjuvant, kena tahu dilute chemo regime Folfox, FEC dll. Kena arrange for chemoport , klu pt tak mampu kena refer social welfare dll Bab Ca ni byk kerja sikit, sampai kena register Makna n palliative care pun semua HO kena buat!. Last sekali: bab electrolyte imbalance . Hyperkalemia kena repeat ECG T tall, then bagi Triple regime, Hypokalemia.. kena tahu kira deficit then decide either nak buat slow or fast correction: 2g KCL in 200cc NS over 2 hours. Hyponatremia.. bagi IVD NS. Hypercalcemia: hydrate first, kiv start pamindronate 90/60/30mg or bagi T. Bonefos

Rasanya more n less yg atas2 ni pun sudah 60-70% kena tahu utk survive kat surgical department.. Hosp lain maybe tak jauh beza kut insyaAllah cuba cari tahu dan ambil tahu setiap point kat atas ni, kalau kurang faham anytime contact dan tanya senior2 yg dah HO insyaAllah; Kami Sedia Membantu! hehe..

Ok sekali lagi mohon doanya buat kami semua, terutamanya dapat memanfaatkan kehadiran Bulan suci Ramadhan ini walau sesibuk manapun HO kami Moga Allah beri kita taufik dan hidayah utk terus berusaha mendekatkan diri kepadaNya amin.