ascites [sumber]
aku mulakan alam klinikal dengan rounds internal medicine di princess basma teaching hospital. teringin nak rounds di KAUH but hey, maybe PBTH is better, who knows.
semalam, aku dah terlebih terkurang excited dengan seorang makcik yang memberi aku peluang untuk lihat dengan mata sendiri dan rasa dengan tangan sendiri ketumbuhan, dan everted umbilicus. selalu tengok kat buku je. ni live and it is sooo awesome.
semalam, aku dah terlebih terkurang excited dengan seorang makcik yang memberi aku peluang untuk lihat dengan mata sendiri dan rasa dengan tangan sendiri ketumbuhan, dan everted umbilicus. selalu tengok kat buku je. ni live and it is sooo awesome.
(rasa bersalah sebab rasa sangat awesome dengan orang sakit tsk tsk T__T)
dr. odeh makes all of us (A7) wait for more than an hour but for me, personally it is all worth it. we did abdominal exam on a patient with ascites. from inspection you could see that the abdomen is distended and large with an everted umbilicus, some striae and dilated veins on the skin. patient looks ill and didn't talk very much. dr asked the patient to get up a little bit and a bulge of masses protude on the epigastric. (saya rasa memang amaze melihat hernia, i think it is an abdominal hernia)
during palpation, we started with superficial palpation. from right iliac fossa to the left iliac fossa. (sebab makcik itu ada gauze on her left iliac fossa) once you palpate the left hypochondrium, you could feel a mass (saya tak tau mass apa, tapi memang tak mungkin akan miss)
with deep palpation, we search for any abnormalities (abdominal mass/rigidity/tenderness) patient seems uncomfortable (taktau sebab kami atau sebab sakit) palpate to search for any organomegaly. palpate the spleen diagonally. (spleenomegaly normally is on the right illiac fossa) no palpable spleen noted. kidney : bimanual (use both hands)
percussion: note that resonance - air and dull - hollow organ. do liver span to identify if patient has hepatomegaly. on the mid axillary, normal liver span is 8-10cm. percuss from the 2nd coastal margin, untill you hear a dull sound; mark them. this is the upper margin. for the lower margin, percuss from the iliac fossa and go up till you hear any dull sound. mark them, this is the lower margin. measure upper to lower margin. patient's liver span is around 14cm = hepatomegaly. do the shifting dullness and fluid thrill. (fluid thrill : akan rasa seperti a wave hitting your hand)
auscultation: dr odeh tak dapat tunjukkan, he is a busy man. tp kalau nak buat, listen for any bruits on the renal artery. indicate stenosis.
secara kebiasaan : 1) inspection 2) palpation 3) percussion 4) auscultation. tapi sesetengah doktor suka buat 1) inspection 2) auscultation 3) palpation 4) percussion. sebab palpation before auscultation may stimulate bolus movement.
p.s. maaf bahasa campur-campur dan kalau kurang paham.
video reference yang aku rasa membantu : bates' physical examination
|