Friday, November 07, 2008

Young woman with Hepatitis

Sekarang aku cycle kt 7th hospital, department of infectious diseases. kelas aku kt tingkat satu, betul2 sebelah bilik2 patient yang HIV positive. Mak ai, nak kuar gi toilet pn takut. patient2 tu pandang kat aku semacam aje. oh tidak....aku diberi patient untuk di clerk. first time aku jumpe patient tu, aku dh dah agak yag die ni ada Hepatitis. Yelah kuning semacam aje. patint aku ni umurnya 23thn, dh kahwin ada anak sorang. masa inspection aku ada nampak kesan kelar kt tangan die, aku tanya apesal. dia refuse to eveal the true story. The worse thing, she also had kesan lebam2 kat tangan yang aku agak cause of parenteral drug usage (IVDU). Patient ni merokok and alcoholic.

Clinical Vignette:-

Patient Eugenia (not real name) come to department of infectious disease, 7th hospital with complaint of yellowish of skin, abdominal discomfort. She mention that 1 week before, she had flu, temperature 38'C. Flu and fever subsided as she took "Terraflu"(symptomatic treatment). The patient had C-section for the delivary of her first daugther 3 years ago, and blood transfusion during the operation. 4 month ago, patient visited dentist for tooth extraction.
On examination, she look pale and jaundice. No enlargement of tonsils, white patches on the tongue. Lungs auscultation reveal crepitation, no ronchi. Axillary temperature recorded - 37'C.
Heart sound is rhytmic, S1S2, no murmur. On palpation, abdomen is tender on the right epigastric region. Liver enlarged (size 9x11x11- Kurlov's), spleen enlarged. no masses palpable in intestines. Symptom Pasternaskiy negative on both kidneys.
Plan: CBC, Urine FEME, LFT, ELISA, AlAT, Billirubin, Plasma Glucose (patient refuse liver biopsy)

the results came back yesterday. ELISA show :

HBeAg +
HBsAg +

Conclusion: Acute Viral Hepatitis B, Jaundice stage

Sedih, mude lagi dh kena Hep. ape nak kerja aku sekarang ialah prescribe the medication

Regime: stationary
Diet: 5a
Detoxication: Phillip's solution, 'Trisol' (three salts)
Hepatoprotector: Carsil
Vitamins: A,B,C,E

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