Learning is fun.
3 hours of standing for CP is tiring. It makes my knee pain and I can't feel my feet anymore. But it is totally worth it. There are so many things that we can learn just by listening to the experienced clinicians. Each of them has their own way of teaching, emphasis and expectations but no matter what they say, it always make me think. It is the approach and thinking skills that I want to master.
A patient coming with a large mass on the upper abdomen. He is 67 years old, looks weak on his legs. He looks slightly pale but he is not in obvious pain. He looks cachexic because I can see the wasting of his temporal muscles. Now what is in your mind? What is the next thing that you'd be curious of? Is he having some mitotic condition? What is he experiencing? He has lost quite a significant amount of weight over the past 1 month. And he claimed that he only noticed the mass for the past 1 month. Logically thinking, it is almost impossible to have such a fast growing mass. For your information, the mass spans over the entire upper abdomen and you can actually see it slightly protruding while patient lies down supine. When I palpated the mass, it has an irregular shape that corresponds to that of the liver. But no pain was elicited. He hasn't been eating solid food for the past one month because there was early satiation. He only had porridge and some protein milk drink everyday. However, he has not vomited and has not felt nauseated. Bowel movements and urine output are normal. There is no change in colour of urine or stool. So, have I ruled out liver problems? Not really. Okay before I carry on elaborating on ruling in and out certain problems, I'd want to point out that at the time I mention that the mass is seated at the upper abdomen, plus the shape corresponds to that of the liver, you most probably should be thinking of a mass arising from the liver. However, you must bear in mind other possibilities too. An upper abdominal mass can be arising from the stomach, gallbladder, the duodenum and even the transverse colon. But in this case, since the shape corresponds to that of the liver and a mass of this size would most probably be from the liver. But he does not have signs of liver problems. No spider naevi, gynecomastia, jaundice whatsoever, but it does not mean that it can be ruled out. Because these picture can develop later. So what can we do for the patient if you were the doctor, if it has been confirmed that it is an HCC? You want to also rule out if there is any mets. Do a CT scan. Do you want to operate on the patient? Liver transplant? There is no chemotherapy for Ca liver yet. Note that the patient is 67 years old. He is no longer eligible to get a liver transplant. The doctor suggested palliative care.
That's enough for the day!
TC =)
3 hours of standing for CP is tiring. It makes my knee pain and I can't feel my feet anymore. But it is totally worth it. There are so many things that we can learn just by listening to the experienced clinicians. Each of them has their own way of teaching, emphasis and expectations but no matter what they say, it always make me think. It is the approach and thinking skills that I want to master.
A patient coming with a large mass on the upper abdomen. He is 67 years old, looks weak on his legs. He looks slightly pale but he is not in obvious pain. He looks cachexic because I can see the wasting of his temporal muscles. Now what is in your mind? What is the next thing that you'd be curious of? Is he having some mitotic condition? What is he experiencing? He has lost quite a significant amount of weight over the past 1 month. And he claimed that he only noticed the mass for the past 1 month. Logically thinking, it is almost impossible to have such a fast growing mass. For your information, the mass spans over the entire upper abdomen and you can actually see it slightly protruding while patient lies down supine. When I palpated the mass, it has an irregular shape that corresponds to that of the liver. But no pain was elicited. He hasn't been eating solid food for the past one month because there was early satiation. He only had porridge and some protein milk drink everyday. However, he has not vomited and has not felt nauseated. Bowel movements and urine output are normal. There is no change in colour of urine or stool. So, have I ruled out liver problems? Not really. Okay before I carry on elaborating on ruling in and out certain problems, I'd want to point out that at the time I mention that the mass is seated at the upper abdomen, plus the shape corresponds to that of the liver, you most probably should be thinking of a mass arising from the liver. However, you must bear in mind other possibilities too. An upper abdominal mass can be arising from the stomach, gallbladder, the duodenum and even the transverse colon. But in this case, since the shape corresponds to that of the liver and a mass of this size would most probably be from the liver. But he does not have signs of liver problems. No spider naevi, gynecomastia, jaundice whatsoever, but it does not mean that it can be ruled out. Because these picture can develop later. So what can we do for the patient if you were the doctor, if it has been confirmed that it is an HCC? You want to also rule out if there is any mets. Do a CT scan. Do you want to operate on the patient? Liver transplant? There is no chemotherapy for Ca liver yet. Note that the patient is 67 years old. He is no longer eligible to get a liver transplant. The doctor suggested palliative care.
That's enough for the day!
TC =)
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