2 minggu sebelumnya
"Ramli, kau tak patut buat macam ni, tolonglah hentikan", kata Luqman sambil memandang tepat ke mata Ramli bagaikan pasangan bercinta walaupun mereka bukannya 'gay'. " Maaflah, aku tak tau macam mana nak bagitau korang pasal ni, sebenarnya dah lama dah Kak Nora jadi macam tu", balas Ramli mengalih pandanganya ke kaki meja di ruang tamu itu. "Sudah berapa lama?", tanya Zam. " Dua bulan lepas", jawab Ramli ringkas. Petang itu Ramli menerangkan segalanya tentang perubahan yang berlaku pada Kak Nora kepada Zam dan Luqman. Bermula dua bulan yang lepas Ramli sering menerima khidmat pesanan ringkas(sms) dari Kak Nora. Mulanya menanyakan keadaan rumah dan Ramli tidak pula mengesyaki apa-apa sebab baginya itu adalah perkara biasa seorang tuan rumah menanyakan keadaan rumah kepada penyewanya. Tambahan pula Ramli adalah ketua rumah mereka bertiga. Namun, semakin hari semakin kerap Kak Nora menghantar sms kepada Ramli dan sms-sms itu sudah tidak begitu formal seperti sebelumnya. Kadang-kadang sampai perkara yang sensitif pun ditulisnya. Salah satu sms yang ditunjukkan Ramli kepada rakan-rakan serumahnya, " panas la hari ni.. akak pakai tube je ni". Ramli mulanya tidak melayan tetapi akhirnya dia kalah dengan nafsu sendiri. Selama ini pun dia memang suka perempuan yang lebih tua dari umurnya. Bagi Ramli umur adalah perkara kecik yang penting bagi seseorang perempuan itu adalah bentuk badan yang 'sexy'. Hubungan Ramli dan Kak Nora menjadi semakin erat tanpa diketahui sesiapa termasuklah suami Kak Nora.
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Wednesday, May 4, 2011
Tuesday, May 3, 2011
Kejadian Rumah Sewa 4
"Haaaah!", jerit Zam yang tersentak dari kamar tidurnya. Peluh di dahinya dilap dengan selimut pink yang jarang-jarang sekali dibasuh itu. Dia tidak henti-henti beristighfar sambil mengusap-usap dada dan cuba memplotkan kembali kisah mimpinya tadi. Semakin diingat, semakin dia tidak tenteram. Dilapnya sekali lagi putik-putik peluh di dahi, pipi, belakang cuping telinga serta di lehernya yang tercetak satu tanda sejak dia lahir lagi. Dalam keadaan fikirannya yang masih ceralu itu, Zam mendengar suatu bunyi seakan-akan ada orang sedang mengetuk atap zink dengan benda keras. " Ada orang menukang lagi ke pukul 3 pagi ni?", fikirnya sendiri sambil melihat jam di skrin telefon bimbitnya. Dihayatinya bunyi itu dengan teliti, "Oh! bunyi degupan jantung aku rupanya", Zam bermonolog dengan sedikit perasaan lega. Dengan bantuan cahaya lampu jalan yang menyelinap masuk dari tingkap kaca biliknya Zam bangun dari katilnya dan mengambil botol air di atas meja tulis. Kehausan, mungkin kerana banyak berpeluh. Air dalam botol itu tinggal tidak sampai suku botol lagi, Zam meneguknya sampai habis. Masih terasa haus tapi Zam merasa malas untuk keluar mengisi semula air di dapur. Selepas itu dia kembali berbaring untuk meneruskan tidurnya. Namun, kejadian dalam mimpi tadi membantutkan hajatnya itu. Masih terngiang-ngiang jeritan hantu Kak Nora dalam kepalanya. Bulu romanya meremang. Tidak dapat tidak, kejadian di rumah sewa Kak Nora kembali fikirannya menghantuinya.
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Tuesday, April 26, 2011
Kejadian Rumah Sewa 3
"Jemputlah masuk Kak Nora, maaflah bersepah sikit maklumlah baru pindah", pelawa Ramli yang semakin galak berkata-kata. Kak Nora merebahkan punggungnya di atas kerusi merah di ruang legar rumah itu. Sebenarnya ada 1 set meja makan beserta 4 kerusi tetapi tinggal 1 sahaja kerusi di ruang itu kerana masing-masing meletakkan kerusi tersebut ke dalam bilik bagi tujuan mengulangkaji pelajaran. Luqman, Zam dan Ramli hanya berdiri di sekeliling meja makan yang berbentuk bulat itu sementara Kak Nora duduk memerhatikan keadaan rumah mereka. "Ini dia duit deposit rm660 yang korang tak sempat ambil hari tu", Kak Nora memulakan bicara. "Oh sebenarnya kami sudah lupakan pasal hal hari tu Kak, tapi dah Akak nak bagi juga kami terima je", balas Zam diselangi dengan senyuman. Sedang Zam menghulurkan tangan untuk mengambil wang itu dari Kak Nora tiba-tiba Kak Nora memegang pergelangan tangan Zam dengan erat. Mereka bertiga terperanjat dan Zam cuba melepaskan tangannya dari gengaman Kak Nora namun gagal. Suara Kak Nora yang lemah lembut tadi bertukar serak. Bunyi seakan-akan dengusan kerbau jantan yang kena sembelih diselang-seli dengan beberapa perkataan yang tidak dapat difahami keluar dari mulut Kak Nora. Tangan Kak Nora yang tadinya gebu bertukar menjadi kering, bersisik dan berbau busuk. "Allahuakhbar!", Luqman melaungkan takbir sekuat hatinya yang sedang gementar. Kak Nora bagaikan bertindak balas dengan laungan takbir itu dan mula menjerit kesakitan. Zam lantas menyentap tangannya lalu terhempas ke dinding dan jatuh terduduk. Dalam sekelip mata Kak Nora ghaib dari kerusi merah namun jeritan kuat itu masih berterusan beberapa saat kemudian dan diselangi hilai tawa yang menyeramkan selama beberapa ketika kemudian. Mereka bertiga kaku dan pucat sampai ke hujung kaki. Masing-masing tergamam dan terdiam.
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Sunday, April 24, 2011
Kejadian Rumah Sewa 2
Mereka memang jarang membuka suis lampu di luar rumah kerana mahu menjimatkan penggunaan elektrik. Cuma kadang kala Ramli ada juga membuka lampu luar itu, katanya itu sebagai petanda yang mereka ada di dalam rumah jadi tidak akan ada pencuri yang berani masuk. Lagipun mereka sekarang tinggal di kawasan perumahan cina, tambah Ramli. Zam dan Luqman memang sudah kenal sangat dengan sikap Ramli yang agak penakut dan cepat panik itu. Bagi Zam bukannya menjadi masalah memasang lampu luar pada waktu malam tetapi tidak ada siapa yang mahu tutup lampu tersebut bila dah menjelang siang kerana mereka bertiga sering bangun lambat dan ponteng kelas.Sambil Zam cuba membuka kunci pintu grill tersebut,dalam kesamaran malam mereka bertiga memerhatikan wajah perempuan yang berbaju T-shirt kuning dan berseluar jeans yang agak ketat itu dari celahan pintu grill rumah mereka yang bermotifkan rekaan pagar orang cina.Ada perkataan cina pada pintu tersebut tetapi tidak pula mereka tahu apa maksud perkataan tersebut malah tidak pula mereka peduli. " Sorry Kak Nora lambat sikit, masuklah dulu", pelawa Zam dengan penuh mesra dan dalam masa yang sama baru dia terfikir "kenapa la aku ajak dia masuk, kan dah malam ni, lagipun dia perempuan". Ramli dan Luqman menjeling Zam dengan perasaan curiga dan tidak puas hati. "Terima kasih dik tapi takpe, akak berdiri di sini saja", jawab Kak Nora. Dengan perasaan lega Zam dan Luqman mengangguk manakala Ramli pula bersembunyi di belakang Luqman tetapi disebabkan tubuh Ramli yang agak gempal, punggungnya yang berisi itu jelas kelihatan. "Sebenarnya akak datang ni sebab nak pulangkan deposit rumah korang dan akak juga nak mintak maaf pasal kejadian tempoh hari", sambung Kak Nora sambil memandang ke lantai, mungkin kerana masih rasa bersalah dengan kejadian di rumah sewa sebelum ini. " Wow! cantik pula aku tengok Kak Nora malam ni"; Zam bermonolog sendirian. Dalam waktu yang sama dia berfikir adakah Luqman dan Ramli juga perasaan akan kecantikan bekas tuan rumah mereka itu. Wajah Kak Nora yang dulunya kusam, berjeragat serta terdapat kesan-kesan inflamasi akibat pengunaan produk yang menghakis lapisan kulit kini menjadi begitu putih dan gebu. " tak elok berdiri di luar malam-malam ni Kak Nora, marilah masuk dulu", Ramli mencelah menyebabkan Zam sedikit tergamam dan fikirnya "Dah mula dah Ramli ni, memang pantang melihat janda cantik, tadi bukan main menyorok. Dia sudah lupa ke peristiwa sebelum ini yang menimpanya?". "erk! tak ape la dik, Akak kat sini saja", balas Kak Nora dengan serba salah. "tak boleh kak, lagipun malam ni macam nak hujan je, masuklah dulu", balas Ramli yang begitu beria-ia mengajak Kak Nora. Kak Nora memandang ke langit. Memang seperti cuaca mahu hujan. Bintang-bintang yang bertaburan menjelang waktu Isyak tadi sudah tidak kelihatan lagi. Yang tinggal hanya samar-samar cahaya bulan yang semakin dilitupi awan hitam yang berarak pantas dan semakin menebal serta semakin berat. Kak Nora tersenyum dan menjawab "baiklah, akak masuk". Zam seakan terganggu dengan senyuman Kak Nora tadi. Baginya senyuman itu bagaikan ada maksud tertentu.
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Saturday, April 23, 2011
Kejadian Rumah Sewa
"Kreekk", bunyi pintu pagar rumah teres setingkat yang didiami Zam, Luqman dan Rusli dibuka. "Eh siapa yang datang malam-malam macam ini, baru nak study", rungut Zam sendirian. Zam tinggal di bilik depan, jadi kalau ada sesiapa datang, dialah yang kene buka pintu. Sebenarnya Zam, Luqman dan Rusli baru sahaja berpindah ke rumah itu. Mereka adalah penuntut di sebuah university swasta di pekan koboi itu. Sebelum ini mereka menyewa sebuah rumah yang agak berdekatan dengan campus dan rumah rakan-rakan yang lain. Namun mereka mengambil keputusan meninggalkan rumah sewa yang lama kerana tidak tahan dengan karenah tuan rumah yang sangat suka datang memeriksa keadaan rumah mereka. Bagi mereka, privasi mereka tergangu, maklumlah tuan rumah itu janda dan sesuka hati sahaja datang ke rumah orang bujang tanpa memberitahu dahulu.Itulah alasan yang mereka berikah jika ada sesiapa yang bertanyakan sebab mereka pindah ke rumah sewa yang agak jauh dari campus. Zam bangun dari katilnya dan cuba mencari kunci rumah di dalam rak bukunya. Selalunya di situlah dia meletakkan kunci rumah bersama-sama beg duit, kunci kereta, jam tangan, makanan tambahan, cotton bud, kad pelajar dan semestinya buku-buku pelajarannya. Pendek kata, semua benda keperluan sehariannya ada pada rak buku itu termasuklah pakaian. "Assalamualaikum", kedengaran suara perempuan muda memberi salam."Waalaikumussalam", jawab Zam yang agak kehairanan, " Eh! itukan suara bekas tuan rumah, kenapa dia datang malam-malam ni?kenapa dia buka pintu pagar rumah dulu sebelum beri salam? dan macam mana dia tau lokasi rumah baru kami?", pelbagai persoalan datang dalam fikirannya. Selepas membelek-belek baju di lantai bilik akhirnya Zam menemui kunci rumahnya. Dalam perjalanan ke pintu utama Zam memanggil Luqman dan Rusli " Man, Li Kak Nora datang ni". Luqman dan Rusli keluar dari bilik masing-masing dengan muka kehairanan.Tetapi Rusli kelihatan lebih gementar. "Eh! bukan ke Kak Nora....", belum sempat Luqman menghabiskan ayatnya Rusli terus menyampuk " Diam!, boleh tak kau jangan cakap pasal tu lagi?". Mereka bertiga pun diam dan menuju ke pintu utama. Zam menarik pintu pertama kerana mereka memang tidak pernah kunci pintu itu dan kunci pintu tersebut pun tidak diberikan oleh tuan rumah baru semasa mereka mula-mula berpindah. Kelihatan sebatang tubuh berdiri tegak di halaman rumah.
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case write-up orthopedic 2
Patient’s Data
Name: Nurul Afiqah
Age:17 year s old
Gender: female
Race: malay
Date of admission: 2/2/2011
Chief complaint:
Patient was referred from Manjung Hospital due to lower back pain after got thrown off from seat and landed on buttock in a bus one day prior to admission.
History of presenting illness:
She said on the way back home from Kem PLKN Selama the bus hit a hole on the road .Then because of the impact she was bouncing on her seat. However the bus was under control and no other passenger had any injury. Post trauma, she experience a severe throbbing pain on her lower back. The intensity was 10/10 and it was persistent. However she still could walk as she move to the front seat because she felt dizziness and vomit one time on the front seat. The pain did not radiate to the lower limb and also no numbness was felt on lower limb. The pain was aggravated by walking but relief a bit by bending forward. However no bowel or urinary incontinence. After arrive home in Manjung, her mother brought her to the Manjung Hospital . At A&E department X-ray imaging was done. The doctor said that her lower spine become compressed due to the trauma. They sent her to Ipoh Hospital for CT scanning and MRI.
Past medical history:
No past medical history.
Past surgical history:
No past surgical history
Family history:
No history of bone disease run in the family. The parents are healthy and so do her siblings.
Social history:
She is a PLKN trainee. She never smoking and never consume any alcohol. The live in Manjung with her parents.
Physical examination:
General examination:
She was alert and conscious. GCS was 15/15. Good hydration status. Hand is warm and pink. Capillary refilling time less than 2 second.
Bp-110/70mmHg
Pulse- 80bpm
Temperature- 37.0 degrees celcius
Respiratory rate-20 per minute
Neurological examination:
For all limbs muscle tone are normal, muscle power is 5/5, normal reflex. For the plantar reflex, the toes are flexing downward. All sensation are intact. No muscle wasting. Spinal examination cannot be done because doctor said he must lying down supine to prevent further injury.
Abdominal examination:
Abdomen is soft, no tenderness and no palpable mass.
Respiratory examination:
Lungs are clear. Normal breath sounds are present.
Cardiovascular examination:
First and second heart sound are present and no murmur detectable.
Investigation :
X-ray imaging- there is a compression on the L1 vertebra. And the alignment is run off.
MRI- there are burst fracture of the L1. The spinal cord still intact.
Full blood count to check the hemoglobin level and neutrophil level.
Management:
Surgically repair the spine and put a internal fixator. Immobilize and follow up the patient to check any deformity and the healing process of her spine.
case write-up orthopedic 1
Identification Data
Name: Mdm R
Age: 61
Race: Malay
Marital Status: Married
Date of Admission: 1 March 2011
Date of Clerking: 1 March 2011
Co-morbid: 1) Diabetes Mellitus for 2 years
2) Hypertension for 3 years
3) Right eye cataract
Chief Complaint
This patient is referred from Hospital Selama with the chief complaint of swelling of the left hand and fever 14 days prior to admission.
History of Present Illness
The patient was well until 14 days ago when she noticed that her left hand started to swell at the left wrist region. She also complained of pain on that swollen area together with redness. The swelling gradually increases in size and the pain became worse but there was no pus noted. She started to have fever right after the swelling started. It was a high grade fever as it is associated with chills and rigors. The fever was relieved temporarily with medication. A week after that, she was taken to Hospital Selama and she was admitted there for 7 days. Within these days, she claimed that the pain became colicky in nature. She also had diarrhea for 5 days with frequency of 3 to 4 times per day. The stool was watery with no blood or mucus. She also complained of vomiting 2 to 3 times a day in the ward for 3 days since the day she was admitted. The vomitus was food particles with no mucus or blood. Her appetite reduced since then. At that hospital she was treated as a patient with acute gastroenteritis and left hand abscess. She was on IV cloxacillin 500 QID for 4 days. Incision and drainage was done yesterday with 30cc of pus being drained but today at Hospital Selama there was still pus discharge noted and it was tracked up to the proximal part of the left wrist. She was then referred to Hospital Taiping on the same day for further management.
Past Medical/Drug History
- The patient is a known case of diabetes mellitus for 2 years. She is on gliclazide 80mg bd and metformin 1g bd.
- She is also hypertensive, diagnosed 3 years ago. She is on perindopril 8mg, lovastatin 20mg, HCT2 37.5mg.
- She refused to go for follow up at Klinik Kesihatan Sungai Bayu in Selama and she is not compliant to her medication.
- The patient is also known to have right eye cataract and it was removed in October 2010.
Family History
· There is no significant family history.
Drug and Allergy History
Besides the medications for DM and hypertension, she is not on any other medication. She is not allergic to any drugs or food.
Social History
· She is a housewife.
· She does not smoke or consume alcohol.
· She eats normal balanced diet.
· Her husband is a retired army. She has three daughters and all are married.
· She lives in Kampung Seri Raja, Selama with her husband.
Clinical examination
Her weight was 82 kg and her height 157cm.
On general examination, the patient looked lethargic but she was not in respiratory distress. There was no sign of jaundice. There was a slight conjunctival pallor on both eyes. There is slight clouding on the lens of her right eye. There was no pitting edema on both legs. Her blood pressure was 150/90 mmHg. Her pulse rate was 82 beats per minute. The rhythm is regular and the volume is good with no special characteristics. Her random blood sugar was 12mmol/L. She was afebrile.
Her thyroid and her breasts were normal.
Cardiovascular examination revealed that both heartsound were normal and there was no murmur.
Respiratory examination revealed that air entry was good bilaterally. There was no crepitation or rhonchi.
Her abdomen was slightly distended. The umbilicus is centrally located and flat. There is no surgical scar or dilated veins. On palpation, the abdomen is soft, not tender and no mass felt.
On examination of her left hand, there is a swelling with pus discharge and redness on her left wrist extending up to the proximal part. The size is 3x5cm. The shape is rounded. On palpation, there is pus discharge noted. It is warm and tender.
Clinical Diagnosis
Left hand abscess
Investigations
· The full blood count: WBC is raised.
· Urine FEME: no significant findings.
· Urinalysis:
1. Ketones = 3+ (higher than normal)
2. Glucose = +-
3. Protein = 1+ (higher than normal)
4. Urobilinogen = 1+ (higher than normal)
· Renal Function Test: sodium and potassium levels are normal.
Management
Monitor the vital signs of the patient, especially her blood pressure and body temperature. Monitor her blood glucose level. Incision and drainage should be done for the abscess. Continue IV antibiotics.
Discussion
An abscess (Latin: abscessus) is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue in which the pus resides on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g., splinters, bullet wounds, or injecting needles). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body. One example of an abscess is a BCG-oma, which is caused because of incorrect administration of the BCG vaccine.
The organisms or foreign materials kill the local cells, resulting in the release of cytokines. The cytokines trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow.
The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.
Abscesses must be differentiated from empyemas, which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity.
Wound abscesses do not generally need to be treated with antibiotics, but they will require surgical intervention, debridement and curettage.
he abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics.
Surgical drainage of the abscess (e.g., lancing) is usually indicated once the abscess has developed from a harder serous inflammation to a softer pus stage. This is expressed in the Latin medical aphorism: Ubi pus, ibi evacua.
In critical areas where surgery presents a high risk, it may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the respiratory tract. Warm compresses and elevation of the limb may be beneficial for a skin abscess.
s Staphylococcus aureus bacteria is a common cause, an anti-staphylococcus antibiotic such as flucloxacillin or dicloxacillin is used. With the emergence of community-acquired methicillin-resistant staphylococcus aureus MRSA, these traditional antibiotics may be ineffective; alternative antibiotics effective against community-acquired MRSA often include clindamycin, trimethoprim-sulfamethoxazole, and doxycycline. These antibiotics may also be prescribed to patients with a documented allergy to penicillin. (If the condition is thought to be cellulitis rather than abscess, consideration should be given to possibility of strep species as cause that are still sensitive to traditional anti-staphylococcus agents such as dicloxacillin or cephalexin in patients able to tolerate penicillin). It is important to note that antibiotic therapy alone without surgical drainage of the abscess is seldom effective due to antibiotics often being unable to get into the abscess and their ineffectiveness at low pH levels. Whilst most medical texts advocate surgical incision some medical doctors will treat small abscesses conservatively with antibiotics.
case write-up radiology 4
Identification Data
Name : Noor Badrul Hisham Bin Noor Shah
Age : 50 years old
Race : Malay
X-Ray No : 2305
Type of Imaging : Intravenous Urography
Positioning : Supine
Clinical History
Patient is a known case of dyslipidemia diagnosed 15 years ago. He complaints of having left loin to groin pain. The pain was dull in nature and he described it as very severe because he had to roll around the bed to relieve it. There were no hematuria, or passing out stone during micturition. Intravenous urography was done to rule stone and other urinary tract pathology.
Patient Preparation
i. No food for 5 hour prior to the examination.
ii. Patient should, preferably be ambulant for 2 hour prior to examination to reduce bowel gas.
iii. If patient has allergy to contrast medium, consideration should be given to administer methyl prednisolone orally 12 and 2 hour prior to injection of contrast medium.
Procedure
i. Preliminary film taken in supine,full length AP position of the abdomen,in inspiration to make sure adequate bowel preparation and to rule out any urinary calculi.
ii. Patient is given Intravenous bolus infusion of contrast media which is Iopamiro 300.
iii. 5 minute film taken to determine if excretion is symmetrical and is invaluable for assessing the need to modify technique.
iv. 15-minute film to demonstrate pelvicalyceal system.
v. Release film is taken to show whole urinary tract.
vi. Post micturition film to assess bladder emptying and to demonstrate return to normal of dilated upper tracts with relief of bladder pressure.
Findings
i. Preliminary film: There is faceted radiopacity seen on the left L1 and L2 vertebral level measuring 3 cm and 1 cm.
ii. Post Contrast :
· Both kidneys are normal in shape, size and position.
· Bipolar length of Right kidney measures 12.0 cm while left kidney measures 15.5 cm.
· No hydronephrosis or hydroureter seen
· Normal configuration of urinary bladder.
· Persistent clubbing seen within the left lower calyx is consistent with the opacity seen in preliminary film.
iii. Post micturition : No contrast hold up and no significant residual volume seen in urinary bladder.
Impression
Left renal calculus with no evidence of obstructive uropathy
case write-up radiology 3
Identification Data
Name : Rajamah a/p komara
Age : 63 years old
Race : Indian
Date : 8 February 2011
X-Ray No : 1209
Type of Imaging : Ultrasound study of abdomen
Positioning : supine
Clinical History
Patient is a known case of chronic liver disease with oesophageal varices diagnosed 2 years ago. Ultrasound of abdomen was done for yearly monitoring of her condition. She does not have any sign and symptoms suggesting portal hypertension.
Procedure
Patient lying on supine position,longitudinal scans from epigastrium or left subcostal region across to right subcostal region.Transverse scans,subcostally to visualise the whole liver.
Findings
Liver is irregular in surface with coarse echotexture.No focal lesion noted.No gallstones noted.Both kidney are normal in echogenicity. No stones noted.Spleen is enlarged.
Impression : Liver cirrhosis with splenomegaly
case write-up radiology 2
Identification Data
Name : Wong Kow
Age : 62 years old
Race : Chinese
Date : 8 February 2011
X-Ray No : 7315
Type of Imaging : Intravenous Urography
Positioning : Supine and prone
Clinical History
Patient is a known case of hypertension, benign prostate hypertrophy and compliant to medication. He was referred to radiology department for assessments of delineation of urinary tract. He was complaining of having nocturia 5 times in one night,increase frequency of micturition and also incomplete voiding. He does not complain of having pain during micturition and passing out blood or stone.
Patient Preparation
i. No food for 5 hour prior to the examination.
ii. Patient should, preferably be ambulant for 2 hour prior to examination to reduce bowel gas.
iii. If patient has allergy to contrast medium, consideration should be given to administer methyl prednisolone orally 12 and 2 hour prior to injection of contrast medium.
Procedure
i. Preliminary film taken in supine,full length AP position of the abdomen,in inspiration to make sure adequate bowel preparation and to rule out any urinary calculi.
ii. Patient is given Intravenous bolus infusion of contrast media which is Iopamiro 300.
iii. 5 minute film taken to determine if excretion is symmetrical and is invaluable for assessing the need to modify technique.
iv. 15-minute film to demonstrate pelvicalyceal system.
v. Release film is taken to show whole urinary tract.
vi. Post micturition film to assess bladder emptying and to demonstrate return to normal of dilated upper tracts with relief of bladder pressure.
Findings
i. Preliminary film: No radiopacity seen along urinary tract
ii. Post Contrast :
· Both kidneys are normal in shape, size and position.
· Bipolar length ofRight kidney measures 13.0 cm while left kidney measures 14.5 cm.
· Left mild hydronephrosis to the distal hydroureter is seen
· There are also strictures in left distal ureter. Beyond this, ureter is normal.
· Right pelvicaliceal system and ureter are normal.
· There is outpouching from the bladder wall in the left side.
· Both kidneys showed normal contrast excretion.
iii. Post micturition : minimal residual urine in the bladder. No hold up of contrast.
Impression
Left mild hydronephrosis and hydroureter due to stricture or recent passing out of calculi in the distal ureter.
Bladder diverticula.
case write-up radiology 1
Identification Data
Name: Abdul Aziz Bin Mohamed
Age : 52 years old
Race : Malay
Date of admission : 7 February 2011
X-Ray No : 1159
Type of Imaging : Ultrasound study of Genitourinary System
Positioning : Supine
Clinical History
Patient is a known case of Diabetes mellitus and hypertension, was admitted with chief complaint of vomiting and diarrhoea for two days duration associated colicky abdominal pain, lethargy and dizziness.
Procedure
Patient lying on supine position, kidneys are scanned longitudinally and transversely. The right kidney is scanned through the liver and posteriorly in the right loin. The left kidney is visualize from the left loin.
Findings
Kidney | Bipolar Length (mm) | Echogenicity | Hydronephrosis |
Left | 90 | increased | nil |
Right | 86 | increased | nil |
Impression : Chronic Renal Parenchymal Disease
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