Congenital diaphragmatic hernia

Peritoneopericardial diaphragmatic hernia in a catCongenital Diaphragmatic Hernia (CDH) is a congenital abnormality that is often life-threatening because it can limit the growth of the lungs. The site of herniation is most commonly found on the left side in the hole originally designed for the entry of alimentary canal. Herniation is sometimes found near sternum.


Defects
It involves three major defects.

A failure of the diaphragm to completely close during development.
Herniation of the abdominal contents into the chest
Pulmonary Hypoplasia

Early diagnosis and presentation
This condition can often be diagnosed before birth and fetal intervention can sometimes help, depending on the severity of the condition.[1] Infants born with diaphragmatic hernia experience respiratory failure due to both pulmonary hypertension and pulmonary hypoplasia. The first condition is a restriction of blood flow through the lungs thought to be caused by defects in the lung. Pulmonary hypoplasia or decreased lung volume is directly related to the abdominal organs presence in the chest cavity which causes the lungs to be severely undersized, especially on the side of the hernia.

Survival rates for infants with this condition vary, but have generally been increasing through advances in neonatal medicine. Work has been done to correlate survival rates to ultrasound measurements of the lung volume as compared to the baby's head circumfrence. This figure known as the lung to head ratio (LHR) may be used to determine if fetal surgery may be used 

Renal failure (腎衰竭)

The doctors are performing kidney transplantation by endoscopy.

Renal failure are classified into chronic and acute. Chronic renal failure is irreversible (over 75% of kidney cells are damaged). It is caused by vascular diseases, obstruction of urine outflow, recurrent infection of kidney and hypersensitive reaction.

Renal failure causes various problem like
1. waste production retention:
- As glomerulus filtration is decreased, less urea is excreted. Thus more urea is retented in blood. High concentration of urea then leads to high concentration of urea in glomerulus filtration. As urea is osmotic reactive, more water is drawn into the renal tubules which may cause hypotension.
- At the same time, K+ excretion is not enough. High concentration of potassium depresses nervous system causing muscle weekness and fatigue
- Retention of PO4= causing inhibition of enzyme for activating vitamin-D which in turn lowers the Calcium absorption in the gut. Bone pain and weakness occur.

2. Inability to control the osmolarity of extracellular volume (inability to control Na+)
-polyurea
-isothenmia
-nocturia (urination at night)

3. Inability to control blood pressure
when sodium intake is more than our bodies require, hypertension occurs.
When sodium intake is insufficient, hypotension occurs.

4. Effect on blood components
uremia affects platelet functions which leads to defective clotting
decrease in erythropoietin production and thus lowers the red blood cells count leading to anaemia

5. Loss of useful substacnce
NaCl, glucose, proteins, HCO3- due to inadequate reabsortion

6. Loss of HCO3-
H2CO3- acts as a buffer in our bodies, insufficient reabsortion casues metabolic acidosis.
Respiratory compensation is acticated to eliminate CO2 in blood.

7. Compensatory hypertrophy

Treatments:
dialysis, kidney transplant, antibiotics for infection, removal of obstruction, sodium bicarbonate intake for acidosis, blood transfusion for anaemia

Acute renal failure is reversible. (urine out is inadequate to eliminate waste product in body, <0.5L/day) 

Prostate cancer

Prostate gland cancer is a common cancer in male. The symptoms are difficulty in urination, painful urination, decrease in urine ouput and increased frequency of urination. Prostate gland hypertrophy has similar symptoms as prastate cancer. To differentiate, testing the level of P.S.A. (前列腺特異抗原) can help. Patient who has cancer has higher level of P.S.A. while those have hypertrophy have only a little elevation. 

The chest drainage system

I have encounter this ATRIUM chest drain system when my boyfriend had the pneumothorax a few years ago.
There are 3 chambers in the closed chest drain system.
1 collecting chamber for collecting air, blood and any fluid drained from the thorax.
1 water seal chamber with sterile water to prevent the air from outside entering patient's lung and prevent from re-collapsing of lung.
The suction chamber...of cuz it's for suction.

The drainage system should be placed under the patient's chest to avoid re-indroducing the fluid or air into the lung which afftects lung-expansion.
Make sure there are no kinkling or looping which may cuz tension pneumothorax if the tension accumulate in the thorax and there is no mean to release.
Collect the trocar and the tube of collecting chamber with sterile technique.

Remember to give local anesthesia to the patient when u are introducing the trocar and cannula...
cuz it's a very invasive procedure 

The tests results are announced

What's worng with me?
B+ only...damn it

life is more stressful...
cuz when u know more, u know u only know a little...
it's so frustrating..

Life is not all about study...
there are lots of things for me to explore...
but should I put my study aside?
it seems it's not possible...
damnit
i hate this feeling so much..

endocrine disorders

Originally, I wanna finish the endocrine disorders notes but I'm running out of time. I'm very sleepy cuz I woke up at 5am for the hospital practicum. There are still half of it left. I wanna finish the whole stuff by tomorrow cuz I won't have any time to prepare for this.
I also have taken a look on the respiratory failure notes but it's not interesting and I think I need more time to digest and to understand some parts of them.


No stress and take it easy. Cuz I don't want to have endocrine disorders like hyperthyroidism.
 

ECG diagnosis

It's crazy....a classmate of mine read this which we are not expected to do
I somehow appreciate somebody can be this hard-working.

The new direction of the blog

Sorry that I have to renew this blog. The blog will become my personal blog which only talks about things happen around me. Thanks for coming to the blog. 

SK-II 驗出有禁用成份

(明報) 09月 15日 星期五 05:10AM
【明報專訊】對於SKII被國家質檢總局驗出含有禁用於化妝品的「鉻」（chromium）和「釹」（Neodymium），皮膚科專科醫生史泰祖說，他並不清楚市面其他化妝品是否同樣含有鉻和釹，因為目前本港廣 告

並無法例要求化妝品須清楚列明所有成分，不過他解釋，鉻和釹均令皮膚有敏感性和刺激性，所謂敏感性，即是市民若對該兩種物質有敏感反應，則不論化妝品的鉻和釹含量是多低，皮膚皆會呈現紅腫、痕癢等徵狀。至於刺激性則與劑量有關，即劑量愈大，刺激性愈大。

停用後可消退敏感

史指出，輕微的敏感反應一般在停用含致敏原的產品一段時間後，便會自動消退，若皮膚敏感較嚴重須求診，醫生會處方類固醇的藥膏治理，一般而言問題不會太大，但他提醒市民，切勿用手抓出現敏感反應的皮膚，因為一旦抓傷便有引致細菌感染的危險，有機會令皮膚因而發炎損傷留疤，「手尾」可以很長。