Wednesday, December 24, 2008

Am I a boy or a girl



Today was the Gynae OT day.I observed a few operations.Assist? Nanti la, tak biasa lagi...


Case one: Its about a 16 Yr old girl who never had menses (turun haid).In medical term, it is called Primary Amenorrhoea.There are many causes to this.The O&G specialist had to resort to a procedure called Diagnostic laparoscopy in order to confirm the diagnosis.This procedure involves in making 3 small holes in your abdomen, with one hole from your umbilicus (pusat).The abdomen is being inflated with carbon diaoxide and the area underlying the skin is being viewed by a camera inside the abdomen.Its the 'in' thing in surgery nowadays coz it is minimally invasive.Faster recovery for the patient.Anyway,Dr J asked me a few questions and one of them is 'What wud u make up if we do not find ovaries?' Hmm, lucky for me I straightaway remembered an episode from House Season 2 (I guess..) and answered 'Androgen Insensitivity Syndrome'.In this condition, patient's body produces the guy's hormone ie Testosterone but the body cells are insensitive to it.Therefore, there will be no development of the secondary sexual characteristic of a male, and instead the patient will physically look like a girl.Genetically patient is 'XY' but phenotypically patient is 'XX'.But, in this patient, 2 ovaries were found.BUT, the Uterus was missing.We also assessed her vagina and it was short and underdeveloped (measuring 1cm in length).Therefore, our diagnosis is 'Mullerian agenesis'.Dont ask me coz I have forgotten Embryology of the reproductive tract.I'm always lousy with embryology.haha.Anyway, the surgeon told me that this case is extremely rare and that I am lucky to be able to see during my undergrad.I feel sad for the patient really, but this is fate.We still need to do karyotyping, to confirm that she/he is XY.KUB X-ray (Kidney-Ureter-Bladder X-ray) is next coz 40% of patients with this condition will have urinary tract abnormalities.

Case two: Its about a 49 yr old lady who had abnormal vaginal bleeding in which we called as Menorrhagia.Did a procedure called 'Laparoscopic assisted Vaginal Hysterectomy (LAVH)'.The surgeon had to remove her uterus because of a presence of a Fibroid (Leiomyoma).See pic.





A well circumscribed tumour.Whorling bundle of smooth muscle over the uterine fundus I guess.Hmm...

We had yet another bedside teaching with Dr Jamil the O&G specialist later in the afternoon.Discussed 2 cases, which were presented by my two colleagues Amilee and Faradiana.
Later, I went back to my home sweet home in Cheras.Had a nice nap coz I am not feeling very well the whole day.I had coryza with runny nose.I really blame the cold OT.I also blame myself for not wearing a long sleeve shirt inside.Hmm.



Hannan and Fizie came after Maghrib.We drove to Selayang to Amilee's house for Christmas makan-makan at her house.Merry Christmas!

p/s1: I used to remember the days when I was in Glasgow,Scotland where I was about 4-5 years old at that time.I used to receive many presents during Christmas.Soo happy =)

p/s2: Ish,malu la pulak rasanye letak gambar sendiri.Rasa geli geleman pun ade.Pasni nk delete la

p/s3: Tho tomorrow is a public holiday, I still need to go the hospital to do my long case write up.Sigh...
p/s4:BEWARE.Medical series such as Grey's and House is a piece of crap.Its only good for entertainment, not more than that.Don't get carried away by it.Plus, in medicine knowing rare diseases will not make you a good doctor.

3 comments:

NL said...

hmm..muka ada npk gaya cam cardiologist hehe..

Ainul Arina Madhiah said...

grey's is quite too much love story while house is very-the-most-genius-who-always-get-the -rare-disease-diagnose...

ER lagi best..! the real busy life of a doc.. =) bila tngok ER, kadang2 macam nak patah balik takmau jadi doktor.. huhu

adli said...

Mullerian agenesis... had a similar case during my posting too.. was almost hit by her husband (siap kawin dah ok) for persistently clerking her.. my bad.. even tho she dont have a vagina (just two ovaries and thats it) they still got married and the husband accepts her no matter what.. that was sooo sweet!! they were only seeking appointment to ask if she could get pregnant which is a no no.. *sigh*

at least she have an amazing husband!