New day, new department

I ended my Orthopaedics posting without much hassle, Alhamdulillah.
 I think I did quite well there, especially in the last 2 months. I knew what operation to expect, what the MOs would want to know and stuff so especially in the last month - February - Ortho was a breeze and so much fun!

Now I'm in Surgical department and it's starting all over again.

My colleagues are not as helpful or nice as those that I had during Orthopaedics. They are more bossy and care more about finishing their own work and covering their own ass. As a tagger, I'm doing all the scut work around here. New case? Guess who's clerking. Trace investigations? Me again. Urgent CT or Ultrasound? Yup, still me.

I'm really not doing so well here. My MOs think I'm a nuisance, I'm sure, as I can't really help them at all. When I clerk new case and present to them, they always sigh and flip through the case sheet themselves. And I always don't do certain investigations that are important - because I didn't know it was important!!

I have so much to catch up and learn, and I have a Viva to do, preferably before the next week.Surgical department is depressing. :'(

Of Surgery and Pancreatitis...

It has been a grueling rotation indeed.
Previously, if I was asked to describe my Surgery rotations knowledge, these words would come to mind

"Easy.."

"Boring.."

"Non-existent"

But after a hard-core month with Professor Yurii Markovich Zigmantovich, I changed my mind!
Damn, surgery is HARD!

To recap, our days with the dear Sir would start early. I don't mean 9am. I mean 8.30am. NOT 8.31am. And definitely NOT 8.45am like other (more fortunate) students. But 8.30 am sharp. And when you're late, you don't get a dirty look and snide remarks. What you get is a boot out the door. Yeah, go home and go back to sleep because he doesn't accept tardiness!

And if the early mornings are not bad enough, we have tests...not everyday (like he threatened) but at least once a week. Usually on the bigger topics like Dysphagia, Post-Gastrectomy syndrome, Pulmonary embolism, etc etc. But I don't mind it so much, because at least it forces me to study. :))


Pancreatitis
In the past 2 weeks, I have had 3 patients suffering from acute pancreatitis! :p That's one too many for me. I want to clerk something more challenging but instead...I'm pancreatitis girl!

Here are some fast facts for my benefit :

• Most common cause : Alcohol abuse and Gallstones
• Least common cause : Scorpion bite! xD
• C/o of acute epigastric pain, belt-like irradiation, nausea and vomiting
• adynamic ileus (sentinal loops on CXR) on auscultation
• Tender epigastric
• Fever
• Patient should be NPO! 
• Analgesic of choice? NOT morphine (it causes the Sphincter of Oddi spasm)
• Prognosis based on Ranson's criteria
• At presentation
• Age >55
• WBC > 16 000
• Glc > 200
• AST > 250
• LDH > 350
•  During first 48hours
• Base deficit > 4
• BUN increase > 5
• Serum Ca++ < 8
• Hct decrease > 10%
• P02 < 60mmHg
• Mortality rate is about 100% if Ranson criteria is > 6