Elective posting in GH

I was a first year medicine student that actually dunno anything..haha

so,my first day of attachment actually is quite terrible..

i dunno where should i stand most of the time n i'm jz blocking the road all the time..

until thr's 1 HO who willing to share n wat happen to the patient n ask me alot questions..finally i started to step into it..

So,here's my first patient ..

an old man(chinese) which around 75 years old..

have hypertension,diabetes.enter to hospital due to oedema(swollen in legs).

so,i still rmb vividly wat the doct say , oedema can cause by few factors,albumin level low , heart or renal disease, venous insufficiency, vasodilators, pelvic mass, pregnancy..

u nid to c whether the swollen part pain or not..

for this patient,the explanation from the doct is his heart is weak enough that causes the vein cannot pump the blood upward,so thr's retention of water there..

so.. one more factor that worsening the case is ,the uncle cannot walk,nobody take care of him due to her wife nid to work n he drink a lot water during night..

what i can c on tat time not the disease , is the wife that is really tough enough to handle all this things happen..

even saw the wife walk away from the patient n look at the uncle with watery eyes..serious..quite sad also when i saw the wife exhausted face n watery eyes..

back to the point so,here what is Oedema..

Definition : abnormal accumulation of fluid beneath the skin or cavities of body that produces swelling.

Oedema can divide into pitting & non-pitting oedema.

In pitting oedema u can see indentation remain for some time after release the pressure.this is result from water retention.

In non-pitting oedema u can indentation does not remain after release the pressure.

Types: 

I. Most common oedema is feet and ankles n both of this r refer as peripheral oedema.

II. Cerebral oedema

III. Pulmomary oedema

IV Macular oedema ( eyes )

Investigation for oedema :

i. Urine test (look for proteinuria +hypoalbuminaemia =nephrotic syndrome)

ii. renal function and electrolytes

iii. ECG ( if heart disease suspected)

iv. CXR

v. abdominal ultrasound

vi. LFT

vii. doppler scan

viii. lymphoscintigraphy

vix. hemoglobin (anemia may be cause of heart failure)

vv. thyroid function test (for hypothyroidism)

Management :

based on the cause.