Clinical Practice Essay

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UNIVERSITY COLLEGE CORK
REFLECTIVE LEARNING LOG 2009/2010
CP2001
NURUL AZIRA SALIM

DR.LARRIE MARTIN
BRIDGE HOUSE SURGERY, CARRIGALINE

Case 1 – Gastrointestinal System
History
On 3rd of December 2009, I went to the Bridge House Surgery , Carrigaline for my Augmented Teaching Practice (ATP) attachment with Dr. Larrie Martin. This week focus was on the Gastrointestinal System. Thus, this is the history of Mrs L, a 53 years old lady who presented with an excruciating painful abdomen. Apart from the pain, she was also worried with the fresh blood passed in the toilet bowl. She also complained of losing her weight. This had been going for about the past 6 months until she finally decided to meet her general practitioner to do a check up. Upon the medical check up, her GP said that there was a lump sitting on the rectum. Only then, she found out that her unbearable painful abdomen was due to the lump compressing on her nerve. Her GP then decided to send a sample of the lump to see whether it is a tumour or something else. A few days later, when the test result had came out, her GP rang her. He asked her to meet him the next day. She went back to see her GP with mounting anxiety in her heart that only God knows. She was surprised to hear that the lump was confirmed as bowel cancer. Her GP then decided to refer her to the hospital for a surgical removal of the tumour. She agreed. She had two surgeries. Firstly, it was for the removal of the tumour while the second one is due to the adhesion that occur after the surgery. She has a colonostomy bag attached to her left flank. The colonostomy bag was given to her due to her lump condition that was way too down to the rectum, making it difficult for the surgeon to rejoin her colon. Besides that, she is suffering from emphysema which is now under control with the inhaler. She is on lithium as well for the manic depression that she had since 18 years old. Apart from that, she has neither other diseases nor allergies. She smoked 10 cigarettes per day and drank one to two glass of alcohol per week. She lives on her own after the divorce with her husband. Her father, mother and grandfather had died due to cancer. Nevertheless, she is currently has a very active live by getting involve with the society such as joining the Animal Protection Society and judo. She reflected that by being active, it helps her to get on with life and help her to forget all the problems that lie at the back of her mind. When asked whether it is difficult to have the colonostomy bag around, she said that it was quite inconvenient for the first time but as time goes by, she got used to it. She was happy with the help and advice given by the nurse on how to change the bag and keep it hygienic. Currently, she is doing very well and has no other problem with her health. Examination and Investigation

Upon general inspection, as the patient walked in, everything look normal from the gait and overall general well-being is good except for the tired look and her sunken eyes maybe due to lack of sleep. Her pulse and blood pressure are normal. Her nails have obvious nicotine staining. The capillary refill was good. Apart from that, there were no significance findings on the patient face and neck. A colonostomy bag can be seen on her left flank as well as two scars from the surgical removal of the tumour. The abdominal aorta pulsation was visible in this patient, as it will be in a normal thin person. Everything else is normal upon palpation, percussion and auscultation. Reflection

Before we start that day, I was quite apprehensive even though this is our third session meeting with patients in this surgery. Luckily, before every session Dr. Martin would give us a brief tutorial session to highlight what is important for the GIT system and how to approach the GIT patients. This includes the 5 basic elements to ask the patient...
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