High Level of Fats in the Blood

...this may happen if you eat too much fats within a short period of time...

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Large Haemorrhoids Need Haemorrhoidectomy

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The above three pictures depict a large prolapsed and thrombosed Haemorrhoids which were removed by operation called Open Haemorrhoidectomy.

Haemorrhoids are very common among young adults.

It is related very much with constipation. Some patients have symptoms worsen by hot chilies.

In the initial stages, Haemorrhoids can just be treated with medications.

At later stages, when the Haemorrhoids get bigger, some form of procedures need to be done.

Large Haemorrhoids like in this picture will almost always need surgery because of associated prolapsing tissues and thrombosis. In this situations, if the Haemorrhoids are not operated, quite often tissues will ulcerate and cause infections. 

Infections in the perineal area is potentially dangerous as they can cause Portal Pyemia ie. Blood infection of the Gut system.

Rare Clinical Symptoms for Duodenal Ulcer

The picture above shows the endoscopic view of a Duodenal Ulcer in the first part of duodenum(=Duodenal Bulb=D1)

Typically, it's being thought to medical students and also assumed by patients that Duodenal Ulcer presents with Upper Abdominal symptoms such as pain, discomfort or bloatedness.

Like many other diseases, Duodenal Ulcer sometimes present with atypical symptoms.

The patient above initially presented to the Urologist in our hospital with Left abdominal pain. The initial clinical impression was Left Renal Colic.

However, thorough investigations of the Kidney systems from Urine analysis to CT Urography were all normal.

The Urologist then referred to for Colonoscopy to assess the Colon especially the Left Colon.

However upon thorough clinical history appraisal, the left-sided abdominal pain was deemed to enclose the whole of the left abdomen from the left upper part to the left lower part.

As such, I had decided to also examine the stomach and duodenum apart from colonoscopy.

The Duodenal Ulcer above was discovered at Upper Gastrointestinal Endoscopy(OesophagoGastroDuodenoScopy=OGDS).

Clinical lessons;

1.It is worthwhile to repeat thorough clinical appraisals by different doctors in less straightforward clinical cases

2.It is worthwhile for Clinical Specialist performing special invasive procedures especially that require some form of anaesthesia  to have a lower threshold of clinical indications so as to save time and resources.

Lipoma - a benign fat cells tumour

Lipoma is a common skin swelling in general surgical practice.

Lipoma is a benign tumour of fat cells underneath the skin.

Lipoma can occur anywhere in the body that has fat cells.

A very large lipoma has a small risk of transformation into a malignant fat cells cancer(Liposarcoma).

A benign Lipoma on the back (above picture) can be very large.Surgery is the only way to treat this tumour. General Anaesthesia is required for the surgery.Wound closure of the flaps carries a significant risks of complications.

Appendectomy is perhaps the commonest gastrointestinal surgery in genera...

Open Cholecystectomy for Gangrenous gallbladder

Simultaneous Laparoscopic Cholecystectomy and Appendectomy

These are samples taken from the same patient during an operation. 

The most left is the removed Appendix. 

The middle is the removed Gallbladder. 

The most right is the soft gallstones removed from the gallbladder. 

This patient presented with one month history of right-sided abdominal pain in the middle. 

Typically, upper right-sided abdominal pain is caused by inflamed gallbladder(Acute Cholecystitis). 

Typically, lower right-sided abdominal pain is caused by inflamed appendix(Acute Appendicitis). 

So, the middle right abdominal pain give rise to the suspicion of simultaneously inflamed gallbladder and appendix(concomitant Acute Cholecystitis and Appendicitis). 

Since the gold standard operation to remove the gallbladder is by Laparoscopic Cholecystectomy, during the procedure, the appendix was also explored and confirmed to be inflamed. 

Laparoscopic Appendectomy was also attempted but due to adhesions and the retrocaecal location, dissection was hazardous and hence the procedure was converted to conventional Open Appendectomy.

Alternative Therapy in Colorectal Cancer

The picture above is a CT scan view of a pelvis in a patient with locally advanced rectal cancer. The red  circle indicates the lateral extent of the rectal tumour. It appears that almost the whole lumen has  been obliterated by the tumour.The remaining compressed lumen is reflected by only three black dots in the centre of the mass.

The patient was diagnosed one year earlier in another hospital when he presented with just painless bleeding in the stools.

After colonoscopy and histological confirmation of the diagnosis, the patient refused the standard surgical operation offered, but instead went for an "Alternative Therapy" in Gerik, Perak.

He came to my clinic asking for a CT scan to check on his disease. 

From the CT scan, he soon will suffer Intestinal Obstruction that will require an emergency surgery. 

I am yet to find a cancer patient successfully treated by an "Altetnative Therapy".