Tuesday, November 17, 2015

A 50 years old man with abdominal pain and loss of appetite since 1 month

This is a HIPAA de-identified open-online-patient-record, posted on autumn 2015 after collecting informed patient consent (form downloadable here ) by LNMCH research assistant and patient-information-communication-executive and discussion (scroll down to the bottom) initiated by patient's primary care physician in-charge: 

A 50 years old man with abdominal pain and loss of appetite since 1 month

Below are the images of doctor notes and patient radiology and investigations uploaded in autumn 2015 by LNMCH research assistant and patient-information-communication-executive: 











latest update: liver abscess drain on yesterday 19NOV15. images is here!!!

 
 


 

new chest x-ray done on today 21nov15


Conversational clinical decision support:

Rakesh Biswas Any feedback on the double diaphragmatic shadow on his CXR pa view ( Dr Chaturbhuj, Dr Satish, Dr Priyank, Dr Mahendra)?
LikeReplyNovember 18 at 9:13pm
Rakesh Biswas We wanted to put a drain in three of these today but were held back due to lack of money:http://3.bp.blogspot.com/.../sfU5QuIhQOk/s1600/DSCN0170.JPG
LikeReplyRemove PreviewNovember 18 at 9:16pm
Santosh Sapkota What are you suspecting?
UnlikeReply1November 18 at 9:27pm
Rakesh Biswas In the CXR pa or the Ultrasound?
LikeReplyNovember 18 at 9:34pm
Santosh Sapkota Are you suspecting different diagnosis based on CXR and USG findings? I have lost my clinical eyes to read the films unfortunately.
UnlikeReply1November 18 at 9:36pm
Rakesh Biswas In USG the diagnosis is clear and i am trying to know if the USG findings can correlate with the findings in CXR pa view and if so what exactly does that double right dome of diaphragm indicate?
LikeReplyNovember 18 at 9:38pm
Santosh Sapkota Also, how challenging it is to get an additional financial help? Remember, we used to have Poor Patient Fund during our MCOMS days? I wonder if there is anything like that there.
UnlikeReply1November 18 at 9:39pm
Rakesh Biswas Yes inspired by that we have recently managed to get some students to develop something similar and we also have a very helpful hospital employee Mr Keshav who is organizing all this.
LikeReplyNovember 18 at 9:41pm
Santosh Sapkota I wonder we can develop something like a baby shower or bridal registries within UDHC website where we can request, "one peritoneal tap-100$ "liver biopsy - 200$ "as our need and we can try to find matching donors from around the world. Is it possible for UDHC to accept paypal donation?
UnlikeReply1November 18 at 9:46pm
Rakesh Biswas Fantastic idea! Yogesh, Nipun how about developing this?Santosh is a health informatics professional in US and was one of our best medical students in Manipal.
LikeReplyNovember 18 at 9:49pm
Rakesh Biswas Roona, Rajib the above idea from Santosh may be in the lines of what you have already thought earlier. Your inputs would be valuable.
LikeReply1November 18 at 9:52pm
Roona Mookerjii We r trying to form or to b attached wid an organization in order to cater needy people offering financial help. Howevr we r in embryo stage to b formed, yet really looking forward to the lines showed by Rajib Sengupta...he z d best person to talk over this...and Rajib have u added Rouhin by ne chance ??
UnlikeReply1November 18 at 10:48pmEdited
Rakesh Biswas
Write a reply...
Santosh Sapkota Based on my limited experience post earthquake in Nepal, I found a targeted donation is easy to manage with very limited logistic challenges
UnlikeReply1November 18 at 10:01pm
Yogesh Sharma Sir its a great idea, as far I think online transfer is possible for our Rafter Charitable Society account. And it would be great if we can develop this system. We will be able to help lot of patients.
Need inputs from santosh sir and you.
LikeReply1November 18 at 11:07pm
Santosh Sapkota I can schedule an online meeting with you and DrRakesh Biswas.
UnlikeReply1November 19 at 12:06am
Yogesh Sharma We can discuss this over email also. zidwid@gmail.com
LikeReplyNovember 20 at 2:03pm
Rakesh Biswas
Write a reply...
Rajib Sengupta Rakesh - We have done this crowdfunding in various forms for various reasons over the years . we are currently discussing on how we can bring these efforts , specifically related to healthcare, under a single platform - hopefully in next few weeks we will be able to come up with a concrete plan..
UnlikeReply2November 18 at 11:33pm
Rakesh Biswas Pus drained yesterday.http://4.bp.blogspot.com/.../s1600/IMG_20151119_110757.jpg The culture is sterile. Does this look like anchovy sauce?
LikeReplyRemove Preview1November 20 at 2:00pm
Rakesh Biswas Dr Bharati, Dr Swagata, The right dome of the diaphragm was abnormal on the CXR as previously discussed. Post drainage of pus the CXR appears normal.
LikeReply1November 20 at 10:25pm
Swagata Brahmachari This is first time I was seeing a double shadow on chest xray
UnlikeReply1November 21 at 10:22pm
Rakesh Biswas Rajesh please take a look at this patient in the ward today. He was better all these days after the aspiration and since today morning he has again developed the odynophagia. We have repeated the usg today and we are repeating the CXR pa today
LikeReplyNovember 24 at 3:26pm
Rajesh Patel Rakesh Biswas sir, the pt is comfortable , still having odynophagia and epigastric burning ..no complaints of vomiting.
LikeReplyNovember 24 at 7:42pm
Rakesh Biswas Thanks Rajesh, Do you think the odynophagia is related to the abscess? The odynophagia seemed to have symptomatically resolved after the large posterior one was drained along with reduction of the CXR-pa double contour in the diaphragm. What does today's USG report show?
LikeReplyNovember 24 at 8:04pm
Rajesh Patel Two liver abscesses first of 112 cc nd 2 nd of 61 cc volume
LikeReplyNovember 24 at 8:20pm
Rakesh Biswas
Write a reply...
Rakesh Biswas Thanks Rajesh, How different is the current report from this previous one here:http://3.bp.blogspot.com/.../Tj6OWVoau2o/s1600/DSCN0171.JPG
LikeReplyRemove PreviewNovember 24 at 8:25pm
मोनिका पठानिया राठौर Other causes need to be ruled out...Chen SC, Huang CC, Tsai SJ, et al. Severity of disease as main predictor for mortality in patients with pyogenic liver abscess. Am J Surg. 2009 Aug. 198(2):164-72. [








Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)