Success is about hard work and not luck Essay Example for Free

Success is about hard work and not luck EssayThis is the case of 74 year old male long-suffering heavy smoker (2 packs per day) presenting to the floor of MGH for the above chief complaints. History goes back to 15 days when the patient noticed 3 successive episodes of blood with urination at morning, one hour apart, painless ,of large amount, complete stream ,also the patient recorded that he saw 2 pieces of clots after voiding at noon of same day .then the color of urine was back to normal as the patient said. theres associated nocturia, urgency, and drippling of one month duration .also cargo loss of 15 kg within 3months.NO burning sensation , no pain ,no dysuria, no fever ,no flank pain,no back pain, no nausea no vomiting, no constipation ,no other system involved symptoms. The patient was admitted to MGH for further investigations.PMH DM 25 years pastHTN 10 years agoCAD 10 years agoMedicationsconcor 5 mg one at morningaspicot 100 mg ODLipitor 20 mg ODglucophage 750 mg PO BIDamaryl 4 mg PO dailytritase 10 mg PO dailyPSH CABG, hemorroidectomy , left herniectomy, expert hip fixation by plates and screws(duration unknown by the patient). Family history Mother(DM,HTN,CAD)Allergy No known drug or food allergy.Physical examination frequent examinationThe patient is conscious, cooperative, oriented, pale, sitting, thin , cachectic ,having foley catheter.(seen 2 days postop) Vital SignsRR 24/minPulse 64/minTemp. 37.4 CBP 160/90 mmhg.HEENT pallor, no cyanosis, no jaundice, no ecchymosis, no mouth ulcers , bad oral hygiene Decreased visual acuity (presbiopia) ,arcus senilis ,diplopia No tinnitus, no vertigo (Dix hallpike exam not through)Chest exgood bilateral air entry. No rub, no crepitations, no wheezes. cardiac exRegular S1S2 with no murmurs.Abdomen ex1. Inspection non distended symmetrical abdomenNo visible pulsation or peristalsisNo localized bulgeMale pattern of hair disseminationUmbilicus is slightly shifted downwards, no dischargeNo full flank sNormal subcostal angleNo spider angiomasNo visible veinsNo scars, or measurered colored urine(in the foleys bag) but the urine is clear due to irrigation of bladder 2.Auscultation audible bowel sounds, no renal artery bruit3.Palpation dim non tender abdomen, warm, no glaring masses, Lower border of liver is not felt, upper border at 5th ICS along the MCL Spleen is not palpable Both kidneys are not palpable , no CVA tenderness. no suprapubic pain.4.Percussiontympanitic urinary bladder5.DRE not done6.Genitalia examination not doneLower limbs positive pedal pulses no lower limb edema, no redness no bruises no muscular atrophy.Differential diagnosis1- bladder crab louse2- BPH3- Prostatitis4- Urolithiasis5- Prostate cancer incidental or advanced.Investigations Labs CBCD, BUN, Creatinine ,electrolytes, CRP, HBA1C,FBS,LDL,HDL,triglyceride PT ,PTT ,PSA, urine analysis and culture. Imaging CT urography(uroscan),cystoscope and urine cytology.What was done at the hospital full stopMinumu mMaximumValue pre opHemoglobinUrine analysis normalUltrasound of pelvis no post residue voiding ,small thick wall, prostate is magnified measuring 39 grams Management Control the glucose level preopTURBTTURP to relieve obstruction with biopsy of prostateSend the samples to pathology and wait the results.If the tumor did not invade the detrusor tendon its superficial and managed according to grading and depth (Ta low grade TUPBT only ,T1 low grade or Ta high grade TURBT + intravesicle guesswork of chemotherapy , T1 high grade TUPBT and relook after 1 month) if invade the detrusor muscle T2 = metastatic workup CT abdomen ,chest , and bone scan.then remove the bladder and do urinary deviance by neobladder or ileostomy(conduit).