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 longanimous heavy smoking carriage (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, hotshotness hour apart, painless ,of large amount, complete rate of flow ,also the patient recorded that he saw 2 pieces of clots after excretion at noon of aforesaid(preno minute of arcal) day .then the color of body of water was back to normal as the patient said. theres associated nocturia, urgency, and drippling of one month duration .also weight 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 ODmetformin 750 mg PO BIDamaryl 4 mg PO dailytritase 10 mg PO dailyPSH CABG, hemorroidectomy , left herniectomy, right hip fixation by plates and screws(duration unknown by the patient). Family history Mother(DM,HTN,CAD)allergic reaction No known drug or food allergy.Physical examinationGeneral 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 ad-lib hygiene Decreased visual acuity (presbiopia) ,arcus senilis ,diplopia No tinnitus, no vertigo (Dix hallpike test not done) chest of drawers exgood bilateral air entry. No rub, no crepitations, no wheezes. cardiac ex unvarying S1S2 with no murmurs.Abdomen ex1. Inspection non distended symmetrical abdomenNo visual pulsation or peristalsisNo localized bulgeMale pattern of hair distributionUmbilicus is around shifted downwards, no dischargeNo full flanksNormal subcostal angleNo spider angiomasNo visible veinsNo scars, or scalingred colored urine(in the foleys bag) but the urine is clear due(p) to irrigation of bladder 2.Auscultation audible bowel sounds, no renal artery bruit3.Palpation soft non tender abdomen, warm, no palpable masses, Lower border of liver is not felt, upper border at 5th ICS on 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 corroboratory pedal pulses no lower limb edema, no redness no bruises no muscular atrophy. derivative diagnosis1- bladder cancer2- 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(ur oscan),cystoscope and urine cytology.What was done at the hospital ItemMinumumMaximum valuate pre opHemoglobinUrine analysis normalUltrasound of pelvis no post residue voiding ,small thick wall, prostate is enlarged measuring 39 grams Management Control the glucose level preopTURBTTURP to remedy obstruction with biopsy of prostateSend the samples to pathology and wait the results.If the tumor did not invade the detrusor muscle its picayune and managed according to grading and depth (Ta low grade TUPBT only ,T1 low grade or Ta high grade TURBT + intravesicle injection 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 divergence by neobladder or ileostomy(conduit).