MBBS UM (malaya) EXTENDERS

1. The title was a bit harsh.

2. I'm actually talking about one of University Malaya (UM) student from Academy of Islamic Studies (API) which is also the President of PMIUM currently doing stupid act.

3. I'm not talking about politics. I'm not a politician, and i hate politics thus, there is no way that I'm gonna talk politics here.

4. Because I'm the most seniors undergrad stud in UM currently, it's important for me to address this messages to him. I care my junior, is that a problem? My junior have a duty and responsible to their parents.

5. Firstly, for me his act is certainly not an intellectual move which is supposedly to be expected from every student from UM.

6. We are not a politician, not an extremist, not a another 'RPK'. We're only a 'Mahasiswa Biasa'.

7. You might seem big to us because you're President of PMI, but do you think you are big enough out here?

8. Do you think that you big enough you can do anything against the law and because of that you run from getting caught from the cops?

9. You're the 'role model' of all the student in UM. Do you think this act should be done on every students here?

10. Or you just want to have a 'publisiti murahan' so that all Malaysians know you.

11. Don't make assumption, where u based only on youtube video without any fact.

12. Don't make a statement threaten to the university admins of having a riot. If you do, i do agree if AUKU is implemented on you.

13. I suggest you shouldn't be doing it. Better for you to do good deeds and welfare to the students.

14. Where is your 'kurangkan yuran universiti' and also 'Riba PTPTN' fight anyway? My yuran is so expensive, and yet i don't have any $$ left in my pocket!

15. University can throw you away anytime they want, because you have done the DUMBESS act which is against the law.

16. And yet they have not done it because they think that you're the Leaders of Islamic Student? Of course not, because the investigation have not been concluded and you've not been prove to be the culprit who behind this DS Rosmah C4 wall painting.

17. If DS Rosmah was really doing all those nasty things, dont you think by putting an oil/petrol on the carpet and try to harm her by putting up a fire are the best way to punish her?

18. Do you think you wont be having a fair trials? Do you think that Anwar Ibrahim and RPK doesn't have a fair trial? Do you think that you'll be beaten at the eye and having a 'panda eye' like Anwar Ibrahim in the lockups?

19. If you have all this you might having a delusion of persecutory which might indicate you a schizophrenic. If it does, you should meet me, here, in Psychiatric ward in UMMC.

20. Maybe, i mean it, maybe, you might or will be given an exemption from the trial.

21. So please don't ask your friends to become one like you.

22. Don't you think that by AUKU is important now?

Haha.. I was a bit surprise when i saw one of the keyword from the readers.



I wonder why would someone really cares about the difference between Medicine Bachelor and Bachelor of Surgery (MBBS) and Doctor of Medicine(MD)? Both of them doctors, and both of them study the same things. The only differences are the name and one is British system, one is American. That's all. I wonder if i put this article, more and more will come to this site. LOL

Prof. Datuk Dr. Adiba Kamarulzaman, my professor of Infectious Disease in Dept Medicine, recently came out in hello Malaysia one of the segment/talk/tv shows in Bernama TV, Astro.. To those who still doesn't know what is Influenza A, can watch this video.. Meanwhile, when i'm writing this article, our cases have reached to 124!


(Click the image to view the video)
p.s.: You need to have real player plugin to view this video..

First of all we're sorry for the missing days guys.. We're too busy for this current posting. Actually, we've been in Obstetric and Gynaecology posting for 1 weeks already. Our posting require us to make 2 case summaries, 3 case presentation, and 5 DELIVERIES!!! sux man, because, we shouldn't be doing deliveries anymore because we've done it before. The department was really strict on us. I can still remember i fail my posting with only 0.1 mark to pass (i got my marks 49.9) because I didn't get the chance to pass out my last case summary only because of I'm late for a day. Anyways guys, I'll try to put up some post and maybe some picture of us later what we've done for the next 2 weeks in O&G.

Next, how was your life then? Many of my batch mates have already been posted to their respective hospital! Good luck guys in the coming days. Do not extend your posting.. LOLZ..

Meanwhile, it's the end of the months now and this would be the most suitable day to cash out my NUFFNANG blogging money! maybe tomorrow would be nice! I would like to thank to you all guys for clicking the ads here by nuffnang. Until then, I'll post about it the moment i got that check..

Topic today would be identifying Intestinal Obstruction in an abdominal X-ray. It's more or less like a quiz. Let's get started

Case 1
A 36 year old male with vomiting- for 1/7



Ok. How to interpret this?
It looks normal isn't it? Of coz it's normal. We need to know which one is normal. But if this normal, u still need to comment. What to look for in a 'normal' x-ray anyway?

Things to look for are

• Technical – Is the X-ray adequate?
• Is the gas in the correct place?
• Is there abnormal calcification or mass?
• Is the visualised bone and soft tissue normal?
• Any foreign bodies?

Case 2
8year old boy with abdominal pain



Hoho.. what do u think? Looks a bit shiny isn't it?

• It's a metallic foreign body projected over the left iliac fossa
• No dilated bowel loops
• Very unlikely to cause intestinal obstruction

Case 3
50 year old male with vomiting and NBO for 5/7



Look a bit bizarre rite? Take a proper look at the right side of the inguinal region. Is that a bowel?
This is actually an inguinal hernia basically a clinical diagnosis. Why do we do an Xray then? To rull out intestinal obstruction.

• Radiograph shows dilated small bowel in abdomen
• Bowel in the left inguinal region extending into the scrotum

Case 4
52 year old female with abdominal distension and vomiting for 2 days with a previous history of appendicectomy



Based from the history, adhesion would be more likely to cause intestinal obstruction due to adhesions from the previous appendicectomy.

• Note the multiple air fluid levels on the erect AXR
• On the supine radiograph – dilated loops of air filled small bowel

There is one question so common to ask in viva - How do you differentiate dilated small and large bowel?

• Easy - Look a the bowel fold
• Small bowel folds extend from one end of the bowel wall to the other
• Large bowel folds- Haustra extend about one third of the way
• Small bowel is also more central in position in the abdomen

Case 5
45 year old female with abdominal distension for 5 months


This one abit difficult. Where is the bowel actually? This is a large abdominal mass!
Bowel loops are displaced laterally and superiorly by a large soft tissue mass which appears to arise from the pelvis. Note a dilated small bowel loop in the right lumbar region.

Case 6
48 year old male – post gastrectomy 1 day



This could be paralytic ileus. I forgot to tell u that apart from adhesion, paralytic ileus could also be the cause of Intestinal Obstruction. However, an ileus can be diagnose based on abdominal examination by absence of bowel sound.
Note dilated small and large bowel. Apart from paralytic ileus, sub acute distal large bowel obstruction can give a identical appearance

Case 7
76 year old female with loss of weight for 3 months and now presents with NBO for 3 days.


Note the dilated air filled large bowel, from the caecum to the splenic flexure. This is a large bowel obstruction at the level of the splenic flexure.
This was due to carcinoma of the colon. A colonscopy would confirm this diagnosis
Ba Enema (Limited)- would also confirm the diagnosis. A CT would show the mass and is useful for staging

Case 8
30 year old female with non specific abdominal pain – 1 year



Non specific abdominal pain.. If you see this in Primary Care, sure you handle this as an irritable bowel syndrome.. HAHA.. yup this one is a normal small bowel enema. Note the “small bowel enema tube”. Normal small bowel folds which become less prominent in the ileum

Case 9
33 year old male with loss of weight – 4 months and vomiting for 5/7



There is thickened small bowel folds and strictures

Diagnosis?
.
.
.
.
It's a Lymphoma

Case 10
43 year old male with vomiting and lower abdominal pain- 1/7



This is a dilated loop of Large bowel. Inverted ‘U’ shaped loop of large bowel arising from the pelvis. Inverted ‘U’ shaped loop of large bowel arising from the pelvis. Suspect a volvulus (twist) of the sigmoid colon. How to confirm?



By doing a barium enema
Note the site of twist. This has been called the ‘Bird’s Beak’ sign

Case 11
20 year old male with history of chronic constipation since childhood



Diagnosis: Hirschprung Disease
Grossly dilated large bowel
Filled with faeces