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salam kawan2....tadi kawan arab ade bagitau pasal exam tropical...

so here are some points to stress upon:

1)ascites -- causes (doc suke dgr general causes and local causes instead of transudate and exudate), investigation, treatment (mainly salt restriction, the only curative ttt is liver transplantation)

2)jaundice -- types or mechanism of jaundice : a)hemolytic (bilirubin overload/indirect hyperbilirubinemia) b) hepatocellular (problems in the uptake,conjugation & secretion of bile) main cause is Liver cell failure. c) obstructive (obstructed bile outflow)

3)manifestation of liver cell failure

4)hematemesis / portal hypertension

5)etiology of spleenomegaly

6)causes of huge spleen

7)spontaneous bacterial peritonitis -- caused by gram -ve bacteria(e.coli, klebsiella)
clinical picture + ascitic fluid tap ( neutrophil count >250 cells/mm3)
ttt -- cefotaxime 2gm every 12 hours for 2-5days
prophylaxis -- ciprofloxacin 500mg once daily

* examine patient's eye ---must be under day light (should say this to the doc)
ade doc yg just nk tahu finding (jaundice), ade doc yg nk kta comment semua(eyebrow,lens,cornea.....i dont know..maybe bleh ignore)

*examine the liver------- include inspection,palpation,percussion & auscultation(?)

*when to suspect patient is having hepatic encephalopathy -----present of fetor hepaticus,mental confusion,increase number of spider nevi

*ambik tahu jgk pasal assignment.....nt doc bleh tanya jgk....

*deep jaundice or olive green jaundice usually due to obstructive type (CBD obstruction)...in old patient mainly due to malignancy (cholangiocarcinoma, cancer head of pancreas) in middle age mainly due to CBD stone

method of exam : examine patient + oral question (10 m)

just menyampaikan je.wallahu a'lam.