Cerita HO 3: Tugasan

Assalamualaikum wrt wbt

Alhamduillah, hari ini saya off setelah Night shift berturut-turut. Penat bukan kepalang apabila hanya ada 4 orang HO duty di department Surgical. Kerjasama dari semua amat diperlukan.

Syukur, saya ditugaskan di Emergency OT. Untung tidak ada kecelakaan serius yang mengharuskan operasi segera. Saya kembali memikul tugas menjaga Ward. 2 ward sekaligus, perempuan dan lelaki. Hampir 40 orang manakala sahabat saya, 3 orang HO lagi, bertungkus-lumus di Emergency Department kerana ada 12 pesakit under Surgical.

Cerita kali ini adalah mengenai TUGASAN.

Semasa ward round pagi,

Mr H (Specialist Surgical - Malaysia, we address specialist in Surgical Department as Mr/Ms).

Mr H: What is normal frequency of bowel sound?

Me and my friends: above 5, (and I with whispering sound, answered "up to 34 times/minute)

Mr H: Different part of gastrointestinal, different frequency. What is the frequency for Gastric, small intestine and large bowel?

Me and others: ..................................... silent mode (me, what? i thought 5 - 34 is included all those 3 organs)

Mr H: What is the quality of bowel sound?

Me and others: Gurgling.

Mr H: What is the pathologic of bowel sound?

Me and others: High pitched tickling in dilated bowel and high pitched rush frequency in obstruction of lumen either small or large.

Mr H: What is the muscles contained in and type of movement in Gastric, small bowel and large bowel?

Me and others: ............................................... (Boss with his eagle eye, looking-straight to my eyes and waiting for the answer)

Me: (stuttering) .... in small intestine there are 2 smooth muscles. Longitudinal and circular. Circular muscle once it contract it cause propulsion, a peristaltic movement of chyme forward oral to caudally motion and longitudinal muscle for...........er..........sorry Boss, I'm not sure. (Rather than I bluff and make a stupid statement, it is better for me to zip my mouth. This is not the time for try and error)

Mr H: Have you heard about Segmental?

Me: Nodding (Oh my goodness! Segmental movement in small intestine is also well-known as movement for absorption. High proportion for absorption is at Jejunum, then Ileum, then Colon. Macam mana boleh lupa??!!)

Mr H: You and you 2, read about Gastric, Small intestine and Large intestine, tomorrow I want to meet you guys (while pointing to my 2 friends, as well)

Me: Ok Boss. We will.

I went back home (post night shift) and had a good rest and started to browse my notes during medical school. Saya tidak rasa kecewa atau tersinggung. Sebaliknya bersyukur ditanya dan diberi tugasan. Sekurang-kurangnya saya dapat belajar dan tahu lebih banyak. Syukur!

Ok, simply says (this is what I can find in my notes and Medical Physiology. Feels free to drop any new info):

1. Frequency of sound:

Gastric sounds 3 - 4x/min
Small intestine 8 - 12x/min
Large intestine 2 - 6x/min

2. Where is the best site to listen to bowel sound?
Right iliac fossa region.

3. What is the type of muscles and movement in those 3 organs?
1. Gastric:
- 3 muscles: Outer Longitudinal, Middle Circular and Oblique smooth muscles (controlled by Vagal and Celiac Plexus)
- Receptive relaxation: whereby the food is mixed with fluid and amylase enzyme
- Antral contraction: peristaltic movement

2. Small intestine
- 2 muscles: outer longitudinal, middle circular, inner mucous (contain villi for absorption)
- Peristaltic and Segmental movement

3. Large intestine
- 2 muscles: outer longitudinal, middle circular
- Peristaltic and segmental movement.
- less frequencies compared to small intestines.

To my dear juniors and friends, belajar rajin-rajin ya!. Ambil pengajaran dari cerita saya :)

Pesan 1: Saya target untuk menghabiskan tentang Gastrointestinal System hari ini. Have to review back everything. Bi iznillah.