hepatorenal syndrome

in a teaching session, Dr H, my boss told about this patient:

40 years old man, premorbid well, ASA 1

in ICU with acute liver failure, acute renal failure and in sepsis

high dose of broad spectrum antibiotic given, but seem not to be responding

CT scan shown cirrhotic liver, most probably due to chronic alcohol consumption, with portal hypertension..

so his question is: tell me 3 reasons that why this patient would have acute renal failure.

i gave the first reason:" because of sepsis."

"yes" he replied: "what others reason?"

"err...." i started struggling.... u know the pressure of Q&A in front of group of fearful specialists...

finally the answer came out from my mouth: "hepatorenal syndrome."

hahahaha... a great laugh came out from the mouth of all bosses..

and Dr H said: "this is the classical example of 'digging ur own grave', you wake all the sleeping dragon up and they start to fire on u..."

seem hepatorenal syndrome has the strict criteria to fulfill before u diagnosed it..

p/s: the other 2 reasons can be

1) antibiotic related, could be hepatotoxic

2) contrast related, from CT scan

Geoduck.. what is this

Geoduck, is not a duck

and it is not even a chicken, or anything on the land

it is a kind of shell species from sea.

and it is a pricy item 'on table'

this meal was billed by a pharmaceutical company,

so we enjoyed all the delicious and luxurious seafood..

including this geoduck

this 'duck' is nothing look like a duck,

in fact it is like a 'dick'

so ppl do believe that it will improve 'male' function.

scientifically speaking, its zinc content is higher that oyster

is that true?

i don't know, but it is delicious

finally, this is a great meal

scene while driving to work

there is a rain in the morning, that is so difficult for me to wake up from bed

however when i out from house, the rain had already stopped

since that is still early, the traffic is not too bad,

and while i passed through the hill, the scene is really nice

thus i do some stunt while driving, and that is the result..

swimming pool

i like to swim at night, there are too many reasons behind it..
mainly is because i am a lousy swimmer, and less ppl would be in the pool at night
but the better reason would be as below..

see, there is so different in the pool between morning and night...

my new working environment

yeah the on call room is nice

with a 29 inches tv, bigger than that in my room..

and also huge big room, better than my living room ler

and out of window can see genting highland not far away...

yeah i will enjoy working here.. and also will go to genting highland once before i leave selayang ok... :)

i change my name!!

announcement!!
i changed my name!!
yes, my name, the 1 following me for the pass 30 over years
(opp!!! should be the 1 following me for the pass 25 years and slightly less than 100 months)
not superstitious, but just change for good!!!!
blessing me ya

张善铨 is my new name !!!