Clinical Correlation in the Cardiovascular Examination

On last august 25, 2011, I've been posting about Clinical correlation that we can find in the abdominal examination. Now I'll show you some CC that usually found in the cardiovascular examination:

1. Some abnormal heart sounds are loud enough that they can be heard without a stethoscope. Examples include an artificial valve or grade 6 murmur.

2. A JVP of 10 or greater is considered elevated and, among other things, may indicated heart failure, specifically right heart failure.

3. Pitting edema is a result of a transudate, where as non-pitting edema is a common sign in congestive heart failure, hepatic cirrhosis, or nephrotic syndrome.

4. If the point of maximal impulse is lateralized it may be indicated left ventricular hypertrophy.

Jaundice: The History of Disease and Related Things

Some things can be related to the mechanism of occurrence of jaundice. Then as a doctor we should ask questions related to several things, such as:

• Age. The older patient, carcinoma is more often the cause of jaundice, While the hepatitis, less frequent in old age.
• Injection or transfusion within the last 6 months (characterizing viral hepatitis), including drug addiction. You also have to looking for evidence of injection site.
• Contact with the patient's jaundice and a history of living abroad
• Jobs. farm employment and work in sewers at risk of leptospirosis.
• History of dark urine and pale stools in biliary obstruction.
• Drugs taken recently, especially phenothiazines and the contraceptive pill.
• Onset of illness until it becomes the main symptom of jaundice. hepatitis Agenerally lasts 1-3 weeks, carcinoma is 1-2 months, hepatitis B 6 weeks-6months, cirrhosis hepatic are usually very long.
• Alcohol consumption
• Abdominal pain which was recently, or dyspepsia may be a sign of chroniccholecystitis, cholangitis, gallstones, or pancreatic carcinoma.
• Recent surgery, anesthesia (halothane).
• Family history, if suspected of having Gilbert's syndrome.

Jaundice: The Causes and Cases

Jaundice is a yellow color to the skin and sclera. Usually only visible when bilirubun serum levels above 35 mol / L. Sclera is not colored in yellow skin due to hiperkeratonemia. The three basic causes: hemolytic, hepatocellular, obstructive. It's how to remember: H2O --> Hemolytic, Hepatocellular, Obstructive
Some of diseases that jaundice as the clinical sign are:

• Acute viral hepatitis, because the recovery is slow, or there is persistent intrahepatic cholestasis.
• Bile duct obstruction due to gallstones or carcinoma of the head of the pancreas.
• Jaundice due to drugs
• Multiple secondary deposits in liver carcinoma (clinical jaundice is rare but often increased bilirubin)
• intrahepatic cholestasis
• Mononukleus infectious
• Gilbert syndrome

At Kuta Beach, Bali

On 12 September 2011, our last day in Bali, me and my twin sister were having fun at Kuta Beach, Bali.

The beach was so beautiful. The wave was big so you can surfing on it.

I took some pictures of us. That's me with the black shirt and my twin sister wearing red shirt.

Pura Tirta Empul, Tapak Siring, Bali

After we visited Batur Mountain and Batur lake, we went to tapak siring. There is a well-known Pura named Pura Tirta Empul.

Tirta Empul Temple or Tapak Siring Temple is a holy spring water temple located in Tapak Siring Village, about 42 km eastwards from Denpasar town.

People usually refining body&mind at the Holy Water temple in Tapak Siring.

I took some pictures of my oldest sister and her husband at this temple :D




















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Batur Mountain volcano and Batur Lake

After we arrived at our bungalow, we went to Kintamani by a rental car. Along the ways there lots of beautiful scenery. There lots of green and beautiful rice field, and also lots of beautiful Pura.

And finally we arrived at Batur mountain and Batur lake. The mountain volcano is still active. It was very beautiful.


I took some pictures of it :D








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Gatotkaca Statue

On last 10-12 Sept 2011, me, my twin sister, my oldest sister and her husband visited Bali for three days.

Arriving in Bali, we were picked up by Mr. ketut, our rental car driver. Our first destination is ubud (1,5 hours from airport).

Along the way, there are lots of beautiful statues. One of them is Gatotkaca Statue.

Gatotkaca statue was built in 1993. Located at the center of road intersection at the northeast of Bali International airport, Ngurah Rai Airport.

In Mahabrata story, Gatotkaca is depicted as a very brave and powerful knight, the son of Bima, one of the five Pandawa Brothers.

I took some pictures of it. I'm sorry that I took from the back of the statue. But it still beautiful :D








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