Friday, 13 May 2011

Total body crumble

To the Hon Casualty Consultant

Thank you for accepting this 71 year old male patient who has a number of acute but cross-discipline medical problems , most of which require intervention;however apart from a referral to psychiatry,I am not sure where to start.

He has just returned this morning from a two month holiday in Thailand;in fact he drove directly from Heathrow to our Minor Injury Unit.

His presenting complaint is acute urinary retention;he has not passed urine for 37 hours.I have inserted an indwelling catheter and gradually emptied his bladder of 3 litres of turbid and offensive smelling urine.
I have sent a sample to the lab for MC&S.

During catheterization it became obvious that he has an acute prostatitis.
Fortunately the catheterization didn't hurt me.

He reports that he has had five bladder infections in the two months for which he received over-the-counter medicines,possibly antibiotics.
It would appear as if a new UTI has partly precipitated this retention episode.

He also has genital warts which he apparently didn't have prior to his trip;and also has what appears to be a chancre.
He reports,-quite proudly,even gleefully-, that he had sex with over 80 different prostitutes in the two months.

He is also jaundiced and has a large , and painfully palpable liver.He says that he drank a litre of whiskey a day for the two months, in addition to his 'normal' beer intake.
His liver is so large that I expect he had to pay excess baggage when he flew back.
And he thought his jaundice was sunburn.

My main concern however is that he also has a central chest pain with some new ECG changes.He reports that he has taken a Viagra a day for the holiday period.

I have told him that there is nothing that can be done for his greasy grey ponytail apart from cutting it off and giving it a decent Christian burial.

Kind regards

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