[Med] Psychi

today is Chinese Valentine's Day, I'm on duty shift tonight, but please bear this in mind, I'm in psychiatric department. According to other intern doctors who have completed rotation in Psychi, duty is merely a way to earn 500NTD, they never received a call, ever. That's what I expect, so I get movie ticket for tonight, waiting to see TDK or Wall-e.
If that's the case, I wouldn't be writing this entry now. God wants me to dedicate this special holiday to my beloved person- my patient. Yeah~

This morning, one 76y/o lady admitted because of major depressive disorder w/ psychotic feature had a abnormal LFT report, which revealed AST 1189 and ALT 840. That's really a big warning in psychi ward, and I could tell from my resident and primary care nurse. So we send her blood for serum amylase, lipase, g-GT, LDH, ALK-P and electrolyte analysis. The data came out later and were all markedly elevated. Under the impression of acute hepatitis and acute pancreatitis, we asked her to start NPO and gave her adequate fluid supplement.
We consulted GI doc and arranged abd sonography tomorrow morning.

GI doc came in late afternoon. She suggested we contacted emergent CT scan and put her on critical. So, farewell my lovely movie night. If there's any patient on critical on the day of duty, you'd better stay within 10 min distance to the hospital (for interns).

Not surprisingly, I got my first phone call around 7:30. I was asked to escort this lady to CT room. Her CT scan revealed severely dilated Gall bladder, CBD, IHD and PD. Fat-stranding presented around pancreas. No stone was seen to cause obstruction. My interpretation is there's some lesion causing chronic obstruction of her biliary tract and she got unlucky today to have this fulminant attack. Well, I am probably responsible to some degree. I ate pineapples yesterday by accident. They are evil!

So I spent 2 hours contacting CR from GI, INF and RAD for advice. They are very nice and resourceful. Even they complained about talking to a intern is sort of a disregard, I get my info anyway.
Now I can only pray her gall bladder to behave and her fluid status stay in balance until tomorrow after PTCD.
AH~~ I have to admit this is a pretty decent getaway from annoying couples on the streets.
I'm sick.