Case Conference October 24th 2012

24-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

Mrs.EJ  53 yo, P5,JAMKESMAS

 

Permagna  Cystic Ovarian Neoplasm  susp maligna, cachexia, unconsciousness ec hypoxia dd/ sepsis

 

 

Patient with history of vaginal bleeding and was done hysterectomy 3 years ago (2009) at  Proklamasi Hospital

Rangkas Dengklok , the result was not maligna.

She’d been has abdominal enlargement since 5 months a go, went to Proklamasi Hospital and reffered to RSUD Karawang then reffered to RSCM. Because of financial problems , patient has just came to RSCM at September 17^th 2012. Decreasing body weight (+), loss appetitte (+), swollen legs (+) since 3 weeks.

 

Clinical Examination  :

BP :120/80 mmHg   pulse : 86 x/m  RR: 18 x/m  t: afebrile

Eye : conjungtiva are not pale , sclera are not icteric

Cor and pulmo : normal

Abdomen : distended with cystic mass until procecus xhipoideus.

Extr : oedema +/+

Gyn state:

I : v/u : normal

Io : portio normal, fluxus(-)

RVT : uterus couldn’t be identified, adnexa  filling with cystic mass,TSA normal, ampula was not collaps,  smooth mucouse rectum

 

 

Ca 125 : 613

Lab (21/10/12) :  12.4  K : 11.7

d-dimer :3900

APTT : 67,5 K;34.4

DPL : 10.4/32,1/6720/156.000

Ur : 42,4  cr : 0.64   uric acid : 7.13   AST : 21  ALT : 7  LDH : 962  blood glocosa : 101

LED : 36

Albumin : 2.16

 

US (18/10/12):

Mass is filling abdominal cavity susp cystic ovarian neoplasma

Grade mild bilateral hydronephrosis

Free fluid in cavum pelvic

Susp  hepar simple cyst

 

US oncology (18/10/12)

Cystic mass is filling abdominal cavity susp malignan cystic ovarian  neoplasma, mild hydronephrosis with free fluid in pelvic cavity

Susp  liver simple cyst

 

Discussion with Dr.dr.Laila, OBGYN ©

Alternative treatment :

Laparatomy , take out the mass for decompression

chemotherapy

 

last follow up  23/10/12  (2.30 pm)

S: unconscious, dispneu (+)

O : BP : 90/50 mmHg  P : 120 bpm  RR:30 times/m  S : afebrile

Eye : conj were not pale  icteric -/-

Neck : JVP : hard to be evaluated, NGT : chocolate yelowish fluid

Cor : normal

Lung : vesicular +/+ rhonci +/+ wh-/-

Abd : distended extrimity : cold

 

Lab (23/10/12)

PT/C : 13.3/11.2  APTT/C : 96.7/31.3  ur/cr 38/0.4  na/k/cl = 129/4.82/96

ECG : normal

 

Assessment :

·         Cystic ovarian neoplasm susp maligna

·         Decreasing consciousness ec hypoxia dd/ sepsis, intracranial metastase

·         Syock sepsis ec  HAP

·         Susp Ileus obstructive  ec mass compression

·         Malnutrition

·         Hypoalbunemia, hyponatremia

·         Hypercoagulable state

 

Planning /

3 position BNO, complete blood perifer, Blood gas analysis, thorax

CVC à target 10-15 mmHg

Albumin transfusion

Nutrition management

BP < 100 mmHg : dobutamin (3 cc/hrs) and vascon (0.1 ug/kgBB/m)