bison, francis romeo p. san beda college case presentation
DESCRIPTION
Chief Complaint Hypogastric PainTRANSCRIPT
Bison, Francis Romeo P.
San Beda College
Case Presentation
General Data
MD 40y.o Married Admitted last April 25 2010
Chief Complaint
Hypogastric Pain
History of Present Illness 10 monts PTA
Hypogastric Pain described as shearing 9/10 pain
Associated with intermenstrual bleeding Uses 2 diaper and 1 napkin for the whole
day Hot compress temporarily relieved
her symptoms No consult was done
8 mos PTA Persistent intermenstrual bloody
discharge and hypogastric pain Consulted QMMC Gyne Fractional Curettage was done due to
thick endometrial lining Biopsy showed proliferative
endometrium Advised to come back for a week
1 week PTA Intermittent hypogastric pain with
generalized body weakness Consulted at Amang Rodriguez Ultrasound and other labs was done Diagnosed “myoma uteri”, and was
advised for surgery Patient then opted to transfer to
another hospital for second opinion, hence consult at QMMC OB-ER.
Review of Systems: Unremarkable
Past Medical History Unremarkable
Occasional cough and colds
Fractional curettage was done at qmmc(2009)
No known food and drug allergy
Personal and Social
Housewife Nonsmoker Non-alcoholic Denies drug abuse
Family History
Maternal Hypertension
Paternal Pott’s disease
Ob-Gyne HistoryG3P3(3003)
Year NSD/CS Pre/Full term
Hospital Complication
G1 1999 NSD Full Kamuning
G2 2001 NSD Full Kamuning
Sepsis
G3 2004 NSD Full Sorsogon Placental Remission (ICU)
Menstrual History
M-14 y.o I- Regular D- 5-7 days A- 3 pads per day S- Dysmnorrhea (7/10)
Sexual History
Coitarche at age 21 Had 2 Sexual partner Last coitus was last month
Physical Examination
General appearance: awake, conscious, coherent, ambulatory, not in cardiorespiratory distress
Vital Signs BP=100/60 HR=81/min RR=20/min Temp: 36.5oC
(+)Pallor, Anicteric sclerae, Pale palpebral conjunctiva, No cervical lymphadenopathies
Heent
Cardiovascular: Adynamic precordium, NRRR, no murmurs
Lungs: Symmetrical chest expansion, no retractions vesicular breath sounds over both lung fields
Thorax
Abdomen
Globular Soft Doughy mass measuring 16 x 18
cm Movable Non-tender
Extremities
Pale nail bed No edema
SPECULUM EXAM IE
Cervix pink Smooth No erosionsNo discharge
Cervix: short
FirmClosed
Uterus: Asymmetrically enlarged to 20 weeks size
Non-tender on deep palpation
MovableDoughy
Admitting Diagnosis
G3P3 (3003) Abnormal Uterine Bleeding Probably Secondary to Myoma Uteri, Anemia Secondary
Course in the Wards April
25April 26
April 28
April 29
May 02
Hgb 40 53 74 89 110
Hct 0.17
0.22
0.27 0.31 0. 38
WBC
5.6 10. 8
*Transfused with 4 units of pRBC properly typed and crossmatched
Medications
Tranexamic acid Ferrous sulfate Vitamin C tablet
Referred to CardioPulmonary service for clearance prior to the procedure.
On the 10th hospital day, patient was scheduled for hysterectomy.
Definition
Uterine leiomyoma are benign monoclonal neoplasm arising from smooth muscle cells in the myometri
Classified by location:
Submucosal – lie just beneath the endometrium.Intramural – lie within the uterine wall.Subserosal – lie at the serosal surface of the uterus or may bulge out from the myometrium and can become pedunculated.
Prevalence Age 20% to50% of
reproductive age Incidence increases
with advancing age Rare before puberty 25-35y/o: 0.31 per
1000 45-50y/o: 6.20 per
1000
Risk FactorAGE
AFRICAN-AMERICAN
RACE
EXPOSURE TO ESTROGEN
FHX
DIET
Advancing age
African american women develop earlier and more symptomatic
Early menarche,ObesityNulliparityOcp’s
1st degree relatives with 2.5x more likely develop fibroids
Red meat, Alcohol,Smoking
Etiology-Unknown
Estrogen
Progesterone
Most common during reproductive years, rare before puberty, decrease size after menopaus
Increases the mitotic activity of fibroids in women
Complication
MenorrhagiaAnemiaInfertility
Diagnostic Approach
Pregnancy test should be obtained in all women
Suggested by symptoms and physical examination
Usually confirm by transabdominal or transvaginal ultrasound
Treatment Approach
Tx of Symptomatic fibroids depends on: Desire for future pregnancy General health Size and location
Medical
Goal: relieve or reduce symptoms
No definitive medical treatment exist
GnRh agonist- induces hypogonadism through pituitary desensitization, down regulation of receptors and inhibition of gonadotropins
Surgery
Hysterectomy- most common and the only definitive treatment
Myomectomy- preserves fertility, risk for reccurence
Current Status of Pt. At 10:35 pm of May 6, BP: O, RR:O, HR:O. ECG showed asystole.
Patient pronounced dead at 10:35 pm by IM ROD. Post-mortem care rendered.
CBC Hgb: 134 Hct: 0. 46 WBC: 30. 2
PT, PTT: PT: 21. 1 PT % Activity: 32. 8 aPTT: 47. 7
Blood Chemistry and Serum Electrolytes CK- MB: 165(inc)Potassium: 4 Crea: 102. 83 Chloride: 105 Sodium: 134 (dec) Troponin I; positive
Cause of death: Sudden cardiac death secondary to acute myocardial infarction;
hypoxic encephalopathy, s/p arrest; s/p subtotal hysterectomy/CLEB+GETA
Thank You