WEEKLY REPORT Dr.arie (Final Obs)

8/18/2019 WEEKLY REPORT Dr.arie (Final Obs)

1/49


2/49

&$ate

a%issi&na%e ,irst ia+n&sis ,ina* $ia+n&sis

e&nates

ia+n&sis

1. 2'(01(16 )rs. *

G+P2A0, 28 ears old,

raid +/-+6 &ees

"ased o SG

e$amiaio, i la"or,

1s a3ie phase, &ih

&o ira%erie lii

e%ses, 3ephali3

preseaio o "oh

e%ses.

P+A0, 28 ears

old, pos par%s

prema%r%s "

spoaeo%s per

aiam delier,

pos episioraph

idi3aed "

perie%m r%p%re

rade !

!5 )ale eoae, +6

&ees a33ordi o 7S &ih "irh

&eih o 21/0

rams, leh o 46

3m ad APGAR

S3ore '(#, &ih

diaose healh

eoae

!!5 )ale eoae, +6

&ees a33ordi o

7S &ih "irh

&eih o 2'10

rams, leh o 48

3m ad APGAR

S3ore '(#, &ih

diaose healh

eoae

2 28(01(16 )rs.

G2P1A0, 1# ears old,

raid +'-+8 &ees

"ased o he irs da

o las mesr%aio

period, &ih seere

Pree3lampsia, i la"or

1s a3ie phase, &ih a

sile ira%erie

lii e%ses, 3ephali3

preseaio

P2A0, 1# ears

old, pos par%s

ma%r%s "

spoaeo%s per

aiam la"or, pos episioraph

idi3aed "

perie%m r%p%re

rade !!, &ih

hisor o seere

pree3lampsia

)ale eoae, +'-

+8 &ees a33ordi

o 7S, "irh

&eih o +,1/0ram, leh o /0

3m, ad APGAR

S3ore #(#, &ih

diaose healh

eoae.

+ 28(01(16 )rs.

G1P0A0 18 ears old,

P1A0, 18 ears

old, pos par%s

)ale eoae, +8-

+# &ees a33ordi


3/49

raid +8-+# &ees

"ased o irs da o

he las mesr%aio

period &ih seere

pree3lampsia, i la"or

&ih proloed 2d

phase, &ih a sile

ira%erie lii

e%s, 3ephali3

preseaio.

ma%r%s "

spoaeo%s per

aiam la"or,

pos episioraph

idi3aed "

perie%m r%p%re

rade !!, &ih

hisor o seere

pree3lampsia

o 7S &ih "irh

&eih o +1+0

rams, leh o 4#

3m ad APGAR

S3ore 8(#, &ih

diaose healh

eoae.

4 2#(01(16 )rs.

G1P0A0 1# ears old,

raid +'-+8 &ees

"ased o SG, i la"or

&ih proloed 1s sae

&ih a sile

ira%erie lii

e%ses, 3ephali3

preseaio

P1A0, 1# ears

old, pos par%s

ma%r%s "

spoaeo%s per

aiam delier,

pos episioraph

idi3aed "

perie%m r%p%re

rade !!

)ale eoae, +'-

+8 &ees a33ordi

o 7S &ih "irh

&eih o +0+/

rams, leh o 46

3m ad APGAR

S3ore '(#, &ih

diaose healh

eoae.


4/49

/SE 1

)3P20 25 years &* +ravi 3736 8ee9s !ase &n S) e:a%inati&n in

*a!&r 1st a(tive phase 8ith t8& intrauterine *ivin+ 'etuses (epha*i(

presentati&n &' !&th 'etuses;

.entity

• ame 5 )rs. *

• Ae 5 28 ears old

• Ehi3 5 S%daese

• Reliio 5 )oslem

• Ed%3aio 5 7a3helor 9eree

• O33%paio 5 o%se&ie

• 9ae o admissio 5 :a%ar 2', 2016

na%nesis

Chie 3omplai5

Paie 3omplais o a"domial dis3omor si3e + ho%rs "eore admissio o

hospial

isor o prese illess5

Paie 3omplais o a"domial dis3omor si3e + ho%rs "eore admissio o

hospial. She also eel 3ora3io ha "e3ome more re;%e. A33ordi o he

moher, here are o "lood aial dis3hare ad leaae o l%id. She has doe

ro%ie Aeaal Care &ih o prea3 id%3ed hperesio, aemia, ad S


5/49

o isor o s%rer 5 9eied

• Familial hisor5

o isor o hperesio 5 9eied

o isor o dia"ees melli%s 5 9eied

o isor o pree3lampsia 5 o&

o isor o esaioal dia"ees 5 o&

o isor o preerm la"or 5 o&

o isor o eei3 disorder 5 o&

• a"i%al hisor 5 al3oholi3 >-?, smoi >-?, dr%s >-?

• isor o mesr%al 33le5

o )ear3he 5 11 ears old

o )esr%al 33le 5 re%larl, &ih d%raio o /

das, 33le eer +0 das, @ 60 ml(da, dsmeorrhea >-?o Firs da o las mesr%al 33le 5 April 8h, 201/

• )arial isor 5 )arried &i3e, has "ee &ih his h%s"ad or 4./

ears.

• O"seri3 hisor

o 9aeGesaioal

Ae

a"or

isor

Res%l

Se$

7irh

Beih 7reas Feedi

1 200/ # mohs Per

aiam

D 2/00 r

2 2011 ' mohs Per

aiam

D 1+00 r

+ Prese +/-+6

&ees

- - - -

• Cora3epio isor 5 !=e3ios

• as %sed 5 2011

• isor o aeaal 3are 5 8 imes a P%sesmas ad + imes a Ama :aa,

prea3 id%3ed hperesio >-?, aemia >-?, ea%s o$oid >-?, se$%al rasmied

disease >-?

Physi(a* E:a%inati&n

•

Geeral appeara3e 5 oos moderael ill• eel o 3os3io%sess 5 Compos meis


6/49

-++-

- --++-

--

++ ++

++++

• ial sis5

7lood press%re 5 110('0 mm

P%lse rae 5 '2 "eas(mi%es

Respiraor rae 5 16 "reahs(mi%es7od empera%re 5 +6.+C

• 7od &eih "eore prea3 5 /0

eih 5 1/+ 3m

• 7)! "eore prea3 5 21,1# (m2

• C%rre "od &eih 5 62

• ?, sriae raidar%m >?

A%s3%laio 5 7o&el so%ds >?, 6 $(mi

Palpaio 5 S%pple, pai &ih palpaio >-?

E$remiies 5 Barm e$remiies,

Edema ,CR< H 2 se3ods

Phsioloi3 rele$ , paholoi3 rele$

O!stetri(s e:a%inati&n

Esimaed d%e dae 5 :a%ar 1/h, 201/

F%dal heih 5 42 3m

Feal &eih esimaio 5 -

erie 3ora3io 5 >? /$(10 mei >40-4/I?

Feal hear rae 5

7 1s 7a"5 140 "pm7 2d 7a"5 1+6 "pm

• eopold mae%er 5

o eopold ! 5 7%o3

o eopold !! 5 7a3 o le side, e$remiies o he rih side

o eopold !!! 5 eado eopold ! 5 9iere +(/


7/49

• aial o%3her 5

- %loaial5 &ihi ormal limis- Posiio5 Aerior - 9ilaaio5 8 3m- Ea3eme5 80J

- Amioi3 mem"rae5 !a3 >?- Preseaio5 ead- 9eomiaor5 )ior Foaelle- Feal Saio5 1

!spe3%lo 5 o perormed

/ari&t&(&+raphy

1st !a!y

erie 3ora3io 5 >-?

!erpreaio 5 S< rea3ie


8/49

2n !a!y ?

9e3eleraio 5 >-?

Feal moeme 5 >?

erie 3ora3io 5 >-?

!erpreaio 5 S< rea3ie

La!&rat&ry e:a%inati&ns

• emolo"i 5 11,# (d• emao3ri 5 +6 J• e%3o3e 5 11.800(• Plaeles 5 1#'.000(• 7lood pe 5 O(Rh >?• "sA 5 >-?

• 7< 5 2 mis• C< 5 4 mis


9/49

• 7lood l%3ose 5 8/ m(d

.nitia* $ia+n&sis

G+P2A0, 28 ears old, raid +/-+6 &ees "ased o SG e$amiaio, i la"or, 1 s a3ie

phase, &ih &o ira%erie lii e%ses, 3ephali3 preseaio o "oh e%ses.

P*annin+

Pro Spoaeo%s per-aiam la"or

,ina* $ia+n&sis

P+A0, 28 ears old, pos par%s prema%r%s " spoaeo%s per aiam delier, pos

episioraph idi3aed " perie%m r%p%re rade !

e&nata* $ia+n&sis

!5 )ale eoae, +6 &ees a33ordi o 7S &ih "irh &eih o 21/0 rams, leh o 46

3m ad APGAR S3ore '(#, &ih diaose healh eoae

!!5 )ale eoae, +6 &ees a33ordi o 7S &ih "irh &eih o 2'10 rams, leh o 48

3m ad APGAR S3ore '(#, &ih diaose healh eoae

P*a(enta

Pla3eaLs sie +2$+2$2 3m, Coledo ia3, hemaoma >-?, soel 3ell >?, Cal3ii3aio >-?,

%m"ili3al 3hordLs leh /# 3m ad 6+ 3m, %m"ili3al 3ord are implaed i &o pla3es5

marial ad 3eral, "leedi @200 33, pla3eal &eih #00 ram.

Therapy

Pos-par%s5

7 Ceadro$il + $ /00 m PO7 )eial + $ /00 m PO7 )eheri + $ 0,12/ m PO


10/49

/SE 2

)2P10 1> years &* +ravi 3?735 8ee9s !ase &n the 'irst ay &' *ast

%enstruati&n peri& 8ith severe Pree(*a%psia in *a!&r 1st a(tive phase

8ith sin+*e intrauterine *ivin+ 'etuses (epha*i( presentati&n

.entity

• ame 5 )rs.

• Ae 5 1# ears old

• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 Elemear S3hool


• 9ae o admissio 5 :a%ar 28h , 2016

na%nesis

Chie 3omplai5

Paie 3omplai o a"domial dis3omor si3e # ho%rs "eore admissio o

he hospial

• isor o prese illess5

Paie 3ame o he hospial "e3a%se he a"domial dis3omor si3e # ho%rs

"eore admissio, paie also el 3ora3io si3e ' ho%rs "eore admissio o he

hospial.


11/49

o isor o hperesio 5 >? !d%3ed " prea3


o isor o aller 5 9eied

o isor o epileps 5 9eied

o isor o hemaoloi3 disease 5 9eied

o isor o %riar ra3(ide disease 5 9eied

o isor o ra%ma 5 9eied


• Familial hisor5



o isor o pree3lampsia 5 9eied

o isor o esaioal dia"ees 5 9eied

o isor o preerm la"or 5 9eied

o isor o eei3 disorder 5 9eied

• a"i%al hisor 5 Al3oholi3 >-?, smoi >-?, dr%s >-?


o )ear3he 5 1/ ears old

o )esr%al 33le 5 Re%larl, eer 28 das, &ih d%raio

o 4 das, @ 4/ ml(da, dsmeorrhea >-?o Firs da o las mesr%al 33le 5 )ei 1/h, 201/

• )arial isor 5 )arried o3e, has "ee &ih his h%s"ad or / ears.

• O"seri3 hisor

o9ae

Gesaio

al Ae

a"or

isor

Res%l

Se$7irh

Beih

7reas

Feedi

oes

1 2012 # mohs Per

aiam

D 2600 r Pree3lamps

ia >?

2 Prese


12/49

-++-

- --++-

--

++ ++

++++

• Cora3epio isor 5 oe

• isor o aeaal 3are 5 2 imes a P%sesmas, prea3 id%3ed hperesio

>?, aemia >-?, ea%s o$oid >-?, se$%al rasmied disease >-?


• Geeral appeara3e 5 oos moderael ill

• eel o 3os3io%sess 5 Compos meis

• ial sis5

7lood press%re 5 180(#0 mm

P%lse rae 5 120 "eas(mi%es

Respiraor rae 5 24 "reahs(mi%es

7od empera%re 5 +'.4C


eih 5 160 3m

• 7)! "eore prea3 5 20.+ (m2

• C%rre "od &eih 5 62

•

?, sriae raidar%m >?

A%s3%laio 5 7o&el so%ds >?, 8 $(mi






13/49


Esimaed d%e dae 5 Fe"r%ar 22d, 201/

F%dal heih 5 +2 3m

Feal &eih esimaio 5 +2// rams

erie 3ora3io 5 >? 2$ i 10 mi%es >H 20 se3?

Feal hear rae 5 148 "pm

• eopold mae%er 5

o eopold ! 5 7%o3

o eopold !! 5 7a3 o he le side

o eopold !!! 5 ead

o eopold ! 5 9iere, +(/

• aial o%3her 5

- %loaial5 &ihi ormal limis- Posiio5 Aerior - 9ilaaio5 10 3m- Ea3eme5 100J- Cosise35 So- Amioi3 mem"rae5 >-?- Preseaio5 ead- 9eomiaor5 )ior Foaelle- Feal Saio5 2


/ari&t&(&+raphy


14/49

7aselie 5 1/0 "pm

aria"ilias 5 ormal >/-10 "pm?

A33eleraio 5 >? 2$ i 20 mi%es

9e3eleraio 5 >-?

erie 3ora3io 5 >?, 4$ i 10 mi%es

!erpreaio 5 CS< eaie


• emolo"i 5 '.2 (d• emao3ri 5 26 J• e%3o3e 5 1/,000(• Plaeles 5 268,000(• 7lood pe 5 A(Rh >?• 7< 5 2 mi%es• C< 5 4 mi%es• 7lood l%3ose 5 84 m(d• SGO< 5 20 (l• SGP< 5 / (l• "sA 5 >-?

rialsis5

• Proei 5

.nitia* $ia+n&sis

G2P1A0, 1# ears old, raid +'-+8 &ees "ased o he irs da o las mesr%aio period,

&ih seere Pree3lampsia, i la"or 1s

a3ie phase, &ih a sile ira%erie lii e%ses,3ephali3 preseaio

P*annin+

)aiea3e dose o )So4 1r(ho%r

Pro spoaeo%s per aiam delier

,ina* $ia+n&sis


15/49

P2A0, 1# ears old, pos par%s ma%r%s " spoaeo%s per aiam la"or, pos episioraph

idi3aed " perie%m r%p%re rade !!, &ih hisor o seere pree3lampsia

e&nata* $ia+n&sis

)ale eoae, +'-+8 &ees a33ordi o 7S, "irh &eih o +,1/0 ram, leh o /0 3m,

ad APGAR S3ore #(#, &ih diaose healh eoae.

P*a(enta

Pla3eaLs sie 21$21$2 3m, Coledo ia3, hemaoma >-?, soel 3ell >?, alsiiasi >-?,

%m"ili3al 3hord leh /' 3m, %m"ili3al 3ord are implaed i he 3eer, "leedi @#0 33,

pla3eal &eih +60 ram.

Therapy

Pos-par%s5

- 2 7as o PRC 7lood ras%sio- Ceadro$il + $ /00 m PO- iedipi + $ 10 m PO- )eeami3 A3id + $ /00 m PO- Che3 emolo"i 6 ho%rs pos-par%s- Re-3he3 SGO


16/49

/SE 3

)1P00 15 years &* +ravi 3573> 8ee9s !ase &n 'irst ay &' the *ast %enstruati&n

peri& 8ith severe pree(*a%psia in *a!&r 8ith pr&*&n+e 2n phase 8ith a sin+*e

intrauterine *ivin+ 'etus (epha*i( presentati&n;

.entity

• ame 5 )rs.


• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 :%ior ih S3hool

• O33%paio 5 Seller


17/49

• 9ae o admissio 5 :a%ar 28h , 2016

na%nesis

Chie 3omplai5

Paie &as reerred rom primar 3ar &ih proloed 2d sae.


Paie has "ee eeli a"domial dis3omor si3e oe da "eore she &as

admied o he hospial, she &e o primar 3are irs. She had her 2d phase oi

a"o% 4 ho%rs, so she &as ae o he hospial " he primar 3are %i. Paie had

doe AC 6 imes i primar 3are, ad she had prea3 id%3ed hperesio.

• isor o pas illess5









• Familial hisor5



o isor o pree3lampsia 5 o&






o )ear3he 5 1+ ears old

o )esr%al 33le 5 re%larl, eer +0 das, &ih d%raio

o / das, @ 60 ml(da, dsmeorrhea >-?o Firs da o las mesr%al 33le 5 )a 8h, 201/

• )arial isor 5 )arried o3e, has "ee &ih his h%s"ad or 1 ear

•

O"seri3 hisor o 9ae Gesaioa a"or Res%l


18/49

l Ae isor Se$7irh

Beih

7reas

Feedi1 prese +8-+#

&ees



>?, aemia >-?, ea%s o$oid >-?, se$%al rasmied disease >-?




• ial sis5

7lood press%re 5 1/0(#0 mm

P%lse rae 5 #0 "eas(mi%es

Respiraor rae 5 +0 "reahs(mi%es

7od empera%re 5 +'.2C


eih 5 1/0 3m

• 7)! "eore prea3 5 22,2 (m2

• C%rre "od &eih 5 /'

•


19/49

-++-

- -

-++-

--

++ ++

++++





Esimaed d%e dae 5 Fe"r%ar 1/h, 2016

F%dal heih 5 +6 3m

Feal &eih esimaio 5 +/6/

erie 3ora3io 5 >? 2$ i 10 mi%es >+0-40I?

Feal hear rae 5 1+0 "pm

• eopold mae%er 5

o eopold ! 5 7%o3

o eopold !! 5 7a3 o le sideo eopold !!! 5 ead


• aial o%3her 5

- %loaial5 &ihi ormal limis- Posiio5 Aerior - 9ilaaio5 10 3m- Ea3eme5 100J- Cosise35 So- Amioi3 mem"rae5 >-?- Preseaio5 ead- 9eomiaor5 )ior Foaelle- Feal Saio5 2


/ari&t&(&+raphy


20/49

7aselie 51+0 "pm

aria"ili 5 ormal

A33eleraio 5

9e3eleraio 5 >? lae de3eleraio5 2$( 10 mi%es

Feal moeme 5 -

erie Cora3io 5 >? 2$ i 10 mi%es

!erpreaio 5 o-reass%ri


• emolo"i 5 12,2 (d• emao3ri 5 +' J• e%3o3e 5 24.200(• Plaeles 5 +28.000(• 7lood pe 5 7(Rh >?• "sA 5 >-?• G9S 5 110• SGO< 5 1+• SGP< 5 '• r(Cr 5 10

• Cr 5 0.6• 7leedi ime 5 + mi%es• Cloi ime 5 / mi%es

rialsis

• Proei 5

.nitia* $ia+n&sis

G1P0A0 18 ears old, raid +8-+# &ees "ased o irs da o he las mesr%aio period

&ih seere pree3lampsia, i la"or &ih proloed 2d

phase, &ih a sile ira%erie liie%s, 3ephali3 preseaio.

P*annin+

!iial loadi dose o )So4 4 i 10033 o salie sol%io

Pro spoaeo%s per aiam delier

,ina* $ia+n&sis


21/49

P1A0, 18 ears old, pos par%s ma%r%s " spoaeo%s per aiam la"or, pos episioraph

idi3aed " perie%m r%p%re rade !!, &ih hisor o seere pree3lampsia

$ia+n&sa e&natus

)ale eoae, +8-+# &ees a33ordi o 7S &ih "irh &eih o +1+0 rams, leh o 4#

3m ad APGAR S3ore 8(#, &ih diaose o a healh eoae.

P*a(enta

Pla3eaLs sie 18$18$2 3m, Coledo ia3, hemaoma >-?, soel 3ell >?, alsiiasi >-?,

%m"ili3al 3hord leh 48 3m, %m"ili3al 3ord are implaed mariall, "leedi @/80 33,

pla3eal &eih +40 ram.

Therapy

7 Ceadro$il + $ /00 m PO7 )eeami3 A3id + $ /00 m PO7 )aiea3e )So4 1 r(ho%r !

/SE 4

)1P00 1> years &* +ravi 3?735 8ee9s !ase &n S) in *a!&r 8ith pr&*&n+e 1st

sta+e

8ith a sin+*e intrauterine *ivin+ 'etuses (epha*i( presentati&n


22/49

.entity

• ame 5 )rs.

• Ae 5 1# ears old

• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 Seior ih S3hool


• 9ae o admissio 5 :a%ar 2#h , 2016

na%nesis

Chie 3omplai5

Paie &as reerred " primar 3are "e3a%se o proloed 1 s phase rom

primar 3are %i

•

isor o prese illess5Paie 3ame o he hospial aer iiiall "ee i he primar 3are or 1/ ho%rs

d%e o he re;%e a"domial dis3omor he paieLs has "ee hai. A33ordi o

he mid&ies i primar 3are, she 3ame o primar 3are &ih 2 3m opei ad &he

she &as "ro%h o he hospial he opei is / 3m.


23/49






o )ear3he 5 1+ ears old

o )esr%al 33le 5 re%larl, eer +0 das, &ih d%raio

o 4 das, @ 60 ml(da, dsmeorrhea >-?o Firs da o las mesr%al 33le 5 April 1+h, 201/

• )arial isor 5 )arried o3e, has "ee &ih his h%s"ad or 1 ear

• O"seri3 hisor

o 9aeGesaioa

l Ae

a"or

isor

Res%l

Se$7irh

Beih

7reas

Feedi

1 prese +'-+8

&ee



>-?, aemia >-?, ea%s o$oid >-?, se$%al rasmied disease >-?




•

ial sis57lood press%re 5 120('0 mm

P%lse rae 5 80 "eas(mi%es

Respiraor rae 5 20 "reahs(mi%es

7od empera%re 5 +6./C

• 7od &eih "eore prea3 5 4'

eih 5 1/1 3m

• 7)! "eore prea3 5 20.8 (m2


24/49

-++-

- --++-

--

++ ++

++++

• C%rre "od &eih 5 //

• ?, sriae raidar%m >?

A%s3%laio 5 7o&el so%ds >?, / $(mi






Esimaed d%e dae 5 :a%ar 20h, 2016

F%dal heih 5 2# 3m

Feal &eih esimaio 5 2'#0

erie 3ora3io 5 >? +$ i 10 mi%es >+0I?

Feal hear rae 5 148 "pm

• eopold mae%er 5

o eopold ! 5 7%o3

o eopold !! 5 7a3 o le side

o eopold !!! 5 ead


• aial o%3her 5

%loaial5 &ihi ormal limis

Posiio5 )iddle

9ilaaio5 / 3m

Ea3eme5 +0J

Cosise35


25/49

Feal Saio5 1


/ari&t&(&+raphy

7aselie 5140 "pm

aria"ili 5 ormal >/-10 "pm?

A33eleraio 5

9e3eleraio 5 -

Feal moeme 5 2$ i 20 mi%esCora3io 5 >? +$ i 10 mi%es

Res%l 5 reass%ri


• emolo"i 5 #.+ (d• emao3ri 5 28 J• e%3o3e 5 14.200(•

Plaeles 5 +##.000(• 7lood pe 5 O(Rh >?• "sA 5 >-?• G9S 5 #1 m(d

.nitia* $ia+n&sis

G1P0A0 1# ears old, raid +'-+8 &ees "ased o SG, i la"or &ih proloed 1 s sae

&ih a sile ira%erie lii e%ses, 3ephali3 preseaio

P*annin+


26/49

O"sere dilaaio &ih )isoprosol 2/ (4 ho%rs

,ina* $ia+n&sis

P1A0, 1# ears old, pos par%s ma%r%s " spoaeo%s per aiam delier, pos he3i

idi3aed " perie%m r%p%re rade !!

e&nata* $ia+n&sis

)ale eoae, +'-+8 &ees a33ordi o 7S &ih "irh &eih o +0+/ rams, leh o 46

3m ad APGAR S3ore '(#, &ih &ih diaose healh eoae.

P*a(enta

Pla3eaLs sie 22$21$2 3m, Coledo ia3, hemaoma >-?, soel 3ell >?, 3al3ii3aio >-?,

%m"ili3al 3hord leh 4' 3m, %m"ili3al 3ord are implaed mariall, "leedi @220 33,

pla3eal &eih 4/0 ram.

Therapy

Pos-Par%s

7 Ceadro$il + $ /00 m PO7 Asam )eeama + $ /00 m PO

o.9ae o

Admissio!dei Bori 9iaosis Fial 9iaosis

1. 24(01(16 )rs.S

P+A0, 4/ ears old, &ih

"ilaeral oaria 3s

P+A0, 4/ ears old, &ih pos

"ilaeral 3se3om s%spe3

edomeriosis


27/49

2 2'(01(16 )rs. )!

P0A0, 28 ears old, &ih

edomeri%m 3s de$ra

P0A0, 28 ears old, pos

3se3om per laparoom

idi3aed " edomeri%m

3s de$ra

+ +0(01(16 )rs. SR

P6A0 42 ears old,&ih

meomeorrhaia

P6A0 42 ears old,&ih

meomeorrhaia

4+1(01(16 )rs. S P/A0 4+ ears old, &ih peli3

ilammaor disease

P/A0 4+ ears old, &ih peli3ilammaor disease

/ +1(01(16 )rs.)A

P+A0, /0 ears old, &ih

moma %eri, hperesio

sae !, CF *A !

P+A0, /0 ears old, &ih

moma %eri, hperesio

sae !, CF *A !

)YE/OLO)Y PT.ET

/SE 1

P30 4 years &* 8ith !i*atera* &varian (yst

.entity

• ame 5 )rs. S


28/49

• Ae 5 4/ ears old

• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 :%ior hih s3hool


• 9ae o admissio 5 :a%ar 24h, 2016

na%nesis

Chie 3omplai5

Paie el pai i her lo&er a"domial par espe3iall &he she had a se3od

da o mesr%aio.


Paie admied o hae "ilaeral oar 3s 3se3om. Paie el pai i

her lo&er a"domial par &he she had he se3od da o mesr%aio.


29/49


o )ear3he 5 1/ ears old

o )esr%al 33le 5 Re%larl eer 28 das, &ih d%raio

o / das, @ 4/ ml(da, dsmeorrheal >-?

o Firs da o las mesr%al 33le 5 :a%ar 1/h

, 201/

• )arial isor 5 )arried 1 imes, has "ee &ih his h%s"ad or 26

ears

• O"seri3 hisor

o9ae

Gesaio

al Ae

a"or

isor

Res%l

Se$7irh

Beih

7reas

Feedi1 1##1 # mohs Spoaeo

%s

peraial

)ale +400 *es

2 1##2 # mohs Spoaeo

%s

peraial

Femal

e

2#00 *es

+ 1##' # mohs Spoaeo

%s peraial

)ale ++00 *es

• Cora3epio isor 5 *es, !9 or 8 ears, remoed i April 201/

isor o aeaal 3are 5 -




• ial sis5

7lood press%re 5 120(80 mm

P%lse rae 5 '2 "eas(mi%e

Respiraor rae 5 16 "reahs(mi%e

7od empera%re 5 +6.4C

• Beih 5 61


30/49

-++-

- --++-

--

++ ++

++++

eih 5 160 3m

• 7)! 5 2+.8 (m2

)enera* e:a%inati&n

Ees 5 Pale 3o=%3ia -(-, i3eri3 s3lera -(-

)o%h 5 Be oral m%3osa mem"rae

-? , allop >-?

o % 5 esi3%lar "reah so%ds (, rho3hi -(-, &heei -(-

o )ammae 5 Areola hperpimeaio -(-, ipple rera3io -(-,

"reas mil -(-

A"dome

!spe3io 5 Coe$, lieaira >-?, sriaeraidar%m >-?

A%s3%laio 5 7o&el so%ds >?, / $( mi%e

Palpaio 5 S%pple.

Per3%io 5 -?,

%d%laed es >-?, d%lless >? i s%prap%"i3 reio.

E$remiies 5 Barm e$remiies, si %ror ormal



)yne(&*&+y e:a%inati&n

• as mesr%al period 5 :a%ar 1/h , 201/

aial o%3her 5 o perormed



• emolo"i 5 14.6(d

• emao3ri 5 4+J

• e%3o3e 5 /,200(

•

Plaeles 5 2/0,000(


31/49

• 7lood l%3ose 5 #/ m(d

• 7lood pe 5 A(Rh >?

•

7leedi


32/49

/SE 2

P00 25 years &* 8ith en&%etriu% (yst e:tra

.entity

• ame 5 )rs. )!


33/49


• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 Elemear S3hool


• 9ae o admissio 5 :a%ar 2'h, 2016

na%nesis

Chie 3omplai5

Paie el pai i her lo&er a"domial par si3e 8 ears "eore he admissio

o he hospial.


Paie el paii her lo&er a"domial par si3e 8 ears ao, ad ei

&orse si3e + mohs "eore he admissio o he hospial. She deied a ra%ma

hisor, eer, aial "leedi(dis3hare, or a mesr%al disr%pio.

• isor o pas illess5








o

isor o s%rer 5 9eied

• Familial hisor5






o

)esr%al 33le 5 o re%larl, &ih d%raio o ' das,@ #0 ml(da, dsmeorrhea >?


34/49

o Firs da o las mesr%al 33le 5 9e3em"er 'h, 201/

• )arial isor 5 )arried 1 imes, has "ee &ih his h%s"ad or 8

ears

• O"seri3 hisor

o9ae

Gesaio

al Ae

a"or

isor

Res%l

Se$7irh

Beih

7reas

Feedi

- - - - - - -

• Cora3epio isor 5 o




• ial sis5

7lood press%re 5 120(80 mm

P%lse rae 5 #6 "eas(mi%e

Respiraor rae 5 20 "reahs(mi%e7od empera%re 5 +6./C

• 7pd &eih 5 '0

eih 5 1// 3m

• 7)! 5 2#.1 (m2

)enera* e:a%inati&n

Ees 5 Pale 3o=%3ia -(-, i3eri3 s3lera -(-


-? , allop >-?



"reas mil -(-

A"dome

!spe3io 5 Coe$, liea ira >-?, sriae raidar%m >-?



35/49

-++-

- --++-

--

++ ++

++++

Palpaio 5 S%pple, pai &ih palpaio >? i s%prap%"i3 reio,

as3ies >-?.


36/49

• SGO< 5 22 (

• SGP< 5 2# (

•

re%m 5 21 m(d

• Creaiie 5 0.6 m(d

• ari%m 51+2 mmol(

• Kali%m 5 4 mmol(

• Cal3i%m 5 1.1' mmol(

• Chloride 510# mmol(

• "sA 5 >-?

S) !&%en


37/49

/SE 3

P60 42 years &* 8ith %en&%ett&rrha+ia

.entity

• ame 5 )rs. SR


• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 S)P

• O33%paio 5 Emploee

• 9ae o admissio 5 :a%ar +0h , 2016

na%nesis

Chie 3omplai5

Paie 3omplais o aial "leedi 2 &ees "eore admissio o hospial


Paie 3ame o Ama :aa ospiaal ad had 3omplais o aial "leedi 2 &ees

"eore admissio o hospial.


38/49




o )esr%al 33le 5 re%larl, &ih d%raio o 'das, 33le eer +0 das, @ 60 ml(da, dsmeorrhea >-?

o Firs da o las mesr%al 33le 5 :a%ar 1'h, 2016

• )arial isor 5 )arried o3e, has "ee &ih his h%s"ad or 2+ ears.

• O"seri3 hisor

o 9ae

Gesaioal

Ae

a"or

isor

Res%l

Se$ 7irhBeih

7reasFeedi

1 1##2 # mohs Spoaeo%s

per aiam

)ale +000

rams


per aiam

)ale +100

rams

+ 1##8 # mohs Spoaeo%s

per aiam

)ale +000

rams

4 2006 # mohs Spoaeo%s

per aiam

Femal

e

+000

rams

/ 200# # mohs Spoaeo%s

per aiam

)ale +000

rams

6 2012 # mohs Spoaeo%s

per aiam

Femal

e

+000

rams

• Cora3epio isor 5 es.


39/49

-++-

- --++-

--

++ ++

++++

7od empera%re 5 +6./C

• 7od &eih 5 /8

eih 5 14' 3m

• 7)! 5 26,8 (m2

)enera* e:a%inati&n

Ees 5 Pale 3o=%3ia (, i3eri3 s3lera -(-

)o%h 5&e oral m%3osa mem"rae

-? , allop >-?


o )ammae 5 Areola hperpimeaio (, ipple rera3io -(-,

"reas mil -(-

A"dome

!spe3io 5 Fla, liea ira >-?, sriae raidar%m >-?

A%s3%laio 5 7o&el so%ds >?, / imes per mi%e





)yne(&*&+i( e:a%inati&n

• Firs da o las mesr%al period 5 :a%ar 1'h, 2016

• aial o%3her 5 o perormed

!spe3%lo 5


• emolo"i 5 10.6 (d• emao3ri 5 +2 J• e%3o3e 5 8.400(• Plaeles 5 24/.000 (• 7leedi ime 5 2 mi%es• Cloi ime 5 4 mi%es• Prea3 es 5 >-?

,irst $ia+n&sis

P6A0 42 ears old,&ih meomeorrhaia


40/49

,ina* $ia+n&sis

P6A0, 42 ears old, &ih meomeorrhaia

,ina* Treat%ent"

- O"sere paieLs ial sis

- !F 5 R /00 33 1 r 8 ho%rs?

5 R /00 33 1 amp meheri >8 ho%rs?

5 R /00 33 1 amp E$ra3e >8 ho%rs?

7 Oral herap 5

7 Prooa 2$2 m PO

7


41/49

/SE 4

P0 43 years &* 8ith pe*vi( in'*a%%at&ry isease

.entity

• ame 5 )rs. S

• Ae 5 4+ ears old

• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 Elemear

• O33%paio 5 Emploee

• 9ae o admissio 5 :a%ar +1s , 2016

na%nesis

Chie 3omplai5

Paie 3omplais o lo&er a"domial pai 2 mohs "eore admissio o hospial


Paie 3ame o Ama :aa ospial 3omplais a"o% pai i her lo&er a"domial 2

mohs "eore admissio o hospial, iermie, p%lsaile. Paie also 3omplais

a"o% aial dis3hare 1 mohs "eore admissio o hospial.


42/49




o )ear3he 5 1+ ears oldo )esr%al 33le 5 re%larl, &ih d%raio o '

das, 33le eer +0 das, @ #0 ml(da, dsmeorrhea >-?o Firs da o las mesr%al 33le 5 :a%ar +0h, 2016

• )arial isor 5 )arried &i3e, has "ee &ih his h%s"ad or 1'

ears.

• O"seri3 hisor

o 9aeGesaioal

Ae

a"or

isor

Res%l

Se$7irh

Beih

7reas

Feedi1 1#8# # mohs Spoaeo%s

per aiam

Femal

e

+000

rams


per aiam

)ale +100

rams

+ 2000 11 mohs Spoaeo%s

per aiam

)ale +000

rams

4 200+ # mohs Spoaeo%s

per aiam

)ale +000

rams

/ 200/ # mohs Spoaeo%s

per aiam

Femal

e

+000

rams

• Cora3epio isor 5 es.


43/49

-++-

- --++-

--

++ ++

++++

7od empera%re 5 +6.6C

• 7od &eih 5 /0

eih 5 1/0 3m

• 7)! 5 22,22 (m2

)enera* e:a%inati&n

Ees 5 Pale 3o=%3ia (, i3eri3 s3lera -(-

)o%h 5&e oral m%3osa mem"rae

-? , allop >-?



"reas mil -(-

A"dome

!spe3io 5 Fla, liea ira >-?, sriae raidar%m >-?

A%s3%laio 5 7o&el so%ds >?, / $(mi

Palpaio 5 S%pple, pai &ih palpaio >? lo&er a"domeAS !!




)yne(&*&+i( e:a%inati&n

• as mesr%al period 5 :a%ar +0h, 2016

• aial o%3her 5 o perormed



• emolo"i 5 10 (d• emao3ri 5 ++ J• e%3o3e 5 1/.100(• Plaeles 5 /10.000(• E9 5 100 mm(ho%r • 9i 3o% 5 0(1(1('+(1'(8• SGO< 5 12 (• SGP< 5 ' (• re%m 5 10 m(d• Creaiie 5 0.6 m(dl•

G9S 5 #4 m(dl• ari%m 5 1+6 mmol(


44/49

• Kali%m 5 4 mmol(• Cal3i%m 5 1.1+ mmol(• Chloride 5 10/ mmol(

rialsis

• Gl%3ose 5 -

• Proei 5 -

• 7ilir%"i 5 -

• ro"lioe 5 ormal

• p 5 6.0

• 7: 5 H100/

• O33%l "lood 5 1

• Keoe 5 -

• e%3o3e 5 1• Sedimes 5 eriro3e /-6( ( p"

5 e%3o3e +-4 ( p"P!9?SG a"domial 5 perioiis lo3al lo&er a"dome ad lmphadeopah

meseeri3a a"dome 1,1$0,6 s%esi 3hroi3 P!9( ade$iisdroephrosis rih rade 1-2 e3 s%spe3 3ompressio o

%reer "e3a%se o P!9.

,irst $ia+n&sis

P/A0 4+ ears old,&ih P!9

,ina* $ia+n&sis

P/A0, 4+ears old, &ih P!9

,ina* Treat%ent"

- )eroidaole +$/00 m PO


45/49

/SE

P30 0 years &* 8ith %y&%a uteri hipertensi&n sta+e 1 /@, Y@ .

.entity

• ame 5 )rs. )A

• Ae 5 /0 ears old

• Ehi3 5 :aaese

• Reliio 5 )oslem

• Ed%3aio 5 Elemear


• 9ae o admissio 5 :a%ar +1h, 2016

na%nesis

Chie 3omplai5

Paie &as s3hed%led or operaio hsere3om.


Paie 3ame o Ama :aa ospial 3omplaied a"o% a"domial dis3omor

>mulas) 10 das prior o admissio o hospial, he paie also 3omplaied a"o% re;%e

aial "leedi, he 3olo%r is dar red, ol%me @1033, spoi. Bhe she &as e$amied

i poli3lii3, here &as a moma, ad she s3hed%led or a hsere3om.


46/49






• Familial hisor5






o )esr%al 33le 5 Re%larl eer +0-40 das, &ih d%raio

o /-' das, @ #0 ml(da, dsmeorrhea >-?o Firs da o las mesr%al 33le 5 )eopa%se or 2 ears

• )arial isor 5 )arried 1 imes, has "ee &ih his h%s"ad or +0 ears

• O"seri3 hisor

o9ae

Gesaioa

l Ae

a"or

isor

Res%l

Se$7irh

Beih

7reas

Feedi1 1##2 10 mohs Spoaeo%

s per

aiam

)ale 2#00

rams

2 1##6 10 mohs Spoaeo%

s per

aiam

)ale +100

rams

+ 1##8 10 mohs Spoaeo%

s per

aiam

)ale +000

rams

• Cora3epio isor 5 *es, pe5 i=e3io + mohs. as %sed 5 1##8




47/49

-++-

- --++-

--

++ ++

++++


• ial sis5

7lood press%re 5 1+0(#0 mm

P%lse rae 5 '2 "eas(mi%eRespiraor rae 5 20 "reahs(mi%e

7od empera%re 5 +6C

• Beih 5 6/

eih 5 1// 3m

• 7)! 5 28.8 (m2

)enera* e:a%inati&n Ees 5 Pale 3o=%3ia -(-, i3eri3 s3lera -(-


-? , allop >-?



"reas mil -(-

A"dome

!spe3io 5 Coe$, lieaira >-?, sriaeraidar%m >-?



Per3%io 5 -?,

%d%laed es >-?

E$remiies 5 Barm e$remiies, si %ror ormal



)yne(&*&+y e:a%inati&n

• as mesr%al period 5 )eopa%se or 2 ears

aial o%3her 5 o perormed


48/49



• emolo"i 5 12./(d

• e%3o3e 5 +.400(

• Plaeles 5 +64.000(

• 7lood l%3ose 5 102 m(d

• 7lood pe 5 A7(Rh >?

•

7leedi


49/49

WEEKLY REPORT Dr.arie (Final Obs)

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Transcript of WEEKLY REPORT Dr.arie (Final Obs)