mr 14-1-2016 fix

8/15/2019 MR 14-1-2016 fix

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MORNING REPORTJanuary, 14 th 2016

Resident In Charge: Waw/Qos/Mun/Bor/Did/Cil

Chief: dr. Hot

Supervisor:Dr.dr. Siti Candra Sp!"#$

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• %&ergen'( Roo& : )• Deliver( Roo&

Physiological case : -Pathological case :

Pervaginam : -Perabdominam : 1

• Ward : *

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Emergency Room

1. Mrs. Sunipah/33 yoG P1!!1"b!!! gr 3#-3$ %ee&s S/'( "bcess submandibula de&stra( Secondary old prime

Patient %ill be reported

. Mrs. Magh)irah/ yoG1P0000Ab000 gr 38-39 weeks S/L+ Severe preeclampsia+ Acute Lung e!em+ "mpen!ing #clampsia+ $ip%albuminemia+ Susp& pleural e'usi%n (+ )etal c%mpr%mise!


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3. Mrs. "yu/ # yo*bservation o) ectopic pregnancy ()ungtional cyst( history o) rupture o) ectopic pregnancy

operation

( primary in)ertilPatient %ill be reported

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Delivery room1. Mrs. +ori,ah / 3 yoG*P1001Ab000 gr 3 -38 weeks S/L+ )irst stage active p,ase+ ,r%nic ,.pertensi%n superimp%se!

preeclampsia

+ Age 3 .&%+ Sec%n!ar. %l! prime+ 2" as.mpt%matic

Patient will be re %rte!

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WARD• 1. Mrs. ilu eng/ $$ yo "0 2 dd "0 M( Post e&sternal drainage ec hyperbilirubinemia dt

cholangio a day - !( "nemia( 4ypoalbuminemia( Pleural e)usion 5/S( 6ungtional cyst


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1

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Subjectives4 5 11* *091/ 1601780

4rs& S/ 33 .&%/ 6 .& %& e/ )armer

4r& P / 3 .& %/ 9 .& %& e/ )armer4arrie! 1 1 .earsA!!ress 5 (s :atu Gilang 2 7/ PasuruanA!missi%n %n ;anuar. 17 t, *016 at *&10

pm

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Subjective• Patient was c%nsulte! <r%m surger. !ept

wit, ig,t Subman!ibula absces +Gravi!a G*P0101 3*-37 weeks

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SUBJECTIVE)+/*,/,+*-

Patient )elt toothache %ent to mid%i)e e7amined8 and said that %as normal8 didn,t get any medicine %ent home

/ */ ,+*-Patient )elt there %as mass at her right lo%er a% patient still at home

*)/*/,+*-

at +-.++ p&9he mass got bigger and spread to nec& edem (;8 pain (; %ent to dentist e7amined8 need to spesi)ic treatment

suggest to <S05 angil

at + .++ p&Patient arrived at <S05 angil e7amined pregnancy %as normal8 got amo77icilin 371 and roborantia 1718 patientsuggest to operation 8 because lac& o) )acilities suggested to <SS" )amily still discussed

*0/*/,+*1

*,.++ p&Patient arrived at <SS"8 e7amined by Surgery 5ept and planne to incicon drainege submandibula de&stra

4ystory o) )ever -;

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SUBJECTIVE

• 4istory o) previous delivery:1. "/3!!ogr/Spt /Mid%i)e/M/13 y.o/'

. 9his pregnancy

• "= : Mid%i)e 7 last controled 3!/1 / !1 ;

• 'MP !/ /1# 3-3$ %ee&s • ontraception: >n ection 3 months stop years

ago

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OBJECTIVES G" : Good G S : # $ 4 : 1 cm : 1 &g P : 11!/?! mm4g P< : @@7/m << : ! 7/m 9a7 : 3?81 o 8 9 rect : 3?83 o

4/= : con . an -/- ict -/- "t regio submandibula de&straMass siAe @71! cm8 smooth sur)ace8 hyperemis8 )luctuation (;8 punctum (; 9h : : S1 S single murmur -;

P: rh - - %h - - - - - - - - - - "bd : 64 : $ cm8 longitudinal lie 0 8 64<: 1 ! bpm 5oppler;8

26 : !1 gr8 uterine contraction -;

B9 : not permor)ed

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LABORATOR:1!81/11. 3!/318!C/3#$.!!!

64 : D8$/ D8 !*9/P9 : ??0r/ r : D83/!8$#

S2 : 1 D/#8 1/DD

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STaseline rate : 13! bpm

Bariability : -1 bpm "cc : (;5ecc : -;

onclusion : =ormal 9G

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US! "#

)etal intrauterine single li<e l%ngitu!inal lie,ea! bel%w

=P( 5 86 * mm >37w !?A 5 *86 mm >3*w !?)L 5 60 6 mm >31w7!?A)" 5 11 3#): 5 *0 9 gr

Placental implantati%n at <un!us4aturati%n gra!e ""

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AssessmentG P1!!1"b!!! gr 3#-3$ %ee&s S/'( "bcess submandibula de&stra( Secondary old prime

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$%A I !• P! 5 -• Pt 5- %nservative treatment

- Lung maturati%n in!ucti%n 5 !e ametas,%n * 16 mgin *7 ,%urs- .gest 700mcg per-rectal 6 ,%urs pre %p an! 6 ,%urs

p%st %p- ral t,erap,. 5 )e * 1- Patient will be @%in care- Pm% 5 bs S sub@ )$- "#- -----------------------------------------Acc (r& !r& Siti an!ra

Sp G-B

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La!t C"n#$t$"n• Mother per)ormed incision and drainase at

operating room at 11.!! pm

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• Register: **, ,*1-

• Mrs. 2/,0 (.o/&arried *3 , - (ears/4++++25++*/6C :7#8/Contra'eption : 7#8/6M4 : , #**#,+*-91# wee s

• 2ddress : 2sra&a ;onif 6inud -+,$e&antren <a5ung Malang

• 2d&inistered *0#+*#,+*1 at ++. p&

ID%=>I>;

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• 4atient 'a&e 5( herself with'hief 'o&plain spotting

S?B<%C>I@%

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*)#+*#,+*1

• Patient )elt spotting8 hal) o) )emale nap&ins C patient still stayed at home

*0#+*#,+*1 at +-.++ p&• Patient )elt spotting more e7cesive 1 )emale

nap&ins C %ent to <SS"

S0 E2 9>B2

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• Patient &ne% that she %as pregnant since early Eanuary8test pac& by hersel)8 the result %as positive8 patient

planned to go to *bstetrician but not yet controlled• 4istory o) rupture o) ectopic pregnancy operation on

Eune !1# at <SS" per)ormed operation at le)t side• 4istory traditional massage Fpi at oyo& ; -;8 trauma -;

• 4istory o) leuchore H 1 months ago and didnt havetreatment• 4istory o) menstruation period %as 3! days8 -? days8

change )emale nap&ins 3-#7/day8 pain -;• 4istory o) mictie and de)ecation %nl

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G" : loo& moderate illness8 MP : 1 !/@! mm4g84< : @! 7/mnt 8<< : !

7/mnt4/= : an -/-8 >ct -/-9h : / S1-S single8 murmur -;

P/ <h ≡ I≡ h ≡ I≡ "bd : )undal height not palpable8 soe)l8

meteorismus -;88 bo%el sound (; %nl8 scarmidline (;

!B<%C>I@%

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• G2 : )le7 (; min• >nsp : v/v )le7 (; min

P*=P closed8 smooth8 lividae (;• B9:

v/v )le7 -;P*MP closed8 smooth8 slinger pain (;

0"6 J $-@ %ee&s "P 5 /S : Mass -;8 Pain -;

5 J not prominen

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CBC : ** 0/**.0 + /)) ,/ ,00.+++AH : *+ )/,14lano test : 7 8B#HC" : *+ 1

?6 : 5a'teri , - 3*+)

%ABORATORIU#

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0SG• 0terine enlargement H@8D17 8# cm8 cavum uterine

open %ith )luid collection inside• Seem gestational sac %ith ring o) )ire at rigth adne&sa

pro ection diameter H 8 3 cm J gestational age $% d8seem amor) lesion in cavum douglas. Seem cyst8 septa

-; at rigth adne&sa pro ection diameter H 38$? cm

• onclusion :KSugested rupture o) ectopic pregnancy at rigth adne&sa

pro ectionK<igth simple ovarial cyst

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!5servation of e'topi' pregnan'( Aungtional '(st Histor( of rupture of e'topi'pregnan'( operation 4ri&ar( infertil

ASSESSMENT

P'"==>=G 942<"PL

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PDx : CBC serial/ 6 hours, USG gyn atwork hour

PTx :• Hospitali e! at "oo# $

• %&'D "( ) *+tp#• Be! rest• Per or#e! a-!o#inal .ir.u#teran.e• %nserte! DC• % sign o a.ute a-!o#en 01 pro exploration

laparoto#y .itoP2o : 3-s &S, su-4 .o#plaintC/ Super5isor appro5e! -y Dr7 !r7 Siti

Chan!ra, Sp3G89

P ==>=G 942< PL

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%&st Con'ition• 5' 1!8 /1! !!/3!/ D!!!• Mother at room #• P 11!/?! mm4g• 4< @@7/m• << !7/m

• =o addition o) abdominal circum)erence

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3

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I'entityD%& 4 11* *1974rs& 4 /** .&%/ 1* .& %& e/ $%usewi<e4r& "( / * .& %/ 1* .& %& e/ S%l!ier4arie! 1 1 .earA!!ress 5 Asrama Bikautai * B%stra! 2 6/

Bemantren ;abung

A!missi%n 5 ;anuar. 1 t, *016 at 01&30 am

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• Patient was re<erre! b. bstetrician Puri=un!a $%spital wit, G1P0000Ab000 gr 38-

39 weeks S/L + severe preeclampsia +"mpen!ing eclampsia + Lung e!em

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SUBJECTIVES

• +/ /*+ 6• Patient <elt !iEEines sta.e! at ,%me

• $/ /*+ 6K 0 &00 pmK Patient <elt !iEEiness getting w%rse went t% mi!wi<e

e amine! =P 1 0/100 suggest t% re're! t% Puri=un!a $%spital

K8& 00 pmKPatient arrive! at Puri =un!a $%spital =P 1 */1**

pr%tein +3 given wit, S470F "4 an! planne! t% SK10&30 pmKArrive! at %perating r%%m patient <elt s,%rtness %<

breat, g%t e amine! b. anaest,esi%l%g. sugeste!t% be re're! t% SSA <amill. still !iscusse!

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SUBJECTIVE• $ist%r. %< ,ig, bl%%! pressure be<%re an!

!uring pregnanc. was !enie!• $ist%r. %< ,ea!ac,e >+? Dausea >-?

%miting >-? epigastric pain >+?

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SUBJECTIVES

$ist%r. %< last pregnanc. 51& 2,is Pregnanc.

AD 5 4i!wi<e 6 >last c%ntr%l /1/*016? L4P * -7-*01 H 38-39 weeks

%ntracepti%n 5 >-?

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OBJECTIVES G" : loo&ed severe ill8G S : # $ P : 1?!/1!! mm4g P< : 1!!7/m << : #- $7/m Sat * : D -D#C 4 : 1 cm : ?# &g 4/= : con . an -/- ict -/- 9h : : S1 S single murmur -;

P: rh - - %h - - - - - - ( ( - - "bd : 64 33 cm8 longitudinal lie 08 64< 13! 7/m

5oppler;8 26 : 3 gr8 uterine contraction-;

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B9 a)ter SM;: !-1 cm8 e)) C8 4>8 amniotic membran (;8

head presentation8 denom di))icult to evaluated8pelvic measurement J %nl

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LABORATOR: 1!8#/11$$!/3#8D/ $#!!!64 : @81/ @810r/ r : 1#8 /!8$$*9/P9 : 3/1!< S : @@ "lb : 8 @'54 : @S2 : 13 /#8 1/110rinalysis : (; 3

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%ABORATOR(• p4 : ?8#• p * : #8?• p* :1 8?• 4 *3 : 1 8#• 2 : -D8$

• Sat * : D?C

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T)or&* $A

• ardiomegali %ithcongestive

pulmonum• Pleural e))usion 5

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US! "#

)etal intrauterine single li<e l%ngitu!inal lie,ea! bel%w=P( 5 97 1mm >38w*!?A 5 330 mm >36w6!?)L 5 3 6 mm >3 w !?A)" 5 9 8

#): 5 3*6 grPlacental implantati%n at <un!us4aturati%n gra!e """

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ST• aseline rate : 13! bpm• Barriabiliy rate : - bpm• "cc -;• 5ecc -;

Patologic 9G

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C+ C&r'iology• G1P!"b! gr 3@-3D %ee&s

KSevere preeclampsiaK4ipoalbuminemiK ardiologi status G <> class >>

2S >ntermediate "dvicePatient %ill be oin care )or general improvement

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C+ $ulmonologist• Susp. <ight Pleura 2)usion

"dvicePd7 : 0SG thora7 promar&erPt7 : Pleura punction test i) there is mar&er )rom

thora7 0SG

Patient %ill be )ollo%ed

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AssessmentG1P0000Ab000 gr 38-39 weeks S/L+ Severe preeclampsia+ Acute Lung e!em+ "mpen!ing #clampsia+ $ip%albuminemia

+ Susp& pleural e'usi%n (+ )etal c%mpr%mise!

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$%A I !

P57 : c/ cardiology8 c/ anaestesiology8 c/ pulmonologistP97 :>ntrauterine resusitation

- * =< M 1! lpm- Mother at le)t recumbent position

- >n SM )ull dose- >n . SM !C # gr iv- >n SM #! C 1! gr >M (; at Puri unda 4ospital- ontinued %ith in)us SM #!C $ gr/$ hours until 1 hours post op- 9ran)uision "lb !C until "lb level N 3 gr/dl

- Proposed termination %ith S cito ( >05 pasca placenta- Prepare )or operation :

- >n . e)aAoline 1 gr s&in test;- >n .<anitidine 1 "mp iv - >n . Metochlopramide 1 "mp iv - >n )urosemide amp iv - >nsert 5 / >n)ormed concent/ blood preparation

Pmo : *bs. BS8sub ective8 64<8 sign o) eclampsia8 urine production8 )luid balance>2

c/spv ---------------------------------- 2'' Dr.dr. Siti Candra Sp!"#$

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OUTCOME

!n Arida( <anuar( *- th ,+*1at +0.* a&

Ae&ale 5a5( was 5orn, ++ gr/ 0 '& /2S 1#

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La!t C"n#$t$"nMother• "t << 2mergency <oom• G S on sedation• P : 11?/$D mm4g• P< : D# 7/m• << : 1# 7/m on ventilator

control ;

• 0rine production 1!! cc/hours

Ba5( "t perinatology >n)us -;* -; "ctive movement

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#

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I'entity• D%& 4 11* *169• 4rs& I / 3 .&%/ 6 .& %& e/ empl%.ee %< )%%!

<act%r.• 4r& / 3 .& %/ 6 .& %& e/ arpenter• 4arie! 1 16 .ears• A!!ress 5 (s =unut :etan 2 6/ Pakis

4alang• A!missi%n5 ;anuar. 17 t, *016 at pm 08&0

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• Patient was re'ere! b. 4i!wi<e wit,G*P1001Ab000 gr 3 -36 weeks wit,severe preeclampsia

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SUBJECTIVES

• $/ /*+ 6 at +7++ a#Patient <elt uterine c%ntracti%n patient still at ,%me• $/ /*+ 6 at + 7++ p#Patient <elt uterine c%ntracti%n m%re <reJuent patientwent t% mi!wi<e =P 160/100 suggest t% SSA <amil. !iscusse!• $/ /*+ 6 at +67++ p#Patient went t% SSA

$ist%r. %< bl%%! presure since * .ears ag% but !i!nKtseek an. me!icati%n$ist%r. %< !iEEines >-? v%miting >-? nausea >-?epigastric pain>-? blurre! visi%n>-?

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SUBJECTIVES

$ist%r. %< last pregnanc. 51& At/ *600 gr/Spt=/ SSA/)/13 .&%/L*& 2,is Pregnanc.

AD 5 4i!wi<e 3 >last c%ntr%l 1 /11/*01 ?

L4P *8-07-*01 H 3 -38 weeks

%ntracepti%n in@ect%n 3 m%nt, st%p 1 .ear

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OBJECTIVES G" : good8G S : # $ P : 1$!/1!! mm4g P< : D!7/m << : !7/m 9 a7 : 3$8 9rect : 3$8@ 4 : 1#? cm : $ &g 4/= : con . an -/- ict -/- 9h : : S1 S single murmur -;

P: rh - - %h - - - - - - - - - - "bd : 64 3 cm8 longitudinal lie 08 64< 1#@ 7/m

5oppler;8 26 : 31!! gr8 uterine contraction

(; 1!.3.3 / MS5i stic& (;

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B9 a)ter SM;: $ cm8 e)) 1!!C8 4>>8 amniotic membran (;8

head presentation8 denom minor )ontanela at o,cloc&8 pelvic measurement J %nl

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LABORATOR: 1 8#/ 1.3!!/3?8#/3 D.!!!64 : @8D/ @830r/ r : 3!8$/!8D1*9/P9 : /11< S : 11 "lb : 38$#'54 : $S2 : 13?/38D/1!@0' : protein (;

bacteri 3 #8#71! 3

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ST• aseline rate : 1#! bpm• Barriabiliy rate : - ! bpm• "cc (;• 5ecc -;

=ormal 9G

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US! "#)etal intrauterine single li<e l%ngitu!inal lie

,ea! bel%w=P( 5 89 8 mm >36w1!?

A 5 3*3 mm >36w1!?)L 5 7 3 mm >38w0!?A)" 5 10 3#): 5 3086 gr

Placental implantati%n at <un!us4aturati%n gra!e """

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AssessmentG*P1001Ab000 gr 3 -38 weeks S/L+ )irst stage active p,ase+ ,r%nic ,.pertensi%n superimp%se!

preeclampsia+ Age 3 .&%

+ Sec%n!ar. %l! prime+ 2" as.mpt%matic

$%A I !

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$%A I !

P57 : co/cardiology dept8 co/ opthalmology P97 :- >n SM )ull dose

- >n . SM !C # gr iv slo%ly - >n SM #! C $ gr in <5 !!cc )or $ hours- >n SM maintenance8 SM #!C 1! gr in <5 !! cc 1 until # hours post partum- =i)edipine 371!mg- Metildopa 37 !!mg- 2valuated hours later- Pro e7pectative pervaginam

Pmo : *bs. BS8sub ective8 64<8 progress o) dilatation sign o) impending eclampsia8uterine contraction8 urine production8 )luid balance

>2

c/spv ---------------------------------- 2'' Dr.dr. Siti Candra Sp!"#$

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C+ C&r'iology• G P1"b! inpartu gr 3?-3@ %ee&s ( 6irst stage

active phase• 4ypertension stage >> chronic Superimposed

preeclampsia

"dvicePatient %ill be oin careP* Metyldopa 37 !! "dalat oros 3!-!

Date andti&e

Su5 e't !5 e'tive 2sses&ent 4lanning

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1#/1/ !1$1!.!!pm

S : 0terinecontractionregurally

G" : Good G S : # $ P : 1 #/@ mm4g P< :

1! 7/m << : 1@ 7/m 9a7 :3$8 o 8 9 rect : 3$8? o

4/= : con . an -/- ict -/- 9h: : S1 S single murmur

-;P : ≡│≡ wh ≡│≡

"bd : 64 : 31 cm8longitudinal lie 0 864<: 1#@ bpm

5oppler;8 26 : 31!!gr8 uterine contraction

(; 1!.3.3 /S

B9 : @ cm8 e)) 1!!C8 4>>8amniotic -; clearly8 headpresentation8 denom J minor)ontanela at 1 o,cloc&8 pelvicmeasurement J %nl

G*P1001Ab000gr 3 -38 weeksS/L+ )irst stageactive stage+ ,r%nic,.pertensi%nsuperimp%se!preeclampsia+ Age 3 .&%+ Sec%n!ar. %l!

prime+ 2"as.mpt%matic

Pd7 : -Pt7 :2valuation hours

!!.!!;Pro e7pectativepervaginamPmo : *bs BS8 sub 864<8 uterinecontraction8 progresso) dilatation

>2o/Spv

OOOOOOOOOOOO " 5r. dr. Siti

andra Sp.*G-

Date andti&e

Su5 e't !5 e'tive 2sses&ent 4lanning

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1 /1/ !1$!!.!!am

S : 0terinecontractionregurally

G" : Good G S : # $ P : 1 ?/@@ mm4g P< :

@@7/m << : ! 7/m 9a7 :3$8 o 8 9 rect : 3$8? o

4/= : con . an -/- ict -/- 9h: : S1 S single murmur-;

P : ≡│≡ wh ≡│≡ "bd : 64 : 31 cm8

longitudinal lie 0 864<: 1#@ bpm

5oppler;8 26 : 31!!gr8 uterine contraction

(; 1!.3.3 /S B9 : @ cm8 e)) 1!!C8 4>>8

amniotic -; clearly8 headpresentation8 denom J di))icultto evaluate8 caput (;

G*P1001Ab000gr 3 -38 weeksS/L+ )irst stage

active stage+ ,r%nic,.pertensi%nsuperimp%se!preeclampsia+ Arrest %<!ilatati%n ec P(+ Age 3 .&%+ Sec%n!ar. %l!prime+ 2"as.mpt%matic

Pd7 : c/anestesiaPt7 :Proposed termination %ith S cito ( >05

pasca placenta>n . e)aAoline 1 gr>B;

>n <anitidine 1 amp>n Metoclopramd 1amp9o&oliti& : &altro)ensupp >

>nsert 5 / >n)ormedconcent/ bloodpreparation

>2o/Spv

OOOOOOOOOOOO " 5r. dr. Siti

andra Sp.*G-

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OUTCOME

!n Arida(<anuar( *- th ,+*1 at +,.*- a& Male 5a5( was 5orn

)+,+ gr/ -+ '& /2S #

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%&st Con'itionMother Ba5(

"t << * G

• P : 1 3/D mm4g• P< : 1!1 7/m• << : 1 7/m on =< M 1!

lpm;• Sa * D@C

• 0rine production : 1!!cc/hours "t Perinatology

• >n)usion -;• * -;• "ctive movement

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• Register:• Mrs. W/11 (.o/&arried *3 -+ (ears/4,++,25+++/6C :00(.o/Contra'eption : 7#8/6M4 :&enopause sin'e *) (ears ago

ID%=>I>;

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• 4atient was 'onsulted 5( 2nesthesiolg(

with post ope3ternal drainageh(per5iliru5ine&ia dt 'holangio Ca

5leeding fro& 5irth 'anal

S?B<%C>I@%

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SUBJECTIVE• 1#-1- !1$ at !?.!! am• Patient %as being operated e7ternal billiary

drainage cholangio a ( obstructive aundice• 1#-1- !1$ at 1!.!! am• Patient post operation at *perating <oom

paviliun8 blood e7cess )rom nirth canal (1underpad8 per)ormed tampoon %ith balooncateter because P %as decreased resusitated move to > 0

•

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SUBJECTIVE• 4istory o) spotting since 3 %ee&s ago patient

still at home

• 4istory o) tumor under hepar at<SS" 3/ / !1 ; P" : metastase "deno amoderate di))erentiated at e&ternal intestine %all

got chemotheraphy $ series8 the lastchemotheraphy on Euly !1

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SUBJECTIVE• Patient )elt her eyes and s&in yello% controlle

to Surgeon because suspected obstruction o)

duct o) gall bladder suggested to operated )amily discussed

• 4istory o) body %eigth loss -;• 4istory o) tumor gynecology in )amily %as

denied• 4istory o) de)ecation %nl• 4istory o) mictie loo& li&e tea in collour

!B<%C>I@%

8/15/2019 MR 14-1-2016 fix


G" : loo& moderate illness8 MP : 1 !/@1 mm4g84< : @@ 7/mnt 8<< : ! 7/mnt8

Sat. * : D?A %ith = # lpm

4/= : an (/(8 >ct -/-9h : / S1-S single8 murmur -;

P/ <h ≡ I≡ h ≡ I≡ "bd : )lat8 soe)l8 bo%el sound 8 met -;8 drain (;8↓↓

operated %ound cover by cassaG2 :v/v )le7 (;8 )luor -;>nsp : v/v )le7 (;8 )luor -;

P*MP closed smooth

!B<%C>I@%

8/15/2019 MR 14-1-2016 fix


B9 : v/v )le7 (;8 )luor (;P*MP closed smooth

0"6 J sligth enlarged "P 5; massa -;8 pain -;

S; mass -;8 pain -;5 %nl

8/15/2019 MR 14-1-2016 fix


CBC : )/ . + /,1 / 10.+++!>/4> : -1/0

2l5 : ,

RBS : ,Bil >otal/ D/I : * /*1 *0/* -Cholesterol >/ >"/HD6/ 6D6 :

0++/)))/* /0-

%ABORATORIU#

8/15/2019 MR 14-1-2016 fix


0SG• =ormal uterus8 seem cyst at adne&sa %ith

thin septa8 siAe 837#8@cm• Seem pleural e))usion 5/S• Sludge vesica velea• *bstructive at distal hepatic duct by mass

cholangio a;8 ma&e obtructive aundice

8/15/2019 MR 14-1-2016 fix


#RI• onclusion:• 5ilatated o) >4 5 bilateral ec mass billiary

common hepatic bile duct sugestive cholangio ca&lats&in tumor tipe >> hepatomegali

• Pleural e))usion 5;

8/15/2019 MR 14-1-2016 fix


2?B % dd 2?B M post e sternal drainage e'h(per5iliru5ine&ia dt 'holangioCa da( + ane&ia h(poal5u&ine&ia

pleural efusion D/S fungtional '(st

ASSESSMENT

P'"==>=G 942<"PL

8/15/2019 MR 14-1-2016 fix


PDx : USG Gyn at work hour itransporta-le, .o/ ';"

PTx :• General i#pro5e#ent with trans usion P"C

*l-/!ay until H- < + gr/!l .ontinue! .uretageP= %8%%

• %n47 Traneksa#at a.i! >x?++#g i5• 3ral theraphy S' *xP2o : 3-s &S, su-4C/ Super5isor appro5e! -y Dr7 !r7 Siti

Can!ra, Sp3G89

8/15/2019 MR 14-1-2016 fix


>H2=$ ;!?

mr 14-1-2016 fix

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