1 / 21

CLINICAL CASE PRESENTATION

CLINICAL CASE PRESENTATION. Intern Eunice Bernadette M. Go. General Data. FA 23/F Single RC Muntinlupa Consulted for the 3 rd time. Chief Complaint. Right lower quadrant pain. HPI. 6 mos PTC – patient noted mass on RLQ, approx 3x3 cm, movable, nontender

ilya
Download Presentation

CLINICAL CASE PRESENTATION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. CLINICAL CASE PRESENTATION Intern Eunice Bernadette M. Go

  2. General Data • FA • 23/F • Single • RC • Muntinlupa • Consulted for the 3rd time

  3. Chief Complaint • Right lower quadrant pain

  4. HPI 6 mos PTC – patient noted mass on RLQ, approx 3x3 cm, movable, nontender 5 mos PTC – noted increase in size of mass, (+) RLQ pain, intermittent, throbbing, VAS 2/10, resolves spontaneously (-) fever, (-) bowel changes, no meds/consult

  5. HPI 2 mos PTC – noted significant increase in size of mass, (+) weight loss, involuntary (+) RLQ pain, intermittent, throbbing, VAS 2/10, resolves spontaneously (+) consult at PGH (FMC-OPD), was referred to OB GYNE, work up was done A> Ovarian mass, given Tramadol 50 mg BID for pain and was advised surgery

  6. HPI 1 day PTC – patient’s RLQ pain recurred but this time it became severe VAS 10/10, radiating to all quadrants, throbbing, continuous (+) nausea, (+) vomiting,nonbilous, nonbloody approx 1 teaspoon per episode (+) early satiety, (+) soft stool, 2x (+) flatus prompted consult

  7. ROS (+) wt loss, 10% over the past 6 mos (+) anorexia (-)fever (-) cough/colds (-) difficulty of breathing (-) muscle or joint pain (-) urinary/bowel changes (-) melena (-)hematochezia

  8. Past Medical History • (-) Allergy • (-) HPN/DM/BA/PTB • (+) hospitalization, High School due to AGE • Meds: Tramadol

  9. Family Medical History Alava Family Legend: 9/16/09 /-deceased L- lung cancer D- DM G- gastric CA L 50 D G 23 21 20

  10. Personal and Social History • Currently unemployed, previously worked in an electronic company • (-) exposure to chemical or radiation • Smoker, 2 pack years • Non alcoholic • Denies illicit drug use/ promiscuity • Diet: rice, meat, vegetables

  11. OB Gyne History • Menarche at 13 yrs old, regular, 3-4 days, 4ppd • (-) dysmenorrhea • LNMP: August 18, 2009 • G0

  12. Physical Examination Awake, coherent, in pain BP 120/80 HR 120 RR 24 T 37.7 SHEENT: (+) pallor, anicteric sclerae, (-) CLAD Chest: Equal chest expansion, Clear breath sounds CVS: Adynamic precordium, tachycardic, normal rhythm, no murmur

  13. Physical Examination Abdomen: globular, no bowel sound appreciated, (+) poorly defined hypogastric mass, firm approx 10x9 cm, (+) tenderness on all quadrant on light palpation with point of maximal tenderness on RLQ Extremities: Full pulses, no edema, pink nailbeds

  14. Diagnosis • Abdominopelvic mass, T/C Gynecologic (Ovarian new growth)

  15. Plan Dx: CBC Tx: Tramadol 50mg BID as needed for pain Referrals: OB Gyne Surgery

  16. Course at the ER OB-Gyne Notes S: Abdominal pain O: Abdomen: globular, no bowel sound appreciated, (+) poorly defined hypogastric mass, firm approx 10x9 cm, (+) tenderness on all quadrant on light palpation with point of maximal tenderness on RLQ Abdominal UTZ showed normal ovary, to consider gastric CA with metastasis

  17. Course at the ER A: T/C Gastric CA with metastasis P: Refer to Surgery and Family Medicine

  18. Course at the ER Surgery Notes S: Abdominal pain O: Abdomen: globular, no bowel sound appreciated, (+) poorly defined hypogastric mass, firm approx 10x9 cm, (+) tenderness on all quadrant on light palpation with point of maximal tenderness on RLQ Abdominal UTZ showed normal ovary, to consider gastric CA with metastasis

  19. Course at the ER A: T/C Gastric CA with metastasis P: For admission Tramadol 50mg BID for pain

  20. Diagnostic Dilemma • In adult patients, what is the sensitivity and specificity of UTZ as compared to CT scan in diagnosing abdominal mass, using cross-sectional study?

  21. Clinical Dilemma • Review of Clinical Practice Guidelines regarding abdominal mass

More Related