OSPITAL NG MAKATI

Sampaguita corner Gumamela St., Brgy. Pembo, Makati City, Philippines

Tel. +632 882 6316 to 36
PhilHealth Accredited
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
JUNE 23, 2024
(SUNDAY)

ADMISSIONS OB WARD LR / DR GYNE WARD PERIPHERALS REFERRALS

OB 6 MERDEGIA, RODA ROMIDA MACAPAGAL OB 12 CORRALES, ROVELYN CABALLES Gyne 1 ESCIETE, MARIAFE GARA 704 PICONES, JOSEL PASCUAL
OB 11 BERIDA, ABIGAIL VILLANUEVA OB 14 DOMINGO, ABIGAIL EUNICE GUDES Gyne 2 ALINDOGAN, MARECIL ESTROPIGAN
OB 10 RIVERA, ELIZABETH ABIGAN OB 15 FERNANDEZ, MARIA LOVELLA OCHAVO Gyne 3 DAILEG, JENNY LAURENTE ARI Bed 5 FRANCIA, LYNETTE BUENAVISTA
Gyne 5 ALIDO, ANALYN DAJUTOY OB 18 MADAJE, MARIZ GUARIN Gyne 4 LIPARDO, MARY GRACE CASTA ICU 513 QUIJANO , ROSA GABINETE
Gyne 6 CASTRO, REGINA ATIENZA OB 19 SAN JOSE, YESHA ANGELA SUCK Gyne 9 DE GUZMAN, REBECCA OCAMPO
OB 20 FERNANDEZ, ARMIL OCAMPO
OB 23 CABUENAS, JENELYN ABEÑON

ADMISSION
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES Remarks
OB 6 G2P2 (1102) Pregnancy BPR: 120/80 NPO; CBC with PC IUD
MERDEGIA, RODA ROMIDA Uterine BP 120/80 D5LR 1l + 10 unit Oxytocin Date Hgb Hct WBC S L M E Plt NICU for
MACAPAGAL Delivered term, cephalic, HR 84 x 30gtts/min to consume 06/23 11.2 0.33 9.2 76 15 6 3 168 *1 unit pRBC properly typed and maternal
33 live baby boy RR 20 then discontinue crossmatched illness
AB+/NR
YC AS 9,9 BW 3.36 kg BL 46 cm T 36.6
Urinalysis
MI 39 weeks AGA
Date Sugar Protein WBC RBC Epithelial Bacteria
3797056 Chronic Hypertension
06/23 Neg 1+ 3.5 2.8 73.8 50.2
06/23/2024 Gestational Diabetes Chronic Hypertension Chronic Hypertension
Chemistry:
Dr. Palomares/Tungcul, Mellitus, insulin requiring, (-) headache Niferdipine 30mg.tab, 1 For BP monitoring and control
Date BUN Crea LDH AST ALT HbA1c
Ballesteros (TL), de Paz/Posadas, controlled (-) blurring of vision tab OD if with BP
Tugado/Vito, Jasarino Subclinical Hypothyroidism, (-) nausea/vomiting elevation >/= 140/90 06/24 2.66 45.24 12.41 12.14 5.21
in euthyroid state Ferritin 6/23 67.27 Gestational Diabetes Mellitus,
2349H/0241H Morbidly Obese FBS (2/21/24) 103.86 H at 16 weeks insulin requiring, controlled
1000CC Gestational Diabetes Mellitus, 24 hour urine protein (6/19, OSMAK) 274.86 CBG q4h while on NPO then CBG
Previous CS I for impending insulin requiring, controlled None for now Thyroid Function Tests TIDACHS once diet progressed
eclampsia (2022, OSMAK) (-) polydipsia Date TSH FT3 FT4 75g OGTT 4-12 weeks
(-) polyuria 06/24 2.09 2.18 1.03 postpartum
By Emergency Low (-) polyphagia CBG monitoring
Transverse Cesarean Date 0300H
Section II followed by IUD 06/24 133 Subclinical Hypothyroidism, in
insertion under CLEA Intra-operative findings: euthyroid state
(06/24/2024) Subclinical Hypothyroidism, in None for now Dense adhesions noted between the fascia, peritoneum and left side of the anterior abdominal wall. Gravid uterus with a well-formed lower uterine segment. There was adequate Referred to IM Endo- awaiting
euthyroid state amount of clear amniotic fluid. Delivered to a term live baby boy AS 9,9 BW 3.36 kg BL 46 cm MI 39 weeks by pediatric aging. Placenta was implanted posteriorly with three- notes
(-) bradycardia vessel cord. The rest of her pelvic organs were grossly normal.
(-) dry skin EBL 1000cc
(-) fatigue
OB wise
For diet progression and repeat
Cefuroxime 500mg/tab 1 CBC 12 hrs post op at 1441H
OB wise tab every 12 hours x 7 For COD TID c/o OB ROD
No profuse vaginal bleeding days Awaiting LDH – frequest given
No severe hypogastric pain Paracetamol/ Tramadol
(-) flatus 325/37.5mg/tab, 1 tablet
(-) BM every 8 hours as needed
for pain
Ferrous sulfate 325mg/tab
1 tab 2x a day
Metronidazole
500mg/tab, 1 tab every 12
hours for 7 days
Vitamin ACE+ ZINC , 1 tab
once a day
OB 11 G3P2 (2012) Pregnancy BP 100/60 Soft diet the DM diet once CBC with PC IUD
BERIDA, ABIGAIL VILLANUEVA Uterine HR 76 with BM Date Hgb Hct WBC S L M E B Plt EINC
30 Delivered term, cephalic, RR 20 Heplock 06/24 10.6 0.31 13.2 80 12 6 2 250
YC live baby girl T 36.6
 AS 9,9 BW 2.72 kg BL 46 cm 06/23 11.3 0.33 8.9 66 23 7 3 1 263
129970 MI 39 weeks AGA A+/NR Gestational diabetes mellitus,
06/23/2024 Gestational diabetes Urinalysis diet controlled
Dr. Odevilas/Tungcul, Ballestero mellitus, diet controlled Gestational diabetes mellitus, None for now Date Sugar Protein WBC RBC Epithelial Bacteria CBG TIDACHS
(TL), de Paz/Posadas, Previous LTCS I diet controlled 06/23 Neg Neg 2.0 0.2 31.1 19.6 75g OGTT 4-12 weeks
Tugado/Vito, Jasarino (Pfannenstiel) for (-) polydipsia Ferritin 06/23 298.70 postpartum
cephalopelvic disproportion (-) polyuria FBS 94.32 H (3/22) at 23 weeks Referred IM Endo notes (Dr.
1407H/1605H (2023, St. Claire) (-) polyphagia HbA1c 06/23 5.18 Pagarigan informed)
800cc CBG monitoring
By Emergency Low OB wise Date 0000H OB wise
Transverse Cesarean No profuse vaginal bleeding For COD today
06/23 66
Section II for repeat No severe hypogastric pain Cefuroxime 500mg/tab 1
followed by IUD insertion (-) flatus tab every 12 hours x 7
under CLEA(06/23/2024) (-) BM days
Mefenamic acid 500mg 1
tablet every 8 hours as
needed for pain
Ferrous sulfate 325mg/tab
1 tab 2x a day

OB 10 G2P1 (1001) Pregnancy BP 90/60 NPO CBC with PC DMPA

RIVERA, ELIZABETH ABIGAN Uterine 38 1/7 weeks AOG HR 79 D5LR 1Lx 30gtts/min Date Hgb Hct WBC S L M E B Plt
30 by LMP cephalic not in RR 20 DAT now, NPO at 06/23 12.0 0.34 6.1 64 26 8 2 150 *2 units PRBC properly typed
YC labor T 36.6 and crossmatched c/o Maam
A+/NR
Gestational Diabetes Sarah
Urinalysis
3932406 Mellitus, diet controlled
Date Sugar Protein WBC RBC Epithelial Bacteria
06/23/2024
06/23 Neg Neg 0.1 0.3 2.0 1.0
Dr. Odevilas/ Tungcul, Previous LTCS I for Placenta Gestational diabetes mellitus, None for now
06/23 Neg Neg 28.5H 1.0 1250.0 2675.9
Ballesteros (TL), De Paz/ previa totalis (2019, San diet controlled
Ferritin 06/23 224.50
Pesigan*, Posadas, Tugado/ Juan Hospital) (-) polydipsia
HbA1c 6/23 4.90
Jasarino, Vito (-) polyuria Gestational diabetes mellitus,
75g OGTT (April 3, 2024, Megason) at 26 weeks
(-) polyphagia diet controlled
FBS: 99.9H
CBG Q4 hours while on NPO then
1st hour: 154
CBG TIDACHS post-partum
2nd hour: 106
75g OGTT 4-12 weeks
Imaging
postpartum
BPS UTZ (OSMAK, SLIUP, Cephalic, AOG 35 4/7, EFW 2707g, FHR 139bpm, Grade II fundal placenta, AFI 18cm, SDP 7.3cm, 8/8
IM Endo Notes 06/23
6.20.24)
Noted plans for CS, no objection
OB wise Cefoxitin 2gm TIV as endo wise
BPS + Placental doppler LIUP, cephalic, 141bpm, 2382g, Left anterolateral HL, gII, sdp 3.77cm, 34w2d, 8/8, No sonologic signs of abnormal placentation
Good fetal movements loading dose ( )ANST 6/6, Makati Life Since with controlled CBGs, may
(-) bloody vaginal discharge 30min prior to OR do CBG while NPO
(-) watery vaginal discharge Tracing For 7 point CBG monitoring then
(-) perceived irregular uterine CBG q2h once on NPO
Date Interpretation BFHT Variability Acceleration Deceleration Contraction
contractions
06/24 AM Reactive 130-135 Moderate (+) (-) No contractions OB wise
06/24 PM Reactive 130-135 Moderate (+) (-) No contractions For Elective LTCS II TF 1st case
G2P1 (1001) CBG monitoring For co-management with IM
LMP: September 30, 2023 Date 0500H 1400H 1700H 2000H 2100H ENDO service
AOG: 38 2/7 weeks by LMP 06/24 90 >Monitor VSq4h, FHTq4h and
AOG: 37 6/7 weeks by UTZ 06/23 101 125 99 89 record
(11/16/23, 6 weeks & 2 days) >Monitor progress of labor
>For NST BID
Globular abdomen, (+) intact PROD informed (Dr. Almario)
midline intraumbilical scar AROD informed (Dr.
FH: 30 Concepcion)>For crossmatching
FHT: 130s of 1 unit pRBC for possible OR
IE: cervix closed, uterus use - once admitted at the ward
enlarged to AOG (2 units pRBC available c/o
Ma'am Jeanet)
>WOF: severe hypogastric pain,
profuse vaginal bleeding,
decreased fetal movement, fetal
tachycardia/bradycardia

Anes Notes 06/23

Anesthesia plans, risks and
complications explained to and
 full understood by patient
Diet: NPO 8 hours prior to OR
IVF: PNSS 1L x KVO rate to hook
prior to OR
MedicationsL 1. Ranitidine 50mg
IV prior to OR
2. Metoclopramide 10mg IV prior
to OR
Please secure 1 unit pRBC
properly typed and
crossmatched for possible OR
use
Please secure second IV line on
contralateral arm then heplock
For CBG and VS prior to wheel in
to DR, to inform AROD at local
1416
Will refer this case to our service
consultant

Gyne 5 G2P2 (2002) BPR palpatory -100/70 Light meals with SAP CBC with PC
ALIDO, ANALYN DAJUTOY Cervical Squamous Cell BP 100/70 PNSS 1L x 60cc/hr Date Hgb Hct WBC S L M E Plt
43 Carcinoma St IIB HR 105 (+) IFC 06/23 6.3L 0.19L 29.8 94 2 4 379
NYC BT of 2u pRBC for HRR 105-120 (+) Cardiac monitor *1u pRBC waived, 1u pRBC
A+/NR
hypovolemic shock RR 20 (+) O2 support via nasal properly typed and
Urinalysis
secondary to anemia severe T 36.8 cannula at 2-3 lpm crossmatched c/o Ma'am Barbie
3933045 Date Sugar Protein WBC RBC Epithelial Bacteria
secondary to malignancy,
06/23/2024 6/23 Neg 1+ 75.5 188.1 103.5 592.0
ongoing correction I: 400
Dr. Santos/Tungcul, Ballesteros Chemistry:
Type II Diabetes Mellitus O: 300
(TL), de Paz/Posadas, Date BUN Crea Na K Cl AST ALT HbA1c
Tugado/Vito, Jasarino 131.25 4.02 101 22.59
Previous cervical punch Ht: 155 cm 06/23 2.79 47.75 13.42 6.77H
biopsy (10/12/2023, EVMC Wt: 49 kg ECG 06/23 Sinus tachycardia, normal axis, no hypertrophy or ischemic changes
Tacloban) BMI: 20 kg/m2 Coagulation test
Date PT %act INR APTT
At the ER, palpatory BP, PNSS
500cc FD now > BP 100/70 > 06/23 15.8 71.6 1.43 33.7
Regulate remaining PNSS Imaging
500cc x 125cc/h 80/50, CXR 6/23 There are no active parenchymal opacities in both lungs.
given PNSS 200cc as FD Pulmonary vascular markings are within normal limits.
90/60 PNSS 200cc as FD to The heart is not enlarged.
Both hemidiaphragms and costophrenic angles are intact.
complete 1.2L (20cc/kg)
Bony thorax is unremarkable.
80/60, PNSS 600cc FD to
Impression
complete 1.8L 90/50 No significant chest findings
Noradrenaline 100/70 TVS UTZ c/o OB sono The rectum, urethra and urinary bladder are distinct.
(11/15/2023, April ann) The uterine corpus is midposition, with regular contour and homogeneous echopattern measuring 4.4 x 4.4 x 5.1 cm. The cervix is
Hypovolemic shock secondary S/P BT of 2u pRBC converted into a heterogeneous mass, occupying the vaginal canal, measuring 7.2 x 4.7 x 7.2 cm (volume= 126.6 cc). Power Doppler
to anemia severe secondary Diphenhydramine 50mg flow of the mass revealed abundant intra-tumoral vascular flow (Color score of 4). The bilateral parametria are obliterated. Hypovolemic shock secondary to
to malignancy, ongoing TIM The endometrium is hyperechogenic measuring 0.4 cm. The subendometrial halo is intact. anemia severe secondary to
correction Calcium gluconate 10% The right ovary measures 2.6 x 1.5 x 1.6 cm (volume= 3.3 cc). malignancy, ongoing correction
(+) Pallor 10cc SIVP post BT of 3u The left ovary was not visualized. or BT of 2 more unit pRBC
(+) pale palpebral conjunctiva PRBC There are no adnexal masses seen. For repeat CBC 6 hours post BT
(-) dizziness Noradrenaline 16mg + There are no pelvic and para-aortic lymphadenopathies seen. of 2 units pRBC (6/24, 1000H)
(-) weakness PNSS 500mL to run at The liver parenchyma is homogeneous. For Ferritin, PBS, Reticulocyte
18.75cc/hr The bilateral renal calyces were unremarkable. count
(0.2mcg/kg/min) to There is no free fluid in the pelvic cavity.
regulate at increments of IMPRESSION:
+/-3cc/hr every 15 CERVICAL MASS, CONSISTENT WITH NEOPLASIA THIN ENDOMETRIUM NORMAL RIGHT OVARY
minutes to maintain BP Histopath (10/12, EVMC): Cervical punch biopsy, Squamous cell CA
=90/60mmHg (min: CBG monitoring
18.75ugtts/min, max: Date 1200H 2000H 2100H
93.75ugtts/min)- 06/23 187
HOLD,06/23, 1630H 06/23 209 228

Diabetes Mellitus, Type 2 START Insulin Glulisine

(-) polydipsia sliding scale Diabetes Mellitus, Type 2
 (-) polyuria CBG 181-220 2 unit SC CBG TIDACHS
(-) polyphagia 221-260 4 units SC IM Endo 6/24
261-300 6 units SC START Insulin Glulisine sliding
300 8 units SC scale
CBG 181-220 2 unit SC
221-260 4 units SC
Gyne wise 261-300 6 units SC
(+) profuse vaginal bleeding Ferrous sulfate 325mg 1 300 8 units SC
(-) severe hypogastric pain tab 2x a day
Tranexamic Acid 1g SIVP
G2P2(2002) every 6 hours Gyne wise
LMP: May 26-,2024 Mefenamic Acid PLAN: For anemia correction
PMP: April 2024 (unrecalled) 500mg/tab, 1 tab every For PE by Gyne service tomorrow
PMP: March 2024 (unrecalled) 8hrs as needed for pain 6/25
For referral to IM IDS- awaiting
Abdomen: soft, non tender, no notes
palpable mass, no muscle Awaiting repeat UA, with PT
guarding and Blood CS
Ideally for WAB and chest CT
Speculum examination: (+) scan- not amenable, refusal form
scanty bleeding per os, (+) signed and secured
cervix is converted to a 8 x 6 x Monitor vsq15 on the 1st hr, q30
5 cm friable fungating mass mins on 2nd hr, q1 on 3rd and 4-
Monitor I&O q shift
Internal examination: (+) pad counting qshift
cervix is converted to a 8 x 6 x WOF: severe hypogastric pain,
5 cm friable fungating mass, profuse vaginal bleeding, BT
obliterating both anterior and reactions: allergies, DOB,
posterior fornices, with jaundice, hypotension,
involvement of the upper 3rd desaturation
of the vagina, uterus not
enlarged
(+) Advanced directives
Rectovaginal examination: no 09675584888
skin tags, no anal fissures, (+)
good sphincteric tone,
obliterated bilateral Pending labs:
parametria, no blood per [ ] UA-TSR
examining finger [ ] Pregnancy Test
[ ] Ferritin- TSR
[ ] For Blood CS
Pad count: 2 pads moderately [ ] PBS, and Reticulocyte count-
soaked not amenable
[ ] Ideally for WAB and chest CT
scan- not amenable,
Gyne 6 G3P2 (2012) BPR 130/80 DASH diet, NPO on June CBC with PC
CASTRO, REGINA ATIENZA AUB - P, L, M BP 130/80 24 2024 2300H Date Hgb Hct WBC S L M E Plt *3u pRBC available c/o Ma'am
48 Perimenopause HR 72 Heplock; D5LR 1L x 06/23 12.9 0.38 6.0 74 17 5 4 394 Barbie
NYC Hypertension st II RR 20 30gtts/min once NPO
B+/NR
Obese I T 36.6
Urinalysis
134705
Date Sugar Protein WBC RBC Epithelial Bacteria
06/23/2024 Previous Endometrial
06/24 Neg Neg 0.3 1.5 39.0 68.4
Dr. Santos, Paningbatan, biopsy (02/03/24 OSMAK)- Height: 159 cm
Chemistry:
Irabon/Tungcul, Ballesteros ENDOMETRIAL POLYP AND Weight: 63.5 kg
Date BUN Crea Na K Cl AST ALT HbA1c
(TL), De NON ATYPICAL BMI: 25.1 9 (Obese I)
Paz/Posadas,Tugado/Vito, ENDOMETRIAL 06/24 3.27 73.44 137.06 4.27 106 14.96 11.47 5.82
Jasarino HYPERPLASIA Previous Hypertension st II None for now Ferritin Hypertension st II
Endometrial biopsy - Scanty (-) neck pain 12L-ECG - normal sinus rhythm 06/23 For BP monitoring and control
endometrial tissue (2018, (-) chest pain Pregnancy Test (06/23) Negative
Osmak) (-) dizziness Coagulation test
Date PT %act INR APTT Gyne wise
Previous Diagnostic Gyne wise Cefoxitin 2g TIV as LD 30 PLAN: For Peritoneal fluid
hysteroscopic guided (-) vaginal bleeding mins prior to OR 06/24 11.3 106.8 1.00 32.8 cytology, Extrafascial
polypectomy followed by (-) hypogastric pain Metronidazole 1g TIV 30 Imaging Hysterectomy Bilateral
endometrial resection mins prior to OR Chest X-ray c/o Dr. No acute opacities Salpingooophorectomy, Bilateral
(04/29/24, OSMAK) Bisacodyl 5mg/tab, 2 tabs Obsum 6/23 Lymph Node dissection on June
48 PO on May 23 2024 - TVS UTZ (03/20/24) Ultrasound (03/20/24) 25 2024 0800H
 G3P2 (2012) 0000H, suppository 2 tabs The uterus is anteverted with irregular contour and heterogenous echopattern measuring 5.34x5.25x5.62cm (volume 82ml). There are For Mammogram post-op
LMP: April 28-May 9 (2 ppd, May 23, 2024 0400H 2 myoma nodules: M-1- Anterior subserous with less than 50% intramural (FIGO 6) measuring 1.69x1.74cm, and M2- posterior Monitor VS q4
minimally soaked) Fleet enema on June 24, subserous with more than 50% intramural (FIGO 5) 2.18x1.81 > I and O q shift and record
LMP: April 1-4 (spotting) 2024 - 0500H The endometrium is heterogenous measuring 1.53 cm in thickness. There is a hyperechoic polypoid structure measuring 1.81x1.42cm For final MRA and IM Endo
LMP: March 13-25 Omeprazole 40mg TIV OD at the lower 3rd of the endometrial canal with pedicle artery sign suggestive of endometrial polyp. clearance
PMP: Feb 1-15 AM while NPO The right ovary is lateral measuring 2.03x1.17x 1.35cm with the volume of ml. Inform AROD
PMP: Jan 5-13 The left ovary is lateral measuring 2.69x2.67x2.59 cm with the volume of 9.4ml. Within the left ovary is a thin-walled, unilocular, Monitor CBG every 6 hours;
PMP: December 3-19 anechoic cystic structure measuring 1.84x1.80cm suggestive of cystic follicle. every 4 hours while on NPO
Cervix measures 3.65x3.25x2.99cm. No nabothian cyst.
PMP: Oct 17-Nov 2 Secure 2 units PRBC for properly
No fluid in the cul de sac.
typed and crossmatched for OR
Abdomen flabby, soft, non- IMPRESSION: use, 1u PRBC for standby
tender,no palpable mass NORMAL SIZED ANTEVERTED UTERUS WITH MYOMA NODULES >Daily body and perineal hygiene
THICK HETEROGNEOUS ENDOMETRIUM WITH INTRACAVITARY STRUCTURE SUGGESTIVE OF ENDOMETRIAL >WOF: severe hypogastric pain,
SE: cervix pink, no lesions POLYP profuse vaginal bleeding
NORMAL RIGHT OVARY
IE: normal looking external CYSTIC FOLLICLE, LEFT OVARY MRA Notes 6/24
genitalia, parous introitus, TVS UTZ (01/05/2024, The uterus is anteverted with smoooth contour and homogenous echopattern measuring 4.32x4.42x4.75cm (vol 47.29ml) with low Cleared to OPD level
vagina admits 2 fingers with Guadahealth) anterior subserous with more than 50% intramural (FIGO 5) 1.59x1.52cm. Referred to Dr. Las
ease, cervix closed,2x2 cm, The endometrium is hyperechoic measuring 1.25cm in thickness. Clin Predictors:Low Risk’
uterus not enlarged size, no The right ovary is lateral measuringf 2.09x1.34x1.26cm with the volume of 1.85ml Functional Predictor:
cervical motion tenderness, no The left ovary is lateral measuring 1.80x1.30x1.71cm with the volume of 2.10ml. Intermediate Risk
adnexal mass tenderness, no Cervix measures 3.43x2.98x3.16cm.No Nabothian cyst. No fluid in the cul-de-sac Surgical PredictorL Intermediate
blood per examining finger Risk
IMPRESSION: Overall MRA: Intermediate Risk
Normal sized anteverted uterus with myoma nodule
Thick endometrium
Small right ovary
Normal left ovary.
TVS UTZ (07/29/2023, The uterus is anteverted and normal in size measuring 6.1 x 5.9 x 4.5 cm. Myometrium is homogenous with no focal mass noted
Alejandro Doctors within.
Medical Clinic) The cervix is intact TVS UTZ (07/29/2023, Alejandro Doctors Medical Clinic).
The endometrial stripe is thickened measuring 1.3 cm.
Both ovaries are not visualized.
No adnexal mass seen nor fluid in the cul de sac.

IMPRESSION:
Normal sized anteverted uterus with thickened endometrium.
Non-visualized ovaries.
Unremarkable adnexae and cul de sac.
TVS UTZ (08/06/2018, Uterus is anteverted, normal in size measuring 4.38 x 4.29 x 5.07 cm
Osmak) Myometrial echopattern is homogeneous.
No focal mass is seen.
Endometrial lining is not thickened measuring 0.4 cm.
Minimal endometrial fluid is seen.
The right ovary is normal in size measuring 2.7 x 1.9 x 2.7 cm (volume of 7.4 cc). A cystic focus is seen within measuring 1.02 x 0.85
x 1.25 cm.
The left ovary is likewise normal in size measuring 2.2 x 1.9 x 2.1 cm (volume of 4.8 cc).
No adnexal mass is noted.
The cervix is normal in size measuring 1.9 x 2.1 x 2.3 cm. No focal lesions identified.
No definite evidence of fluid seen in the posterior cul-de-sac.
IMPRESSION:
Normal sized anteverted uterus with nonthickened endometrium.
Cyst, right ovary most likely physiologic
Minimal endometrial fluid
Unremarkable ultrasound of the left ovary
Histopath result (04/29/24)
A AND B. ENDOMETRIAL POLYP AND ENDOMETRIAL TISSUE: POLYPECTOMY AND BIOPSY
-- TYPICAL ENDOMETRIAL HYPERPLASIA WITH FOCAL ATYPICAL ENDOMETRIAL HYPERPLASIA ARISING IN AN ENDOMETRIAL POLYP
S/P BIOPSY (02/16/2024)
-- ENDOMETRIAL POLYP AND NON ATYPICAL ENDOMETRIAL HYPERPLASIA AND MODERATE CHRONIC ENDOMETRITIS
S/P ENDOMETRIAL BIOPSY (06/14/2018)
-- SCANTY ENDOMETRIAL TISSUE

LR DR
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES Remarks

OB Ward
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES Remarks
OB 12 G4P3 (3013) Pregnancy Uterine BPR 130-140/ 90 DASH diet + add banana to CBC NICU for
CORRALES, ROVELYN CABALLES Delivered term cephalic BP 130/90 diet Date Hgb Hct WBC S L M E Plt maternal
26 Live baby girl HRR 52-64 MgSO4 drip completed 06/20 14.2 0.41 28.5 H 90 5 5 323 illness
YC APGAR score 9,9 BW 3.05kg BL HR 64 (06/21) 06/19 14.7 0.43 11.8 75 16 6 3 326 Implant
50cm MI 40 weeks AGA RR 20 B+/NR
06/19/2024 Preeclampsia with severe T 36.7 Urinalysis
359431 features
Date Sugar Protein WBC RBC Epithelial Bacteria
Dr. Ordono/ Tungcul/ Gestational Diabetes Mellitus, I: 5100
06/19 Neg 1+ 1.5 1.1 24.7 6.2
Gavino(TL)/ De Guia, Pesigan/ insulin requiring, controlled O: 3500
Ferritin (06/19): 105.2
Alzaga, Tiongson Hypokalemia probably
Chemistry:
secondary to 1) preeclampsia 2) Preeclampsia with severe
1706H/1801H r/o RTA features Nifedipine 30mg 1 tab once a Date BUN Crea LDH Na K Mg AST ALT Preeclampsia with severe
700cc Asymptomatic bradycardia (-) headache day 0.81mmol/L features
06/23 3.94
URTI, resolved (-) dizziness MgSO4 drip – given 1.96mg/dL BP monitoring and control
Subclinical hypothyroidism (-) blurring of vision 1.83 mmol/L
06/21 2.51 L
(-) Vomiting 4.44mg/dl
By Emergency LTCS I under (-) SOB/SOB 06/20 1.86 L 45.51
General Anesthesia for Non- 25.09 17.73
06/19 1.91 L 52.77 333.51 137.43 2.94 L
reassuring Fetal Status 6/19: At the DR, during
(06/19/2024) induction upon giving Thyroid function tests
Midazolam noted decrease in FT3 FT4 TSH
G4P3 (3013) sensorium (desaturations 06/21 1.01 L 0.64 L 1.82
s/p LTCS I under General 72% -> 96%; bradycardia 45 HbA1c (6/19/24): 5.38%
Anesthesia for Non-reassuring bpm -> 80 bpm; DOB) FBS (2/2, OsMak @18 weeks): 92.16 mg/dL
Fetal Status Colposcopy (05/23): Normal findings
Day 5 Cytopathology (02/22):
Preeclampsia with severe Asymptomatic bradycardia UNSATISFACTORY FOR EVALUATION DUE TO INFLAMMATION Asymptomatic bradycardia
features (-) easy fatigability No meds for now NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY IM Cardio 06/23
Gestational Diabetes Mellitus, (-) athletic COVID RAT (6/19/24): Negative Suggest 24 h Holter monitoring as
insulin requiring, controlled (-) sluggishness VIA: Positive OPD basis, since asymptomatic
Hypokalemia probably 06/23 1200H, 52 12L ECG (6/20): sinus bradycardia with sinus arrhythmia bradycardia, no medical
secondary to 1) preeclampsia 2) 24 hour urine protein (6/22/24): 420.67 H management warranted,
r/o RTA Gestational Diabetes Urine potassium (6/22/24): 9.7 mmol/L L respectfully signing out
Asymptomatic bradycardia Mellitus, insulin requiring, Regular insulin Imaging
URTI, resolved controlled 180 – 220 2 units Chest x-ray (06/19/24): Multiple subcentimeter ovoid opacities are seen overlying the cardiac and pericardiac regions. Gestational Diabetes Mellitus,
Subclinical hypothyroidism (-) polyphagia 220 – 260 4 units Pulmonary vascular markings are within normal limits. insulin requiring, controlled
(-) polydipsia 260 – 300 6 units The heart is not enlarged. CBG TID ACHS
(-) polyuria >300 8 units Both hemidiaphragms and costophrenic angles are intact. For 75g OGTT 4-12 weeks
See CBG table Bony thorax is unremarkable. postpartum
Impression:
Consider vessel en face versus pulmonary nodules, bilateral. Follow up is suggested IM Endo (6/23)
CBG monitoring Continue present management
Hypokalemia probably Date 0000H 0500H 0800H 1100H 1400H 1600H 1700H 2000H 2100H Respectfully signing out
secondary to 1) preeclampsia KCl 750 mg tab 2 tabs every 4 06/23 90 99 86 90
2) r/o RTA, corrected hours for 11 cycles - 06/22 86 - 109 - - 81 - 110 Hypokalemia probably
(-) tremors completed 06/21 84 - 82 - - 76 - 111 secondary to 1) preeclampsia 2)
(-) weakness Pantoprazole 40mg/tab 1 06/20 121 93 97 100 120 99 r/o RTA, corrected
(-) numbeness tablet per orem 30 minutes IM Nephro 06/23
06/19 89 92 95 08 100
before breakfast For Mg, repeat K post-correction
Continue K correction as ordered
Please facilitate via LOA the ff:
Urine Na, K, ABG

URTI,resolved
Increase oral fluid intake

URTI, resolved IM Pulmo (06/20)

(-) colds No meds for now Noted official CXR results
(-) cough Pt is asymptomatic, young
(-) fever female, malignancy unlikely
Clear breath sounds For surveillance CXR, may do
after 6 months or earlier if
clinically warranted
Signing out

Subclinical hypothyroidism
IM Endo (6/22)
 Patient seen and examined
Noted TFT, within trimester
specific value
For repeat TFT 6 weeks
postpartum
Subclinical hypothyroidism
(-) recurrence of bradycardia None for now OB wise
(-) palpitations For KUB UTZ on June 24 2024,
(-) anterior neck mass 0900H, c/o Dr. Torres full bladder
prior to procedure
For canvassing ABG
WOF: profuse vaginal bleeding,
severe hypogastric pain,
DOB/SOB
OB wise
No profuse vaginal bleeding Cefuroxime 500mg tab 1 tab Pending labs:
No severe hypogastric pain every 12 hours x 7 days [ ] For KUB UTZ on June 24 2024,
(+) Flatus Paracetamol + Tramadol 0900H, c/o Dr. Torres full bladder
(+) BM 325/37.5mg 1 tablet every 8 prior to procedure
hours as needed for pain [ ] Still canvassing of ABG
Ferrous sulfate 325mg 1 tab
2x a day
OB 14 G2P0 (0010) Pregnancy Uterine BPR 110-120/ 70-80 DASH Diet CBC NA
DOMINGO, ABIGAIL EUNICE 31 3/7 weeks AOG cephalic not BP 120/80 MgSO4 drip completed Date Hgb Hct WBC S L M E Plt
GUDES in labor PR 80 (06/21/24) 06/19 12.6 0.37 8.0 65 19 8 1 277
28 Preeclampsia with severe RR 20 B+/NR
NYC features T 36.5 Urinalysis
Overt diabetes mellitus, insulin Date Sugar Protein WBC RBC Epithelial Bacteria
3931671 requiring I: 2250
06/19 NEG NEG 1.4 0.6 128.2 245.8
06/19/2024 Placenta previa O: 2300
Ferritin (06/19): 44.45
Dr Calo/Tungcul, Go/Gavino(TL), t/c Fetal Macrosomia
Coagulation Test
Reyes, Roque (Patho)/ Gallano, Overweight Prepregnancy wt: 56kg
Gauiran/Kadappurath Ht: 154cm Date PT % Act INR APTT
BMI: 23.6 (overweight) 06/19 12.0 100.8 1.07 27.1
HbA1c (06/19) 6.51 H
Preeclampsia with severe Methyldopa 250mg/tab, 1 tab 75g OGTT (03/17, BioAids)@ 15 2/7 weeks AOG
features 3x a day FBS 113.76 H Preeclampsia with severe
(-) headache Aspirin 80mg/tab 1 tab once 1st hr 222.48 H features
(-) dizziness a day until 36 weeks AOG 2nd hr 218.8 H For BP monitoring and control
(-) blurring of vision Standby Hydralazine 5mg Chemistry:
(-) Vomiting then 10mg thereafter (max of Date BUN Crea LDH AST ALT
Last BP elevation: at home 25mg) if with BP of
June 13, 165/109 >/=160/110 06/19 2.47 42.01 174.85 15.22 9.29
MgSo4 4g SIVP – given Imaging
BPS UTZ (06/19, SLIUP. Cephalic. 31w4d. 138bpm. EFW 1845g. AFI 14.82. SDP 4.95. Placenta maturity is grade 2 located at the anterior upper Overt diabetes mellitus, insulin
Overt diabetes mellitus, Insulin detemir to 14-> 16 u OSMAK) portion of the uterus. Its leading edge partially covers the internal os. Consider placenta previa (grade III). 8/8 requiring
insulin requiring SC At 30 weeks AOG EFW at 30 weeks AOG by Colorado: 1150-1750g For 7 point CBG monitoring
(-) polyphagia Insulin Regular Sliding scale BPS UTZ (5/29, OsMak) SLIUPBreech 26 5/7 weeks AOG. FHR 140 bpm. AFI 14.10. SDP 5.20. EFW 1030 grams. Grade 1, consider anterior marginal Strict fetal kick monitoring
(-) polydipsia only to be given on Post- placenta. Suggest follow up. 8/8 Referred ti NST serive for
(-) polyuria Prandial CBGs of Tracing optimum nutritional intake and
See CBG table 120 – 150 – 2u Date Interpretation BFHT Variability Acceleration Deceleration Contraction 24h food recall
151 – 200 – 4u IM Endo (06/23)
06/24 AM Reactive 125-130 bpm Moderate (+) (-) No contraction
201 – 250 – 6u CBG trends noted
251 – 300 – 8u 06/23 PM Reactive 120-125 bpm Moderate (+) (-) No contraction 1. Continue Insulin Detemir16u
> 300 - 10u 06/23 AM Reactive 120-125 bpm Moderate (+) (-) No contraction SC OD
06/22 PM Reactive 130-135 bpm Moderate (+) (-) No contraction 2. Insulin regular sliding scale
3. Decrease Insulin premeals
06/22 AM Reactive 140-145 bpm Moderate (+) (-) No contraction
Insulin aspart as ff:
06/21 PM Reactive 125- 130 bpm Moderate (+) (-) No contraction Pre-breakfast 10u
06/21 AM Reactive 135-140 bpm Moderate (+) (-) No contraction prelunch 1u
06/20 PM Reactive 120-125 bpm Moderate (+) (-) No contraction predinner 8u
CBG 7 pt monitoring strict DM
06/20 AM Reactive 120-125 bpm Moderate (+) (-) No contraction
OB Wise Multivitamins 1 tab once a diet
Good fetal movement day 06/19 PM Reactive 130-135 bpm Moderate (+) (-) No contraction
(-) watery vaginal discharge Ferrous Sulfate 325mg/tab, 1 06/19 AM Reactive 140-145 bpm Moderate (+) (-) No contraction
(-) bloody vaginal discharge tab once a day CBG monitoring OB Wise
(-) perceived regular Calcium Carbonate 500mg Date 0500H 0800H 1100H 1400H 1700H 2000H 2100H PLAN: for CBG and BP monitoring
 contractions tab 1 tab 2x a day 06/23 84 149 104 103 97 188 168 and control;
Dexamethasone 6mg TIM 06/22 75 126 69 136 158 91 88 For repeat BPS ultrasound after 2
every 12 hours for 4 doses 06/21 89 123 88 105 95 151 131 weeks (July 3, 2024)
G2P0 (0010)
(Completed 06/24, 4am) 06/20 107 121 93 97 100 120 99 Monitor vsq4, FHTq4 and record
LMP: Nov 17, 2024
06/19 -- 135 136 202 140 134 115 For NST BID
AOG: 31 3/7 weeks
Fetal kick monitoring q shift
AOG: 30 1/7 weeks (01/16; 7
Daily body and perineal hygiene
2/7 weeks)
PROD informed (Dr. Calacday)
WOF: headache, blurring of
Globular abdomen vision, vomiting, severe
FH 27 cm hypogastric pain, profuse vaginal
FHT 140s bleeding, dec. FHT, dec. fetal
SE: Cervix violaceous, smooth, movement
no erosions, no mass, no
bleeding per os Pending :
IE: not done [ ] For repeat BPS ultrasound
after 2 weeks (July 3, 2024)
OB 15 G3P2 (1112) 11 weeks AOG BP 100/70 DM diet CBC n/a
FERNANDEZ, MARIA LOVELLA Incomplete abortion HR 74 Heplock Date Hgb Hct WBC S L M E Plt
OCHAVO Non septic, non-induced RR 20 06/23 136.6 0.39 12.1 68 22 8 2 300
42 Myoma uteri T 36.5 06/22 13.3 0.38 9.0 61 28 8 2 276
NYC Overt Diabetes Mellitus, insulin O+/NR
requiring, uncontrolled Overt Diabetes Mellitus, Urinalysis
Asymptomatic Bacteriuria insulin requiring, Insulin sliding scale as Overt Diabetes Mellitus, insulin
06/22/2024 Protei
Advanced maternal age uncontrolled follows: Date Sugar WBC RBC Epithelial Bacteria requiring, uncontrolled
197734 n
Previous LTCS x 2 (-) polyphagia 180-220 4u For CBG monitoring and control
Dr. Palomares/Tungcul/ Gavino 06/22 Neg Neg 1.0 2.8 21.2 183.3 H
(I for arrest in cervical dilatation, (-) polydipsia 220-260 6u For CBG TIDACHS
(TL)/De Guia, Pesigan/ Alzaga, Chemistry:
2008, San Juan De Dios; II for (-) polyuria 260-300 8u For HbA1c after 3 months
Tiongson Date TC TAG HDL LDL VLDL HbA1c
placenta previa totalis, 2018, See CBG table >300 10u and refer
OSMAK) START Insulin 70/30 18u SC at 06/23 4.03 1.23 0.91L 2.95 0.56 8.99H IM Endo (6/22)
night Coagulation studies >Referred to Dr. Fonte
S/P Completion Curettage under Date PT % Activity INR APTT >Noted on NPO
GA-TIVA (06/23/24) 06/22 11.4 105.9 1.01 40.5 > Insulin sliding scale as follows:
180-220 4u
Ferritin (6/23/24): 180.50 H
220-260 6u
HBA1C (5/31/24, Taguig Clinical Laboratory): 9.4% H
G3P2 (1112) s/p Completion 260-300 8u
curettage day 1 75g OGTT (5/14/24) >300 10u and refer
Myoma uteri FBS 144 H START Insulin 70/30 18u SC at
Overt Diabetes Mellitus, insulin 1st Hour 277 H night
requiring, controlled 2nd Hour 363 H CBG q6h while on NPO
Asymptomatic Bacteriuria Ultrasound Refer back to duty referrals (IM)
Advanced maternal age once at ward
TVUTZ (OSMAK, 6/22/24) Findings:
Previous LTCS x 2 >For HbA1c- done
(I for arrest in cervical dilatation, Uterus is anteverted and enlarged measuring 8.07 x 9.13 x 7.57 cm. A gestational sac is seen measuring 5.39 x 2.28 x 2.83 >For lipid profile- done
2008, San Juan De Dios; II for Asymptomatic Bacteriuria Cefuroxime 500mg/tab 1 cm, with mean sac diameter of 3.5 cm. An embryo is noted with crown rump length of 1.61 cm compatible with 8 weeks
placenta previa totalis, 2018, (-) dysuria tablet every 12 hours to age of gestation. No appreciable cardiac activity noted. Asymptomatic Bacteriuria
OSMAK) (-) hematuria complete for 7 days The previously noted heterogeneous, predominantly hypoechoic, ovoid intramural foci are again seen with the following For completion of antibiotics
(-) flank pain location and measurement (CCxAPxW):
1. M1: Anterior - 3.24 x 2.65 x 3.02 cm (FIGO 2-5, previously 3.4 x 1.8 x 3.1 cm), with submucosal, subserosal components OB Wise
OB Wise Methylergometrine maleate For possible discharge today once
2. M2: Posterior - 3.03 x 2.78 x 2.92 cm (FIGO 3, previously 3.1 x 2.9 x 2.8 cm), with endometrial contact
(-) severe hypogastric pain 125mcg/tab 1 tablet every 8 IM ENDO cleared
(-) profuse vaginal bleeding hours for 3 days Cervix is normal in size and open measuring 3.28 x 4.01 x 2.33 cm. No focal lesions noted. For transvaginal ultrasound after
Mefenamic acid 500mg/tab 1 The right ovary is non-visualized. 6 months for myoma surveillance
tab every 8 hours as needed The left ovary is normal in size measuring 1.92 x 1.95 x 1.29 cm (volume of 2.52 mL). Daily body and perineal hygiene.
for pain No evidence of adnexal mass. Monitor VSq4h I&Oqshift
Ferrous sulfate 325mg/tab 1 No definite evidence of fluid seen in the posterior cul-de-sac. WOF: profuse vaginal bleeding,
tablet twice a day for 30 days IMPRESSION: severe hypogastric pain
Sonographic findings suggestive of embryonic demise
Myoma uteri, as described
Non-visualized right ovary
Normal ultrasound of the left ovary
No evidence of posterior cul-de-sac pathology

CBG monitoring
Date 0330H 1100H 1700H 2130H
 06/23 83 180H 255H 293H
06/22 178 H
OB 17 G4P2 (2021) 10 weeks AOG BPR 110-120/60-70 DAT CBC n/a
FERNANDEZ, ARMIL OCAMPO Incomplete abortion BP 110/70 Heplock Date Hgb Hct WBC S L M E Plt
34 Non-septic, non-induced HR 80 06/23 12.4 0.36 18.4 83 14 3 0 299
NYC Hypovolemic shock secondary RR 20 B+/NR
to acute blood loss, resolved T 36.5 Urinalysis
Poor OB History - Recurrent O 98% Protei
13253
Pregnancy Loss Date Sugar WBC RBC Epithelial Bacteria
06/23/24 n
Previous Completion Curettage At the ER 6/23 0409H: BP
Dr. Palomares/Tungcul/ Gavino 06/23 Neg Trace 5.8 10.0 37.2 2.3
(Ospital ng Makati, 05/23/2015) 100/60 > palp 60 with
(TL)/De Guia, Pesigan/ Alzaga, 06/23 Trace 3+ 3+ TNTC FEW FEW
dizziness  PNSS 1L x FD Hypovolemic shock secondary to
Tiongson Pregnancy test (6/23/24): POSITIVE
S/P Completion Curettage under 500cc  100/60 acute blood loss, resolved
Ferritin (06/23) 64.92
GA-TIVA (06/23/24) None for now
Hypovolemic shock None for now
secondary to acute blood
loss, resolved
(-) pallor
(+) pink palpebral OB Wise
conjunctivae For possible discharge today
(-) weakness Daily body and perineal hygiene.
Monitor VSq4h I&Oqshift
OB Wise Cefuroxime 500mg/tab 1 WOF: profuse vaginal bleeding,
(-) severe hypogastric pain tablet every 12 hours to severe hypogastric
(-) profuse vaginal bleeding complete for 7 days
Methylergometrine maleate
125mcg/tab 1 tablet every 8
hours for 3 days
Mefenamic acid 500mg/tab 1
tab every 8 hours as needed
for pain
Ferrous sulfate 325mg/tab 1
tablet twice a day for 30 days
OB 18 G3P2(2002) Pregnancy Uterine BP 100/80 DAT except dark colored CBC *Wife of Sir
MADAJE, MARIZ GUARIN 12 3/7 weeks AOG by LMP HR 81 foods Date Hgb Hct WBC S L M E Plt Erwin Madaje
30 Dengue Fever with warning RR 20 IVF: PNSS 1L x 100cc/hr 06/24 AM 13.4 0.38 6.6 38 53 7 2 166 of Planet
NYC Signs T 36.5 06/23 PM 13.1 0.38 7.6 39 51 9 1 155
Day 7 of Illness 06/23 PM 13.6 0.39 6.4 38 51 10 1 147L
347823 URTI, resolved I: 4220
06/23 AM 13.6 0.39 7.1 38 48 13 1 131 L
06/20/2024 O: 3570
06/22 PM 14.0 0.41 4.9 L 40 47 11 2 132 L
Dr. Palomares/Tungcul, Dengue Fever with warning signs
06/22 AM 13.7 0.39 3.5 L 38 51 7 4 135 L
Ballesteros (TL), de Paz/Posadas, Dengue Fever with warning Paracetamol 30mg TIV every Referred back to IM Gastro for
Tugado/Vito, Jasarino signs 4 hours for T>38.5C 06/21 PM 14.5 0.42 2.8 L 44 44 11 1 176 elevated AST and ALT result- Dr.
(-) abdominal pain 06/21 15.1 0.44 4.5 L 77 18 5 219 Manayon informed- awaiting
(-) gum bleeding O+/NR acknowledgement
(-) persistent vomiting Urinalysis Avoid dark colored foods
(-) lethargy/restlessness Date Sugar Protein WBC RBC Epithelial Bacteria For daily CBC with PC q8h -
(-) RUQ pain 06/21 Neg Neg 0.7 0.1 4.7 9.4 extraction time (4am, 12nn, 8pm)
Day 3 afebrile Chemistry: Continue hydration; for chest
First febrile episode (6/17 Date BUN Crea Na AST ALT auscultation and documentation
12nn Tmax 38.8) prior to IVF change
Last febrile episode: 06/24 78.16H 54.21H STRICT I&O monitoring qshift
06/20 2231H 38C -> 06/22 59.62 H 34.01 H As per IM service, parameter for
Paracetamol 300mg TIV -> platelet transfusion (<20 if no
06/21 58.92 H 28.89
37.6 bleeding, <50 if with bleeding)
06/21 0.87 43.98 L 139.49 57.13 H 28.05
Coagulation studies IM Gastro (06/22)
Date PT % Activity INR APTT Noted referred for elevated AST
06/21 11.2 107.7 0.99 31.6 levels
Hba1c (06/21): 5.43 Monitor AST levels every 48
hours
Ferritin (06/21): 1815 H
Gastro referral not warranted at
Pregnancy test (06/21): Positive this time since with no symptoms
RAT (06/21): Negative and 2x elevated AST
Dengue Duo c/o Ace Pateros (06/20/2024)
NS1: Positive IDS Notes (06/23)
 Dengue IgG: Positive Decrease IVF to 60cc/hr
Dengue IgM: Negative --
Imaging Maintain IVF: 100cc/hr
For CBC q8h (4am, 12nn, 8pm)
CXR official(06/20) No significant chest findings
please facilitate BCG monitoring
TVS UTZ (06/21, Osmak) Findings:
Encourage oral fluid intake
Uterus is enlarged measuring 4.78 x 10.77 x 8.34 cm. Myometrial echopattern is homogeneous. Within is a gestational sac
URTI, resolved No meds for now Monitor I&O strictly and record
measuring 6.86 x 2.98 x 3.77cm with mean sac diameter measuring 4.53 cm compatible with 10 weeks age of gestation.
(-) dry cough
Within is a single embryo with a crown-rump length of 4.03 cm compatible with 10 weeks and 6 days age of gestation.
(-) colds URTI, resolved
Good cardiac activity noted at 196 beats/min.
(-) recurrence of fever No active management
There is a hypoechoic subchorionic fluid collection measuring 1 ml.
Clear breath sounds
Cervix is measuring 4.64 x 2.1 x 4 cm with no demonstrable lesions.
OB wise
The right ovary is normal in size measuring 1.86 x 1.24 x 1.12 cm (volume of 1.35 mL). No focal lesions seen.
OB wise Monitor FHT qshift and record
The left ovary is likewise normal in size measuring 1.61 x 1.4 x 1.26 cm (volume of 1.49 mL). No focal lesions seen.
(-) vaginal bleeding Multivitamins 1 tab, 1 tab WOF: profuse vaginal bleeding,
No definite lesion in both adnexa.
(-) severe hypogastric pain once a day severe hypogastric pain,
No definite evidence of fluid seen in the posterior cul-de-sac.
(-) passage of meaty material Folic Acid 5mg/tab, 1 tab epigastric pain, fever, warning
Impression
once a day signs: abdominal
Single live intrauterine pregnancy compatible with 10 weeks and 6 days age of gestation by crown-rump length.
G3P2(2002) Dydrogesterone 10 mg/tab 1 pain/tenderness, persistent
Minimal subchorionic hemorrhage
LMP: March 29,2024 tab every 8 hours for 7 days vomiting, any mucosal bleeding,
Unremarkable sonogram of the cervix.
AOG by LMP: 12w3d lethargy/restlessness
Normal-sized ovaries.
AOG by UTZ: 11w3d (6/20,
No evident posterior cul-de-sac fluid.
10w6d) Pending
[ ] CBC q8h (4am, 12nn, 8pm)
Soft flabby abdomen, non- [ ] AST, ALT (06/26)
tender
FHT: 140s
IE: cervix closed
OB 23 G3P2 (2002) Pregnancy Uterine BPR 100-120/60-80 LSLF diet CBC/PC n/a
CABUENAS, JENELYN ABEÑON 30 1/7 weeks AOG by LMP BP 120/80 Heplock Date Hgb Hct WBC S L M E Plt
32 transverse not in labor HR 86 06/11 11.9 0.34 12.7 82 13 5 - 245
YC Intrauterine growth restriction RR 20 *1u pRBC secured c/o Maam
Deep Vein Thrombosis T 36.5 05/30 13.0 0.38 74 18 7 1 - 276 Sarah
286599 Chronic Hypertension 05/11 12.0 0.35 9.5 74 15 9 2 278
04/24/24 Chronic Active Hepatitis B I: 2700 05/08 11.1 0.32 11.1 67 25 7 1 269
Dr. Palomares, Castro/Tungcul, infection, high infectivity O: 2400
05/04 11.7 0.33 9.7 64 24 9 1 281
Ballesteros, De Paz (TL) / Hepatitis A infection
Gauiran, Posadas, Myoma Uteri Chronic Hypertension Methyldopa 250mg 1 tab BID 04/29 12.2 0.36 9.3 75 16 6 3 280 Chronic Hypertension
Gallano*/Alzaga, Kadappurath t/c Anxiety disorder (-) BOV ISDN 5mg/tab, 1 tab SL as 04/20 11.2 0.34 9.0 67 24 7 2 277 For BP monitoring and control
Vaginal Candidiasis, resolved (-) headache needed for chest pain B+/R
(-) dizziness Urinalysis Deep Vein Thrombosis
(-) chest pain Date Sugar Protein WBC RBC Epithelial Bacteria Well’s score 5
(-) DOB/SOB VTE score 1
05/11 Neg Neg 0-2 0-2 Mod Rare
(-) vomiting IM Cardio 06/23/2024
05/03 neg neg 0.9 0.4 13.7 27.7 Continue Enoxaparin 8000 units
Deep Vein Thrombosis Enoxaparin 8000 units SC 2x a 04/29 Neg Neg 2.1 0.9 26.5 40.9 SC 2x a day
Well’s score 5 day 04/24 Neg Neg 3.1 0.5 51.2 233.1 H Continue application of
VTE score 1 Chemistry: compression stockings
(+) swelling of the leg and Refer accordingly
Date BUN BUA Crea Na K T Ca Mg AST ALT Trop I FBS HBA1c
thigh, left
(-) direct tenderness 06/11 2.43 43.76 133.62 L 3.90 12.20 15.45 Surgery (06/12/24)
(-) warm to touch, left leg 46.22 134.97 L 4.05 0.80 Continue present management
05/30 2.27
(-) red/discoloration on the Provide adequate analgesia
affected leg 05/15 2.62 46.02 134.63L 3.9 0.73 Still for IVC filter insertion at
(-) shortness of breathing 05/08 2.61 45.74 institution of choice (PGH)
(-) pain on deep breathing No active management TCVS-
(-) pain/tenderness on the 05/05 75.06 4.94 wise, respectfully signing out
affected leg when 04/29 2.76 50.52 131.9 L 3.93 2.34 0.68 Refer back as needed
standing/walking
04/20 2.25 325.07 46.27 10.58 12.59 0.37
(-) sensory loss IM Vascular (06/14/2024)
(+) good lower extremity Coagulation studies Continue Enoxaparin 8000 units
pulses (posterior popliteal, Date PT % Activity INR APTT SC 2x a day
posterior tibial, dorsalis pedis 06/10 12.0 100.8 1.07 27.3 Continue application of
2+) compression stockings (12 hours
05/08 12.0 100.8 1.07 26.3
on, 12 hours off)
04/20 11.7 103.3 1.04 24.9 L Refer accordingly
D-dimer (03/01/24): >3000 (H)
Hepatitis profile (04/05/24) Anesthesiology notes (06/09)
 HbsAg REACTIVE Referred last night at 6pm via
Anti-HAV REACTIVE phone call by Dr. Pesigan
No clinical referral sheet as of
Anti-HAV IgM NONREACTIVE now, still awaiting
Anti-HCV NONREACTIVE Noted history and labs
Anti-HBc IgG REACTIVE Please secure 1u pRBC properly
typed and crossmatched and 1u
Anti-HBc IgM NONREACTIVE
pRBC as standby for possible OR
HbeAg REACTIVE use
Anti-HBs NONREACTIVE Please secure second IV line on
Anti-Hbe NONREACTIVE contralateral arm then heplock if
12L ECG for OR
Please discontinue enoxaparin 24
04/26 Normal sinus rhythm
hours prior to OR
04/23 Normal sinus rhythm **Referred back to Dr Dalmacion
Vaginal GS/KOH 05/03/2024: Positive; (clinical referral given) –
Vaginal GS/KOH 05/03/2024 SMEAR SHOWS PREDOMINANCE OF GRAM POSITIVE LACTOBACILLI WITH MANY LEUKOCYTES, MANY EPITHELIAL CELLS AND previously attached to chart
PRESENCE OF FUNGAL ELEMENTS
Imaging Chronic Active Hepatitis B
Chronic Active Hepatitis B No meds for now BPS + Doppler SLIUP, transverse, 26 weeks and 6 days; 969g , 132bpm infection, high infectivity
infection, high infectivity velocimetry Adequate amniotic fluid volume, 6.33cm Hepatitis A infection
Hepatitis A infection (06/14/24) Fundal, grade II placenta For HBV DNA viral load c/o
(-) icteric sclerae/jaundice The estimated fetal weight is less than 2nd percentile (Hadlock) and less than the 10th by Colorado, findings suggestive of fetal growth outside institution -refused,
(-) abdominal pain restriction. waiver secured
known Hep B since 2011 CPR: 1.956
The doppler velocimetry showed normal indices of UMA and MCA with CPR >1 (1.956), suggestive of adequate fetomaternal perfusion. GASTRO 04/25/2024
BPS: 8/8 Known to service from previous
Pelvic UTZ c/o SLIUP, 25w2d, Breech, 127bpm,SDP: 5.69, 777g, Fundal Grade II placenta admission
OB Sono Impression: Still for HBV DNA
(06/03/24) *Estimated fetal weight is below the 10th percentile of the established gestational age, suggest serial growth monitoring. No medications for now
*Fetal face cannot be fully assessed due to unfavorable fetal position Contact precaution
No active gastro management,
Venous duplex Vein diameter (cm): Left
respectfully signing out of this
Scan Greater saphenous vein (above knee): 0.22
case
(05/31/24 Greater saphenous vein (below knee): 0.19
Refer back once with HBV DNA
OSMAK) Greater saphenous vein (ankle): 0.15
result
Lesser saphenous vein: 0.26
Thank you
Saphenofemoral junction: 1.31
The left common femoral vein, superficial femoral vein, deep femoral vein and popliteal veins are now partially compressible. The left
t/c Anxiety disorder
saphenofemoral junction and greater saphenous vein are now compressible with intraluminal medium level echoes. The left posterior tibial
MHU (06/12)
and peroneal veins are now compressible.
Patient comfortable, no pain at
No significant varicosities seen.
t/c Anxiety disorder the moment
The lesser saphenous vein again has thickened walls with calcifications.
(-) difficulty of sleeping None for now Continue management
The previously noted cobblestoning along the subcutaneous region of the popliteal region extending to the ankle is no longer evident.
(-) palpitation
Impression
(-) DOB
- Interval regression of findings suggestive of venous thrombosis, as detailed above.
(-) chest pain Vaginal Candidiasis, resolved
- Unchanged thickened wall with calcifications, left lesser saphenous vein.
05/11 0830H DOB (no No active management
- Resolution of subcutaneous edema, popliteal down to the ankle region
triggering factors)
CAS (05/13 SLIUP, 22w4d, breech, AHL grade I, 150bpm, SDP 2.89cm, 547g
Vaginal Candidiasis, resolved OSMAK) The estimated fetal weight is below the 10th percentile of the established gestational age, suggest serial growth monitoring.
(-) white frothy discharge Metronidazole + Miconazole Limited congenital anomaly scan showed no gross congenital anomaly seen at the time of scan (Face not fully assessed due to unfavorable
(-) perceived uterine 750/200mcg/tab, 1 tab once fetal position); Suggest re-evaluation of the fetal face. OB wise
contractions a day before bedtime Chest xray No significant chest findings Definitive plan:
(-) foul smelling discharge (completed 05/13) (05/11) For readmission to PGH at 36
Pelvic UTZ SLIUP, Breech presentation, 20 2/7 weeks AOG by BPD, 137bpm, 340g, AFI: 4.54cm, SDP: 4.54cm, Posterior High Lying gr 0 weeks for possible IVC filter
OB wise (04/24) insertion (for reassessment if still
Good fetal movement Multivitamins + amino acid warranted)
Pelvic UTZ SLIUP cephalic 17w1d 174 g 147 bpm SDP 3.8 cm AHL gr 1
(-) perceived uterine tab 1 tab 2x daily For vacuum delivery, but for
(04/01)
contractions Ferrous sulfate 325mg/tab 1 delivery anytime if with
(-) watery/bloody vaginal tab twice a day Chest xray no active parenchymal opacities in both lungs. fetomaternal indication such as
discharge Calcium 500mg/tab 1 tab 2x a (04/04) Pulmonary vascular markings are within normal limits. recurrent severe hypertension,
day The heart is not enlarged. progressive renal insufficiency,
G3P2 (2002) Dexamethasone 6mg TIM Both hemidiaphragms and costophrenic angles are intact. persistent thrombocytopenia,
LMP: November 25, 2023 every TIM for 4 doses- Bony thorax is unremarkable. pulmonary edema, eclampsia,
AOG: completed(06/10) Impression: No significant chest findings suspected abruptio placenta,
30 2/7 weeks by LMP Nifedipine 10mg/tab, TID for Venous duplex The left common femoral and proximal superficial femoral, visualized deep femoral, as well as the popliteal, posterior tibial and peroneal severe fetal growth restriction,
29 4/7 weeks (02/14; 10w6d) 48 hours – completed Scan veins are non-compressible now with intraluminal hyperechoic component and with absent color flow upon Doppler interrogation. The left BPS 4/10 or less on at least 2
 Isoxuprine 10mg/tab, 1 tab (03/23/24) saphenofemoral junction and proximal greater saphenous vein are now also non-compressible and with intraluminal hyperechoic foci and occasional 6 hours apart,
FH 26cm every 8 hours x7 days- with absent color Doppler flow. recurrent variable or late
FHT: 130 bpm completed The rest of the greater saphenous vein is non-dilated and compressible. No significant varicosities seen. decelerations
IE: cervix closed, uterus The lesser saphenous vein again has thickened walls with calcifications. For NST BID
enlarged to AOG There is further decrease in the degree of cobblestoning of the subcutaneous region of the popliteal region down to the ankle. Monitor vsq4, FHTq6 and record
Impression: Apply compression stockings at
- Interval evolution of findings suggestive of venous thrombosis, as detailed above. all times
- Thickened wall with calcifications, left lesser saphenous vein. PROD informed (Dr. Calacday)
- Regression of subcutaneous edema, popliteal down to the ankle region AROD informed (Dr. Concepcion)
WOF: severe hypogastric pain,
Pelvic UTZ SLIUP, cephalic, 15w2d, AHL, G0, SDP 3.32cm, 118g, ; A hypoechoic focus is seen in the posterior wall of the uterus measuring 5.05 x 7.12 x
(03/16/2024) 6.03 cm, consider myoma uteri profuse vaginal bleeding, chest
pain, DOB/SOB, decreased fetal
Venous duplex The left common femoral and entire superficial femoral and visualized deep femoral veins, as well as the popliteal, posterior tibial and movement
Scan peroneal veins are non-compressible with absent color flow upon Doppler interrogation. The proximal segment of the left saphenous vein is Please measure calf
(03/09/24) partially to non-compressible with thickened walls. Wall calcifications are seen in the lesser saphenous veins. circumference, thigh
There is also no noted vascular flow in the visualized left external iliac vein. circumference daily and record
The greater saphenous vein is non-dilated and compressible. No significant varicosities seen. No significant venous blood flow reflux seen
on maneuvers. Perinatology Notes 06/23/2024
There are unenlarged left inguinal lymph nodes with intact fatty hila. Suggest Doppler velocimetry
There is cobble stoning of the subcutaneous region of the proximal left thigh down to the distal leg.
- Consider venous-occlusive disease or thrombosis, left common femoral, entire superficial femoral, visualized deep femoral, popliteal, Perinatology notes (06/15/24)
posterior tibial, peroneal and proximal lesser saphenous veins. Case referred back to
- Consider venous-occlusive disease or thrombosis, left external iliac vein. Perinatology service (dr. Castro)
- Wall calcifications, left lesser saphenous vein. LSLF diet
- Subcutaneous edema, proximal left thigh down to the distal leg Heplock
- Unenlarged left inguinal lymph nodes Meds:
TVS UTZ Uterus is anteverted and enlarged measuring 9.63 x 8.79 x 1.67 cm. Myometrial echopattern is homogeneous. A hypoechoic focus 1. Continue Enoxaparin 80000 u
(2/14/24, emanating posterior shadowing is noted in the posterior wall measuring 7.19 x 4.60 x 4.79 cm (FIGO 5: subserosal; ≥ 50% intramural) SC BID
OSMAK) There is a gestational sac measuring 5.25 x 6.58 x 2.52 with mean sac diameter measuring 4.78 compatible with 10 weeks and 2 days age of 2.Continue present medications
gestation. Within is a single embryo with a crown-rump length of 4.01 cm compatible with 10 weeks and 6 days age of gestation. Good Daily body and perineal hygiene
cardiac activity noted at 171 beats/min. Monitor VS every 4 hours I and O
There is no subchorionic hemorrhage. every shift
Cervix is long and closed measuring 4.37 x 4.55 x 3.65 cm with no demonstrable lesions. Continue compression stockings
The right ovary is normal in size measuring 4.38 x 1.73 x 3.15 cm (volume of 12.54 mL). A cystic focus is seen without surrounding 12 hours on and 12 hours off
vasculature measuring 1.27 x 1.14 x 1.51 cm. NST BID
The left ovary is obscured by bowel gas. WOF: decrease fetal movement,
No definite lesion in both adnexa. watery or bloody vaginal
No definite evidence of fluid seen in the posterior cul-de-sac. discharge, perceived
IMPRESSION: contractions, headache, nausea
Single live intrauterine pregnancy compatible with 10 weeks and 6 days age of gestation by crown-rump length. and vomiting
EDD: September 5, 2024
Unremarkable sonogram of the cervix. Pending labs:
Normal-sized right ovary with physiologic cyst. Non-visualized left ovary [ ] For 2D echo at Makatilife on
No evident posterior cul-de-sac fluid. July 9,2024
[ ] BPS ultrasound (06/28)
Tracing [ ] Ideally for 75g OGTT at 24-28
Date Interpretation BFHT Variability Acceleration Deceleration Contraction weeks - GA not amenable since
the patient is admitted
06/24 AM Reactive 135-140 Moderate (+) (-) No contractions
[x] HBV DNA-refused
06/23 PM Reactive 130-135 Moderate (+) (-) No contractions [ ] To retrieve duplex scan result
06/23 AM Reactive 140-145 Moderate (+) (-) No contraction done at PGH
06/22 PM Reactive 140-145 Moderate (+) (-) No contraction
*Still processing aid from other
06/22 AM Reactive 140-145 Moderate (+) (-) No contraction
government institution for
06/21 PM Reactive 135-140 Moderate (+) (-) No contraction guarantee letter
06/21 AM Reactive 140-145 Moderate (+) (-) No contraction DSWD P5000
06/20 PM Reactive 140-145 Moderate (+) (-) No contraction PCSO-rejected
Office of VP- awaiting
06/20 AM Reactive 140-145 Moderate (+) (-) No contraction
Bong Go- not available,
06/19 PM Reactive 140-145 Moderate (+) (-) No contraction Enoxaparin
06/19 AM Reactive 140-145 Moderate (+) (-) No contraction
06/18 PM Reactive 140-145 Moderate (+) (-) No contraction
06/18 AM Reactive 135-140 Moderate (+) (-) No contraction
06/17 PM Reactive 135-140 Moderate (+) (-) No contraction
06/17 AM Reactive 135-140 Moderate (+) (-) No contraction
06/16 PM Reactive 140-145 Moderate (+) (-) No contraction
 06/16 AM Reactive 130-135 Moderate (+) (-) No contractions
06/15 PM Reactive 135-140 Moderate (+) (-) No contractions
06/15 AM Reactive 135-140 Moderate (+) (-) No contractions

Mid-Calf, R Mid-Thigh, R Mid-Calf, L Mid-Thigh, L

06/23 33 60 35 88
06/22 36 57 32 57
06/21 36 57 32 57
06/20 34 56 32 53
06/19 37 61 37 61
06/18 36 56 37 58
06/17 38 59 39 59
06/16 38 59 39 58
06/15 38 57 39 59

GYNE WARD
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES
Gyne 1 Nulligravid BP 110-120/60-80 Diet: TCR of 1250kcal/day (SF CBC with PC
ESCIETE, MARIAFE GARA Twisted Ovarian new BP 110/60 25x50 kg) *Endorsed patient by Dr. Binay
Date Hgb Hct WBC S L M E Plt
52 growth, right probably HR 98 50% from TPN: 625 kcal using *with reserved blood products c/o Dr.
NYC benign RR 20 MGTN-Peri 1400kcal in 1900ml 06/24 9.0 0.26 17.3 79 8 10 3 562 Binay – 2 crossmatched c/o Maam Me-
Myoma Uteri T 36.5 to run at 36cc/hr for 24 hours ann available
06/04/24 Blood transfusion of 1 unit with the ff incorporations: 06/21 9.1 L 0.26 L 15.5 89 5 5 1 307 *secured waiver that specimen is for
3931955 pRBC for anemia mild I: 2024 1amp multivitamins 1 vial trace send out and is well explained to
Dr. Palomares/Tungcul, probably secondary to acute O: 2110 elements 06/17 12.1 0.36 27 H 92 H 4 4 211 patient and relative
Go*/Reyes (TL)/Gallano, blood loss JP drain: 10cc 50% from oral: 625 kcal using 06/11 s/p
12.0 0.36 10.4 84 12 3 1 192
Gauiran/Kadappurath Multiple electrolyte Ileostomy: 225cc regular diet divided into 3 BT 1upRBC
imbalance probably meals and 2 snacks the ff:
06/09 10.7 L 0.31 L 5.4 57 33 8 2 214
1308H/ 1528H secondary to GI losses HT: 157cm CHON 25g 100kcal
EBL 300 cc (hyponatremia, WT: 45kg CHO 79g 315kcal 06/08 11.4 0.34 5.9 55 36 7 2 228
hypomagnesemia , BMI: 18.3 (underweight) Fats 23g 210kcal
corrected, hypokalemia, Heplock 06/07 11.7 0.34 6.1 58 32 8 2 212
corrected)
Bilateral pleural effusion and Anemia mild probably S/p BT of 1u pRBC 06/05 11.3 0.33 6.7 59 33 7 1 199 Anemia mild probably secondary to
pulmonary congestion secondary to acute blood Diphenhydramine 1am TIM acute blood loss
06/04 12.6 0.37 9.7 70 23 7 0 258
probably secondary to loss prior to BT- given s/p BT of 1u pRBC
1) Infection (-) pallor Iron Sucrose Drip: 2amps + O+/NR Iron Sucrose drip 2 amps + 100 cc x FD
2) t/c CHF (-) dizziness PNSS 100cc x FD (1st dose given Urinalysis every 3 days x 3 cycles (2nd dose: 6/24
Partial Gut Obstruction (-) generalized body 6/21) Date Sugar Protein WBC RBC Epithelial Bacteria
secondary to Intraabdominal weakness 06/05 NEG NEG 0.6 0.4 41.6 1.5 Multiple electrolyte imbalance
Abscess secondary to Grade Pink palpebral conjunctiva 06/04 NEG Trace 8.0 H 0.8 55.5 H 61.7 H probably secondary to GI losses
2 Rectal Injury Chemistry (hypomagnesemia, hypokalemia,
Multiple electrolyte KCl 750 mg/tab 2 tab every 4 Date BUA HbA1c AST ALT BUN Na K Cl Mg Phos Crea BUN ALB Tca Pro BNP corrected; hyponatremia)
s/p Total Abdominal imbalance probably hours for 5 doses – completed 06/23 2.49 130.03L 4.63 0.82 1.13 IM NST 06/22
Hysterectomy, Bilateral secondary to GI losses (06/21) 06/22 4.22 30.97 L Patient seen and examined
salpingoophorectomy under (hypomagnesemia, MgsO4 drip: MgSo4 2g + 250cc Diet as follows
06/21 4.27
CLEA (06/10/2024) hypokalemia, corrected; D5W to run for 24hours – TCR of 1250kcal/day (SF 25x50 kg)
12.2 0.85 0.72 L 1.42
Day 14 hyponatremia) completed 06/20 06/21 19.60 133.73 L 3.70 87.39 H 50% from TPN: 625 kcal using MGTN-
2 L
(-) generalized weakness 40mEq KCl in current IVF to run Peri 1400kcal in 1900ml to run at
06/20 131.0 L 2.95 L 0.90
s/p Ultrasound-guided IJ (-) tremors for 1 cycle only – completed 36cc/hr for 24 hours with the ff
catheter insertion, Right (-) numbness KCl drip 20meqs + 80cc PNSS to 06/19 129.8 L 3.20 L 0.85 0.08 incorporations: 1amp multivitamins 1
(06/17/2024) Day 7 Motor 5/5 on all extremities run for 4 hours x 3 cycles – 0.51 3.31 1.89 L vial trace elements
06/17 134.93 L 3.27 L 82.54
s/p Emergency Exploratory given L 50% from oral: 625 kcal using regular
Laparotomy, Drainage of 15.5 104.40 0.57 0.51 L 3.60 diet divided into 3 meals and 2 snacks
06/17 18.20 133.40 L 3.25 L 86.50
Intraabdominal Abscess, 0 L the ff:
Adhesiolysis, Primary Repair 06/16 137.32 4.17 0.67 84.42 5.17 CHON 25g 100kcal
of Rectal Injury, Loop 17.2 26.81L CHO 79g 315kcal
06/15 22.69 91.14H
Ileostomy, JP drain 5 Fats 23g 210kcal
Placement (06/17/2024) 06/15 132.04 L 3.39 L 101.04 0.72 0.50
Day 7 06/14 101.32 H IM Nephro (06/21)
06/13 134.58 L 3.10 L 101.31 Noted electrolytes
06/09 138.88 Respectfully signing out of this case
 06/09 refer back if still warranted
06/08 139.27
Bilateral pleural effusion 19.3 Bilateral pleural effusion and
and pulmonary congestion 06/05 247.46 5.07 23.08 pulmonary congestion probably
4
probably secondary to Human albumin 20%per vial IV 06/04 133.30 L 3.86 93.84 H 4.09 secondary to
1) Infection every 12 hours for 5 days - Coagulation studies 1) Infection
2) t/c CHF completed Date PT % Activity INR APTT 2) t/c CHF
(-) chest pain Furosemide 40mg TIV every 12
06/15 11.8 102.4 1.05 38.0
(-) SOB/DOB post albumin infusion IM-Pulmo notes (06/22)
06/05 11.2 107.7 0.99 37.5
(+) occasional cough with Patent seen and examined
Pregnancy Test (06/04/24): NEGATIVE
whitish phlegm Noted regression of pleural effusion an
COVID 19 RAT (06/04/24): NEGATIVE
(+) decrease breath sounds, non-O2 requiring
12L ECG (06/04/24): sinus bradycardia
right > left Respectfully signing out of this case
Tumor Markers (06/05/2024):
Grade 1 edema, left LE
Ca-125: 15.43
Ca-19-9: 9.92
Papsmear (06/06): MILD TO MODERATE INFLAMMATION CONSISTENT WIH ACUTE CERVICOVAGINITIS
Partial Gut Obstruction Partial Gut Obstruction secondary to
Vaginal Discharge KOH 06/04/24) NEGATIVE
secondary to Intraabdominal Abscess secondary to
Vaginal Discharge SGS (06/04/24) SMEAR SHOWS OCCASIONAL GRAM POSITIVE LACTOBACILLI WITH OCCASIONAL LEUKOCYTES AND EPITHELIAL CELLS
Intraabdominal Abscess Grade 2 Rectal Injury
Fecalysis (06/13): Dark mucoid, WBC 10-12, RBC 5-7, NO INTESTINAL PARASITE SEEN
secondary to Grade 2 ORS 1 sachet volume per
Intraabdominal abscess GS (06/17): MODERATE GRAM NEGATIVE BACILLI, FEW GRAM POSITIVE COCCI IN SINGLY, PAIRS AND CHAIN MODERATE LEUKOCYTES AND MODERATE
Rectal Injury volume loss Vol per vol Surgery Notes (06/23)
EPITHELIAL CELLS WITH PRESENCE OF FUNGAL ELEMENTS.
(-) recurrence of vomiting replacement for vomiting/LBM DAT + Bananas
Blood CS (06/21): NO GROWTH AFTER 2 DAYS OF INCUBATION
(-) loose stools – HOLD Heplock
Intraabdominal Abscess CS (6/22): NO GROWTH AFTER 5 DAYS OF INCUBATION.
Continue IV antibiotics
Imaging
Last vomiting: 6/15 8AM Provide adequate analgesia
yellowish vomitus 1 cup, CXR (06/21/24, Osmak) Previous studies dated June 4 and 20, 2024 was reviewed. BID wound care
Day 5 of Furosemide Present study shows interval decrease in the bilateral pleural effusions. Monitor Ileostomy and JP drain)
Last loose stools Faint linear opacities remain in the left lower lung. Encourage deep breathing exercise
6/15 0500H Pulmonary vascular markings are now within normal limits.
Heart is not enlarged. IM-Gastro notes (06/19/2024)
Hemidiaphragms are intact. Respectfully signing out
Bony thorax is unremarkable.
A right-sided central venous catheter is again seen terminating at the right atrial region. IM 06/23
Air lucencies are again seen in the bilateral subdiaphragmatic recesses. Continue diet as ordered
Impression: Repeat Na, K, Mg, Phos, CBC, tom
Regression in the bilateral pleural effusion. Concomitant pneumonia is not ruled out. Continue Piperacillin- Tazobactam and
Subsegmental atelectasis, left lower lung Fluconazole for now
CXR (06/20/24, Osmak) There is interval decrease in the bilateral pleural effusion. TPN to consume then discontinue
Day 3 of Furosemide Pulmonary vascular markings are less accentuated. SHIFT diet to:
Heart is magnified. TCR of 1250kcal/day (SF 25x50 kg)
Bony thorax is unremarkable. using regular diet divided into 3 meals
A right-sided IJ catheter is seen in situ. and 2 snacks the ff:
The endotracheal tube is no longer visualized. CHON 50g 200kcal
CHO 152.5g 630kcal
Impression: Fats 46g 420kcal
Regression in the degree of pulmonary congestion and bilateral pleural effusion. Concomitant pneumonia is not ruled out. ONS: Ensure Gold 6 scoops in 1 glass
water 2x/day as snack
Chest xray (06/17, s/p IJ insertion) Findings:
Reference made with study dated June 16, 2024. IM-IDS notes (06/21)
A veil of haziness is noted in both lower hemithoraces, still associated with lateral ascending bands of opacity. The hemidiaphragms and Noted labs
costophrenic sulci are now obscured. Updated service consultant regarding
Pulmonary vascular markings are accentuated. de-escalation of antibiotic and their
Heart is magnified but appears enlarged. duration
Bony thorax is unremarkable. Continue Piperacillin-Tazobactam and
The previously noted bilateral subdiaphragmatic free air collections are no longer visualized. Fluconazole for now
An endotracheal tube is visualized terminating 4.2 cm above the carina. If ambulatory, suggest to remove IFC
A right-sided IJ catheter is seen with its tip within the cavoatrial junction.
Impression Rehab Med (06/24)
Probable cardiomegaly with progression in the degree of pulmonary congestion Plan to initiate PT tomorrow of stable
Consider progression of bilateral pleural effusion Encourage upright sitting and
Concurrent bibasal pneumonia is not ruled out. ambulation with close ambulation
Consider resolution of pneumoperitoneum Seen and examined
Gyne Wise Abdominal x-ray initial (06/16) Unchanged caliber of bowel; Pneumoperitoneum Deep breathing exercised
(-) Severe hypogastric pain Chest x-ray (06/16) Consider pleural effusion, right Observe daily daily postop site care
(-) Profuse vaginal bleeding Abdominal x-ray (06/15) Previous study done June 14, 2024 was reviewed. Provide adequate analgesia
(+) Flatus Piperacillin-tazobactam 4.5g Contrast-enhanced CT of the abdomen done the day prior was also noted. WOF: unstable VS, bleeding, wound
(+) BM TIBV every 6 hours (D4+2) Free air is still present in the bilateral subdiaphragmatic and anterolateral peritoneal recesses. dehiscence
Fluconazole 200mg TIV OD (D4) Dilated small bowel segments with air-fluid levels are seen in the center of the abdomen. The rest of the previously noted gas distended
Celecoxib 200 mg/tab 1 tab as small bowel segments are less delineable in the present study, likely due to identified fluid distension in CT done the day prior. Will reassess prior to insertion of PT on
needed for pain Retained contrast is still appreciated in the urinary bladder, left proximal ureter and bilateral pelvocalyceal systems, exhibiting severe 6/24
Paracetamol 1 TIV q8h RTC dilatation in the right. Encourage upright sitting and hallway
Omeprazole 40mg TIV OD, 30 Visualized osseous structures are intact. ambulation as tolerated
mins before breakfast Impression: Deep breathing exercise
Cefoxitin 1g TIV q8 (D4+1)- Persistent moderate pneumoperitoneum Fall precaution
DISCONTINUED 06/19 Retained contrast in the urinary system with severe right pelvocaliectasia, as detailed. Suggest correlation with CT. WOF: unstable VS, DOB, desaturation,
Metronidazole 500mg TIV Segmental ileus. Cannot rule out beginning small bowel obstruction. Suggest close interval follow up. severe pain, wound dehiscence
every 8 hours (D3+2)- WAB CT Scan with IVC (06/14) There are gas and fluid dilated small intestinal segments with the widest transverse diameter of 4.6 cm. There is transition from dilated
DISCONTINUED 06/19 initial to collapsed bowel in the region of the right lower abdomen apparently involving the distal ileum. The large bowels are also non- Gyne Wise
Metoclopramide 10mg TIV dilated. For antibiotic completion
every 8 hours round the clock Impression: Wear abdominal binder at all times
—HOLD - Finding of mural discontinuity along the vaginal cuff suture line. Cannot exclude vaginal cuff dehiscence. Encouraged ambulation
Ferrous sulfate 325mg/tab,1 - Dilated small bowel loops with apparent transition point in the distal ileum. Daily wound care BID c/o Surgery
tab twice a day-- HOLD - Rule-out beginning mechanical distal small bowel obstruction. Suggest follow-up. service
- Moderate pneumoperitoneum, minimal ascites, scattered peritoneal stranding, infraumbilical soft tissue emphysema and Monitor JP drain and ileostomy output
abdominopelvic subcutaneous fat stranding, likely part of post q shift and record
- Total Abdominal Hysterectomy and Bilateral Salpingoophorectomy changes Continue incentive spirometry as
- Small-sized right kidney with severe pelvocalyceal dilatation and probable incomplete ureteral duplication ordered
- Incidental chest findings as detailed. VSq1, I and O q shift
Abdominal x-ray (06/14) Gas-filled small bowel segments are noted.
Non-differential air-fluid levels are seen.
Rectal gas is evident.
Free air is seen underneath the right hemidiaphragm.
No abnormal intra-abdominal calcifications visualized.
Soft tissues appear unremarkable.
Visualized osseous structures are intact.
Impression:
Ileus suggest close interval follow up
Pneumoperitoneum
Xray – CHEST/ABDOMEN Chest:
(6/04/24) There are no active parenchymal opacities in both lungs.
Pulmonary vascular markings are within normal limits.
The heart is not enlarged.
Both hemidiaphragms and costophrenic angles are intact.
Bony thorax is unremarkable.
Impression:
No significant chest findings
Follow-up study (6-4-2024 0655H) shows no significant change since the prior study.
--------------------
Abdomen:
The bowel gas pattern is within normal limits.
No differential air fluid levels noted.
Rectal gas is seen.
There are no abnormal intra-abdominal calcifications.
The soft tissues do not appear unusual.
The visualized bones are intact.
Impression:
No localizing signs in the abdomen
PLAIN WHOLE ABDOMINAL CT FINDINGS:
SCAN The liver is normal in size and attenuation with no definite mass noted. Intrahepatic ducts are not dilated.
CLINICAL DATA: Gallbladder shows no evidence of hyperdense structures intraluminally. The wall is not thickened.
(+) RLQ PAIN, VOMITING) The pancreas, spleen and adrenals are unremarkable.
(06/03/24) The right kidney is small in size measuring 6.6 x 3.0 cm while the left kidney is normal in size measuring 9.3 x 5.13 cm. No
hydronephrosis, lithiasis or mass seen. Visualized ureters are not dilated.
The small and large bowel loops are in a non-obstructive pattern. No evidence of bowel wall thickening noted. Fecal materials are seen
within the colon. The appendix is distinct and measures 0.5 cm. No evident periappendiceal strandings noted.
No enlarged retroperitoneal nodes seen.
The urinary bladder is distensible with no stones nor mass. The wall is not thickened.
The uterus measures 6.2 x 5.4 x 5.1 cm, is anteverted and Is unremarkable. Both adnexae show no abnormal findings.
There is no evidence of ascites.
Minimal spur formation is seen along the anterolateral endplates of the lumbar spine.
Visualized lower lungs are unremarkable.
No other findings of note.
IMPRESSION:
CONSIDER RENAL ATROPHY, RIGHT.
 NONDILATED APPENDIX WITH NO CT SIGNS OF INFLAMMATION.
MILD/BEGINNING HYPERTROPHIC DEGENERATIVE CHANGES, LUMBAR SPINE.
Surgery Intraoperative findings – Emergency Exploratory Laparotomy (06/17)
Upon opening, drained ~200cc of purulent, foul-smelling fluid collection at the pelvis and right hemiabdomen. The small bowels were slightly dilated. On bowel run, noted interloop
abscesses in the small bowel segments. Noted soft adhesions with pockets of abscesses at 50cm, 60cm, and 100cm from ileocecal valve with transition point identified 20cm from the
ileocecal valve. The large bowel was not dilated and appear grossly normal. On pelvic washing and exploration, identified a 1.5cm full thickness perforation at the anterior portion of the
upper rectum, adjacent to the vaginal stump, with noted spillage of foul-smelling fecaloid fluid. Injury confirmed with digital rectal examination and internal examination. Primary repair
of injury done. Loop ileostomy created and matured at the right upper quadrant. No active bleeding prior to closure.
EBL: 60cc
Surgery Intraoperative findings – Ultrasound-guided IJ catheter insertion, Right (06/17)
IJ vein interrogated, no noted filling defects.
Noted good inflow and outflow of venous blood from both ports. Guidewire removed and inspected
EBL: minimal
Intraoperative findings:
On laparotomy:
No noted ascites.
The uterus approximately measures 5 x 5 x 3.5 cm. Multiple myoma noted at the uterus as follows:
M1: anterior fundal measuring 2.5 x 1 x 0.8cm
M2: fundal subserous measuring 6 x 4.5 x 4cm
M3: left posterior intramural measuring 3 x 3 x 2cm
The right ovary is cystically enlarged measuring 11 x 9.5 x 5.3 cm, twisted once around its pedicle while the left ovary is normal in size measuring 2 x 1 x 1 cm.
Both fallopian tubes are normal, the right fallopian tube measures 6 x 1 x 0.5 cm
while the left fallopian tube measures 8 x 2 x 1.5 cm
On cut section of right ovary, the cyst is noted to be unilocular and drained serous fluid.
Gyne 2 G1P1(1001) BPR 90-110/60-80 DAT with SAP CBC
ALINDOGAN, MARECIL AUB – prob P BP 110/60 IVF: PNSS 1L x 30cc/hour, then Date Hgb Hct WBC S L M E Plt
ESTROPIGAN Blood transfusion of 4 units HR 86 KVO once on BT 7
44 pRBC for Hypovolemic shock RR 20 (+) O2 support via nasal 06/23 s/p BT of 5u pRBC 8.0L 0.23L 9.3 14 6 5 151
8
NYC secondary to anemia severe T 36.7 cannula at 2-3LPM 8
secondary to acute blood (+) IFC 06/23 s/p BT of 4u pRBC 7.9 L 0.23 L 11.5 11 5 1 191
3
06/19/2024 loss, resolved I: 1205 (+) cardiac monitor 7
3932832 Acute Hepatitis A infection, O: 1400 06/22 s/p BT of 3u pRBC 8.8 L 0.25 L 6.9 20 6 1 190
3
Dr. Odevilas/ Tungcul/ Chronic Hepatitis B infection
8
Gavino(TL)/ De Guia, Pesigan/ with low infectivity Ht 172 kg 06/21 s/p BT of 2u pRBC 8.9 L 0.26 L 8.9 9 4 - 199
7
Alzaga, Tiongson t/c Catheter- associated UTI Wt 58 kg
6
BMI 19.6 06/20 s/p BT of 1u pRBC 8.4 L 0.24 L 6.0 26 7 2 208
5
6
Last hypotensive episode: 06/19 9.5 L 0.27 L 12.6 H 29 4 - 284
7
6/23 0620H 60/40 (able to
evacuate around 500cc 5
06/19 10.6 0.31 7.8 35 6 1 273
blood clots)  PNSS 300cc 8
fast drip  90/60 O+/Reactive Hypovolemic shock secondary to
Urinalysis anemia severe secondary to acute
Hypovolemic shock S/P BT of 5u pRBC Date Sugar Protein WBC RBC Epithelial Bacteria blood loss, resolved
secondary to anemia Diphenhydramine 50mg TIM – 06/23 Neg Trace 73.0 0.8 16.3 5067.9 s/p BT of 5 unit pRBC
severe secondary to acute given 06/23 Neg 2+ 528.0 66.5 43.9 15095.3 Will await IM Hema disposition for now
blood loss, resolved Calcium gluconate 10% 10cc 06/19 Neg Neg 1-2 3-5 Few Few IM Hema 6/24
(+) pallor SIVP post BT of 3u PRBC - given Bleeding Time 6/23 3min Anemia from blood loss
(-) DOB/SOB Clotting Time 6/23 5min Continue BT
(-) weakness Pregnancy test (06/19): Negative
(+) pink palpebral Reticulocyte count (06/23): 6.0% H IM Hema 6/23
conjunctiva Ferritin (06/23): 210 H No liver pathology, no known clotting
Reticulocyte count (06/23): 6.0 H factor deficiency
Referred for chills at Reticulocyte count (06/20): 2.6 H FFP not warranted
1235H transfused BT for Chemistry:
1 hour Date BUN Crea HbA1c Na K Cl AST ALT Acute Hepatitis A infection, Chronic
Hepatitis B infection with low
06/23 2.81 69.89 135.92 4.28 108 22.01 12.29
Acute Hepatitis A infection, infectivity
Chronic Hepatitis B 06/19 2.24 77.68 5.01% 132.06 4.09 102.69 21.31 11.13 IM Gastro (6/22/24)
infection with low No meds for now Coagulation studies > Thank you for this referral
infectivity Date PT % Activity INR APTT > Patient seen and examined
(-) icteric sclerae 06/23 12.1 100 1.08 29.5 > Referred to Dr Crisostomo
(-) abdominal pain 06/19 12.4 97.7 1.10 31.6 >Past Hepatitis A infection, Chronic
Chest x-ray (06/19): Elevated right hemidiaphragm Hepatitis B infection with low infectivit
ECG (06/19): Sinus rhythm, normal axis, twave inversion V3-V5 > No active management warranted
t/c Catheter- associated Coomb’s Test
UTI Cefuroxime 500mg/tab, 1 tab
 (-) dysuria every 12 hours for 7 days- Direct Coomb's Test Negative t/c Catheter- associated UTI
(-) fever HOLD Indirect Coomb's Test Negative For antibiotic completion
(-) flank pain [ ] For urine CS- TSR
IM IDS notes 6/24
Hepatitis profile (06/20)
Hold antibiotics for now
TEST NAME OBSERVED VALUE Please collect urine specimen from
Gyne wise [HbsAg Remarks] REACTIVE freshly placed IFC –with request-TSR
(+) vaginal bleeding Ferrous sulfate 325mg 1 tab 2x [Anti-HAV Total Remarks] REACTIVE
(-) severe hypogastric pain a day
Tranexamic Acid 1g SIVP every [Anti-HAV IgM Remarks] NONREACTIVE Gyne wise
G1P1(1001) 6 hours [Anti-HCV Remarks] NONREACTIVE For anemi
LMP: June 12 – present (3 Mefenamic Acid 500mg/tab, 1 [Anti-HBc IgG Remarks] REACTIVE a correction then for polypectomy and
regular pads per day for tab every 8hrs as needed for [Anti-HBc IgM Remarks] NONREACTIVE possible endometrial biopsy
first 5 days; 7 pads per day pain For repeat TVS c/o OB SONO (tentative
for succeeding days) DMPA 150mg TIM given (6/23) ‘ [HbeAg Remarks] NONREACTIVE sched: 6/24, Dr. Gallano informed,
PMP: May 14-16, 2024 [Anti-HBs Remarks] NONREACTIVE request attached to chart)
PMP: April 19-21, 2024 [Anti-Hbe Remarks] REACTIVE For pelvic MRI with IV contrast
PMP: April 8-10, 2024 Imaging scheduled on JULY 23, 2024; however i
TVS UTZ (06/21/24) Findings: with available slot on June 24 or 25, wi
SE: cervix pinkish, (+) OSMAK Uterus is anteverted, normal in size measuring 5.4 x 3.9 x 5.2 cm schedule patient (As coordinated with
irregular non-friable fleshy Myometrial echopattern is homogeneous. Dr. Savaitnisagun)
mass protruding the No focal mass is seen. Monitor VS q15 for 1h, then q30 on 2nd
cervical os (around 2 x Endometrial lining is thickened measuring 0.7 cm hour, then q1h until stable BP trends
1.5cm, (+) scanty bleeding The cervix measures 2.7 x 3.1 x 3.0 cm. An apparent heterogenous mass is seen arising from the cervix and appears to invade the upper vagina. The mass I & O qshift and record
per os measures 9.1 x 5.6 x 7.9 cm and exhibits minimal vascularity upon Doppler interrogation. Pad counting qshift
The right ovary is normal in size measuring 1.6 x 1.8 x 2.6 cm (volume of 4.1 cc). WOF: profuse vaginal bleeding, severe
IE: cervix closed, 3x3 cm, The left ovary is likewise normal in size measuring 1.8 x 1.8 x 2.8 cm (volume of 4.6 cc) hypogastric pain
firm, posterior, (+) palpable Impression:
mass around 2x 1.5 cm, no -Normal sized anteverted uterus with thickened endometrium. Pending labs:
cervical motion tenderness, -Heterogenous mass probably arising from the cervix with extensions into the vagina; Correlate with histopathologic findings; MRI is suggested for further TSR UA (6/24/2024)
uterus not enlarged, no evaluation. TSR Urine CS (6/24/2024)
adnexal masses nor -Normal ultrasound of both ovaries.
tenderness

RVE: no skin tags, no anal

fissures, (+) good
sphincteric tone, no mass,
free parametria, no blood
per examining finger

Pad count:
2 fully soaked diaper (total
of around 1000cc for 24
hours)
Gyne 3 DR G2P2 (2002) BPR 110-120/80 Low salt, low fat; NPO on June CBC
DAILEG, JENNY LAURENTE Ovarian New Growth, left, BP 100/80 24, 0000H Date Hgb Hct WBC S L M E Plt
50 probably benign HR 94 Heplock; IVF D5LR 1L x 06/22 11.1 0.35 6.2 50 37 10 3 265
NYC Myoma uteri RR 20 30gtts/min once NPO O+/NR
Menopause for 4 years T 36.7 Urinalysis *3u purchased pRBC available c/o
06/22/2024 Protei ma'am Chariza (2 units crossmatched)
360865 Seizure disorder Date Sugar WBC RBC Epithelial Bacteria
I: 700 (16h) n
Dr. Palomares /Tungcul / Go Hypertension Stage II,
O: 900 (16h) 06/23 Neg Neg 0.3 0.1 0.6 1.0
(TL)/ Gavino/De Guia, controlled
06/22 3+ 3+ 9.3 0.1 96.8 130.1
Pesigan/ Alzaga, Tiongson Overweight Seizure disorder
Wt 63.5kg Chemistry:
Continue maintenance medication
Ht 156cm Date BUN Crea HbA1c Na K AST ALT
BMI 26.1 (overweight)
06/22 4.08 58.00 6.15 139 4.41 21.18 18.94 IM Neuro (6/22/24)
Phenobarbital 90mg 1tab 3x a Coagulation studies >Referred to Dr. Abe
Seizure disorder
day Date PT % Activity INR APTT >Dx: Seizure disorder
(-) recurrence of seizure
Standby Diazepam 5mg TIV as 06/22 10.7 112.5 0.94 36.7 >Procedure: For contemplated TAHBSO
(-) decreased sensorium
needed for frank seizure >Neuro wise: No objection for
Last attack: 2020 due to Pregnancy test (06/22): Negative
contemplated procedure
stress and fatigue 12L ECG (06/22): Sinus Bradycardia (HR 42)
Recommendation:
Ca-125 (5/10):: 9.55 (N)
>Continue Phenobarbital 90mg/tab, 1
Neuro PE: Imaging tab 3x a day
Cerebrum: Conscious
CXRi c/o Dr. Abilay (06/22): No acute opacities >Standby Diazepam 5mg TIV as needed
coherent oriented to 3
TVS (05/30/2024, OB SONO Findings: for frank seizure once admitted
spheres, obeys command, Uterus: 4.75 x 4.77 x 2.99 cm >WOF: Seizure
responds to queries M1: multilocular, posterior, subserous (<50% intramural) measuring 5.97x4.36x4.0cm (FIGO 6)
Cerebellum: (-) Nystagmus, Endometrium: 0.75cm homogenous, hypoechogenic, trilaminate, regular endomyometrial junction, no color
(-) dysdiadokinesia (-) on color flow mapping
dysmetria Cervix: 2.68 x 2.39 x 2.22 cm
Cranial nerves Right ovary: 1.16 x 1.32 x 1.06 cm
CN I: not assessed Left ovary: 6. 14 x 4.87 x 4.80 cm
OSMAK)
CN II: 2-3 mm pupils equally Others Left ovary: unilocular, cystic, no solid component, no papillary structure, no acoustic shadowing, no
reactive to light color on color flow mapping, benign by IOTA simple rules
CN III, IV, VI: full extra Impression:
ocular movement Myoma uteri
CN V: intact V1, V2, V3, (+) Intact endometrium
corneal reflex,(+) masseter Small right ovary
tone Ovarian new growth left probably benign by IOTA simple rules
VII: (-) facial asymmetry
VII: (+) gross hearing
IX and X: Good Gag
XI: Good Shoulder Shrug
XII: Tongue at midline

Motor Strength
5/5 5/5
5/5 5/5

Sensory
100 100
100 100 Hypertension Stage II, controlled
Losartan 50mg 1tab once a day Continue maintenance medications
Hypertension Stage II, at AM
controlled Rosuvastatin 20mg 1tab once
(-) chest pain at bedtime Gyne Wise
(-) nape pain For total abdominal hysterectomy with
(-) blurring of vision bilateral salpingooophorectomy on Jun
(-) dizziness 24, Monday, (0730H)
Referred to Anesthesia
Gyne wise Cefoxitin 2g TIV LD ( ) ANST 30 For crossmatching of 2 units pRBC
(-) severe hypogastric pain mins prior to OR properly typed and crossmatched for
(-) profuse vaginal bleeding Metronidazole 1g IV 30 mins possible OR use
prior to OR Daily body and perineal hygiene
G2P2 (2002) Bisacodyl 2 suppositories per WOF: profuse vaginal bleeding, severe
Menopause for 4 years rectum at 2300H, June 23 hypogastric pain
Fleet enema on June 24 at
Abdominal girth: 98cm 0300H MRA Notes (6/22/24)
Abdomen soft nontender, Omeprazole 40mg TIV OD while >Referred to Dr. Las
no muscle guarding on NPO MRA
SE: cervix pinkish, no lesions A. Clinical Predictor: Low Risk
IE: cervix closed, smooth, B. Functional Predictor: Intermediate
firm 2x2cm, no cervical Risk (4-6 METS)
motion tenderness, uterus C. Surgical Predictor: Intermediate risk
not enlarged, (+) left (Intraperitoneal Surgery)
adnexal mass, no left Over-all Medical Risk Assessment:
adnexal tenderness Patient has Intermediate risk to develo
RVE: free bilateral cardiopulmonary complications
parametria
Anesthesia Notes (06/23/2024)
NPO x 8 hours proor to OR
PLR 1L x KVO rate to hook prior to OR
1, Omeprazole 40mg TIV, oD once on
NPO
2. May continue phenobarbital 90mgas
ordered even ifeven on NPO with smal
spis of water
Please secure 2 unit pRBCs properly
typed and crossmatched as standby for
possible OR use
Please secure several IV line on
contraclateral arm then heplock
 For CBG and VS to inform AROD at loca
1416H
Will reer this case to our service
consultant
Gyne 9 G4P4(4004) BP 90-120/60-80 Soft diet CBC with PC
DE GUZMAN, REBECCA Ovarian cancer St IIB r/o HR 96 Heplock Date Hgb Hct WBC S L M E Plt
OCAMPO fallopian tube carcinoma RR 20
10
59 Menopause x 11 years T 36.7 06/23 11.5 0.34 6.1 84 3 3 200
1
NYC Hypertension St. II,
06/22 s/p 4 units pRBC 13.4 0.40 6.4 80 13 5 2 243
controlled I: 710
10.7
06/18/24 Blood transfusion of 4 units O:120 06/19 s/p BT 1u pRBC 0.32 L 4.7 61 27 10 2 347
L
3930681 pRBC for hypovolemic shock JP drain: 220
Dr Alfabeto, secondary to anemia 06/18 9.2 L 0.28 L 5.1 63 24 11 2 334
Palomares/Tungcul/Go / secondary to acute blood Height: 153 cm A+/NR
Roque(TL) Reyes/Gallano loss, resolved Wight: 54 kg Urinalysis
Gauiran/Kadappurath Hypoalbuminemia BMI: 23.07 (overweight) Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
Hypokalemia secondary to No meds for now 06/18 Neg Trace 1.2 1.0 29.1 11.0 Neg Hypertension Stage II, controlled
1518H/1850H poor nutrition vs GI losses, Hypertension Stage II, Chemistry For BP monitoring and control
EBL: 1400cc corrected controlled Date BUN Crea AST ALT Na K Mg Phos Alb Cl
(-) headache 06/23 3.84 IM Cardio (6/22)
s/p Exploratory laparotomy, (-) blurring of vision 06/23 3.46 53.67 137.64 3.20 L 0.64 0.99 Seen and examined
Peritoneal fluid cytology, (-) dizziness 06/22 3.60 54.11 137.59 4.20 0.74 25.61 L Noted events
Total abdominal (-) epigastric pain/RLQ pain 06/21 131.73 L Noted already transfused 3u pRBC
hysterectomy, bilateral (-) nausea/vomiting 06/20 131.97 L Please facilitate repeat CBC
salpingooophorectomy, (-) chest pain 06/19 132.83 L Pls correct Hgb to tarte at Hgb 10
bilateral lymph node Human albumin infusion 20% 06/18 2.95 65.40 24.98 7.01 131. 58 L 3.57 97.49 L
dissection, infracolic Hypoalbuminemia TIV q12 x 3 days Hypoalbuminemia
Coagulation studies
omentectomy, JP drain (-) edema Ongoing Albumin correction
Date PT %activity INR aPTT
insertion under CRIA (-) fatigue For repeat Alb on 6/26
06/22 14.1 83.9 1.27 33.9
(6/21/2024) (-) weakness IM Nephro (6/22)
Day 3 06/18 12.6 96.2 1.12 32.1 Noted lab
12L ECG (6/18/24 OSMAK): sinus tachycardia START Human albumin infusion 20% TI
Tumor markers (05/08 OSMAK) q12 x 3 days
CA 125 340.30 (H) Suggest referral to NST service for
CA 19-9 5.17 (N) nutritional buildup
CEA (05/15/2024): 0.45 ng/ml
Imaging NST Notes (6/22)
Unchanged subsegmental atelectasis vs fibrosis, bilateral lung fields Referred to Dr. Amba
CXRi (c/o Dr. Abilay)
Unchanged effusion, left lower lobe Diet: TCR 1375kcal/day (25SF x 55kg)
Chest CT scan (06/18/24 OSMAK) FINDINGS: Using low salt low fat diet divided into
No evidence of pulmonary nodules or masses in both lungs. meals and 2 snacks with the ff macros
Pleural effusion with interfissural seepage is seen in the left hemithorax with slight CHON 55g 220kcal
passive atelectasis of the left lower lobe. CHO 173.25g 693kcal
Thick linear densities with adjacent bronchiectatic changes are noted in the medial Fat 47g 463kcal
segment of the right middle lobe, lobe, ONS: Give boost optimum 75 scoops +
inferior lingula, and superior segment of the left lower lobe. Minimal reticular scoops of beneprotein twice a day as
Hypokalemia secondary to densities are seen in the superior segment of the right lower lobe. snacks
poor nutrition vs GI losses, KCl 750 mg/tab 2 tabs every 4 Mediastinal structures are in place.
corrected hours for 5 doses The heart is slightly enlarged. The aorta and great Hypokalemia secondary to poor
(-) weakness vessels are normal in course and caliber. Intimal wall calcifications are noted along nutrition vs GI losses, corrected
(-) chest pain the coronary arteries. K corrected
(-) palpitations Trachea and mainstem bronchi are patent with no endobronchial lesion. Negative
for pericardial effusion.
Anemia mild secondary to s/p BT of 4u pRBC (2 units No enlarged hilar or mediastinal lymph nodes. Anemia mild secondary to chronic
chronic disease, resolved intraoperatively) Mild anterior wedge deformity of l1 is noted. Minimal osteophytes line the disease, resolved
(-) dizziness Diphenhydramine 1amp TIM 30 visualized spine. Small sclerotic focus is seen in the right 1st rib, probably bone s/p BT of 4u pRBC
(-) generalized body minutes prior to BT-given island.
weakness Calcium gluconate 10% 10cc There is a 0.5 x 0.4 x 0.6 cm hypo-enhancing left thyroid lobe nodule.
Moderate ascites is noted. There is an ill-defined enhancing nodule in hepatic Gyne wise
(-) pallor SIVP post BT of 3u PRBC - given
segment IVA. Continue present management
Pink palpebral conjunctiva
IMPRESSION Keep abdominal binder at all times
- No evidence of pulmonary nodules or massesLeft sided pleural effusion Compression stocking 4 hours on 4
Gyne wise Tranexamic Acid 1g SIVP evey 6
- Bilateral fibrotic densities and bronchiectatic changes with probable atelectasis hours off
No profuse vaginal bleeding hrs x 48 hrs
of the medial segment of the right middle lobe, likely from a previous Monitor Vital Signs every 4 hours and
No severe hypogastric pain Ondansetron 4mg TIV every 8
granulomatous infection record
(+) flatus hrs x 48 hours
- Mild cardiomegaly with coronary atherosclerosisCompression deformity, L1 I and O q shift and record
(-) BM Cefoxitin 2g TIV every 8 hrs x
- Mild degenerative osseous changes of the spine Monitor CBG every 2 hours while on
24 hrs then shift to Cefixime
200mg tab 1 tab every 12 hours - Left thyroid lobe nodule; ultrasound correlation is suggested for further NPO
x 7 days evaluation Moderate ascitesEnhancing hepatic nodule, worrisome for metastasis. Watch out for profuse bleeding, severe
Follow up is suggested hypogastric pain, hypotension
CXRi (c/o Dr. Torres) 06/18 /24 OSMAK Subsegmental atelectasis, right lower lung
Relatively unchanged bilateral pleural effusion MRA notes (06/23)
UTERUS: 3.73x2.72x3.29, anteverted More than 24 hours postop, respectful
ES: 0.31cm homogenous, hyperechogenic, linear midline echo not well defined. No signing out
color in color flow mapping Continue KCL tab, 2 tabs every 4 hours
CERVIX: 2.94x2.5x2.08 6 doses (on 3rd dose) every 4 hours (on
OTHERS: 3rd dozes)
Encourage K enriched food
Combined transvaginal and transabdominal ultrasound shows a pelvoabdominal Continue diet as ordered
mass probably ovarian, laterality cannot be identified, located posterior to the For repat K post correction
uterus, irregular solid, measuring 9.0 x 8.4 x 8.4 cm, with no posterior shadows,
TVS UTZ c/o OB Sono (05/07)
with presence of ascites, abundant color on color doppler studies probably non-
benign by IOTA simple rules. Contralateral ovary is not visualized. IM-Pulmo notes (06/22)
>Referred to Dr. Mangaser
IMPRESSION >Procedure: exploratory laparotomy,
Normal sized anteverted uterus PFC, TAHBSO, BLND, PALS,IO,possible
Thin endometrium appendectomy on June 6, 2024
Ovarian new growth, probably non-benign by IOTA simple rules, laterality cannot >Noted CXR result, with no cough, no
be identified fever, clear breath sounds on
Contralateral ovary not visualised auscultation
Pelvic Ascites with no leukocytosis on CBC, will not
Unchanged subsegmental atelectasis and/or fibrosis, both lower lungs treat as pneumonia, will consider
Chest x-ray (05/20/2024 OSMAK) minimal
Unchanged minimal pleural effusion, left. Concomitant pneumonia is not ruled out.
UTZ Whole abdomen: pleural effusion from t/c
fluid collection is noted in the hepatorenal, splenorenal and pelvic compartment. paramalignancy from pelvoabdominal
the liver is normal in size and contour. intra hepatic duct not dilated. galbadder is mass
nomal in volume and configuration. no intraluminal echoes noted. wall is not >Pulmo wise: No objection for
thickened. pancereas and spleen unremarkable. both kidneys normal in size. contemplated procedure.
corticomedullary border in both sides is distinct. the urinary blaader is suboptimally >ARISCAT: Intermediate risk (29 points
filled precluding optimum evaluation. no intraluminal ehoes noted.
a large fairly defined irregular lobulated complex hetrogenous mass is seen in the Anes Notes (06/20)
pelvoabdominal region measuring 5.5x12.7x10.6 cm. internal and peripheral Please carryout previous postop orders
vascularity is noted upon doppler interrogation. inferiorly thew mass compresses NPO 8 hour prior to OR
WAB UTZ (4/3/23 Megason)
the urinary bladder and uterus. both ovaries are not visualized. the anteverted
uterus is normal in size measuring 4.5x2.2x3.1cm No focal mass lesion seen. the
endometrium is not thickened measuring 0.3cm
IMPRESSION: large fairly defined lobulated complex heterogenous pelvoabdominal
mass with mass effects, as decsribed; probably ovarian/paraovarian in teiology.
contrast enhanced CT scan of the abdomen is recommended for further evaluation;
massive ascites
sonograohically normal liver, gallbladder, visiualized pancreas, spleen, kideys.
suboptimally filled urinary b;adder
normal sized anteverted uterus with non thickened endometrium
non visualized ovaries
WAB CT SCAN (OSMAK, Apr 30, 2024) FINDINGS:
There is a large, heterogeneously enhancing, complex mass arising from the
bilateral adnexal regions occupying the pelvic cavity. It measures approximately 8.9
x 14.2 x 9.3 cm (APxTxCC). It envelops the normal-sized uterus and parametrial
vessels. There is associated relative prominence of the right ovarian vein with
maintained patency.
Moderate free fluid is detected along the entire peritoneal cavity. It displaces the
non-obstructive bowels centrally. Nodularities are seen in the omentum.
Prominent lymph nodes measuring up to 0.5 cm are seen along the paraaortic,
bilateral pelvic and inguinal regions.
The liver is not enlarged with smooth contour. Varisized, luminal hyperdensities are
appreciated along the central biliary ducts of segments V and VI, with the largest in
the former measuring 1 x 1.5 cm (APxT). Upstream dilatation of the more
peripheral radicles is apparent. Portal vein is patent.
The prominent sized gallbladder measuring 4.3 x 7.8 cm (TxCC) exhibits no
abnormal intraluminal densities. Wall is not thickened. Common duct is not dilated.
The pancreas is normal in size and configuration. Pancreatic duct is not dilated.
The spleen and adrenal glands are normal without undue enhancement.
Both kidneys are normal in size and exhibit prompt and bilateral nephrogram.
Subcentimeter hypodense foci are seen in the right renal cortex. No evidence of
 hydronephrosis or opaque lithiasis. Ureters are not dilated.
The urinary bladder is suboptimally distended without intraluminal filling defects.
Small hiatal hernia is noted.
Segmental intimal wall calcifications are appreciated along the aorta and some of
its branches.
Anterior wedging of the L1 vertebral body is noted. Multilevel Schmorl's nodes are
noted. Air locules are present in the bilateral sacroiliac joints. Focal calcification of
the anterior longitudinal ligament is seen at the L4-L5 intervertebral disc space
level.
Trace left-sided pleural effusion is appreciated. Subsegmental atelectasis is present
in the bilateral lower lungs. Linear densities are noted along the inferior lingula and
imaged medial segment of the right middle lobe. A suspicious nodule is noted in
the inferior lingula measuring 0.6 x 0.8 cm (APxT).

IMPRESSION:
- Complex, heterogeneously enhancing, bilateral adnexal masses. Tissue correlation
is suggested.
- Consider secondary omental involvement and paraaortic, bilateral pelvic and
inguinal lymphadenopathies
- Moderate ascites
- Obstructing intraductal lithiases, right inferior hepatic lobe
- Prominent sized gallbladder
- Right renal cortical cysts (Bosniak I)
- Small hiatal hernia
- Atherosclerotic vessel disease
- Degenerative changes of the bilateral sacroiliac joints and spine
- Incidental chest findings as detailed.
Papsmear (905/09 OSMAK): NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY

Intraoperative findings (06/21)

IE under anesthesia: Normal external genitalia, smooth vagina, cervix 1 x 1 cm smooth, uterine corpus not adequately assessed due to pelvoabdominal mass and ascites.
Bilateral parametria smooth and pliable
There was noted ascites of 2800ml. The liver, peritoneum and subdiaphragmatic surface, stomach, spleen, kidneys, small intestines, large intestines, mesentery, appendix and bladder
were smooth and grossly normal on inspection and palpation. There were multiple perihepatic adhesions noted.
There were no palpable pelvic lymph nodes.
The uterus measures 5.0 x 4.0 x 2.0 cm, with a smooth and tan serosal surface. The cervix was not dilated and not effaced with a smooth ectocervix. The endocervical canal measured 3
cm.
Cut section of the uterus shows homogenous pale tan, smooth surface. The uterine cavity measures 7 cm, 3 cm of which was the endocervical canal.
The right ovary was grossly enlarged, multilocular, with cystic and solid areas measuring 8.0 x 5.0 x 4.0 cm.
The right ovary was punctured intraoperatively, and was noted to drain mostly serous fluid.
On cut section the right ovary was mostly solid with multiple cystic components with areas of hemorrhage and necrosis.
The left ovary is mostly solid, measuring 4 x 3 x 2 cm.
The left and right fallopian tubes cannot be clearly be delineated.
The right and left lymph nodes were noted to be several pieces of yellow tan, fibrofatty tissue.
The right lymph node measured 2 x 2 x 1 cm. While the left lymph node measures 2 x 2 x 1 cm.
The omentum measured 30 x 0.5 cm
Bilateral residual tissue were noted, measuring 5x4xcm on the right, intimately related with the right ureter; and measuring 5x3x2 on the left.

Referrals
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES
704 G3P3 (3003) BP 100/60 TCR 1000 Kcal via NGT CBC
PICONES, JOSEL Cervical Carcinoma (POORLY HR 80 feeding with ensure 6 Date Hgb Hct WBC S L M E Plt
PASCUAL DIFFERENTIATED) St IIB RR 20 scoops in 200 ml water 6 06/16
32 S/P Brachytherapy x 4 (May, feedings s/p BT 10.2 0.30 15.1 94 3 3 486
YC 2024) T 37.6 IVF: shift to D5NSS 1 L x 80 of 6u
s/p Radiotherapy x 28 fraction cc/hr 06/14 9.6 L 0.29 L 14.0 94 H 2 4 514 H
s/p Chemotherapy x 4 cycles I: 3787 (+) NGT 06/13 8.7 L 0.27 L 13.7 H 91 H 6 3 580H
61564
(Dec 18 2023, Jan 14 2024) O: 1180
Date Admitted: 06/08 10.2 L 0.31 L 18.5 H 92 H 3 5 596 H
Persistent/Progressive Disease
05/10/2024 05/25 13.3 0.39 14.5 91 H 4 4 1 515 H
(Bone Metastasis) Ht: 47 kg
Date Referred: 05/22 10.5 L 0.31 L 16.5 H 93 H 5L 2 581 H
Wt: 150 cm
05/24/2024 05/19 8.7 L 0.26 L 16.0 H 94 H 2L 4 603 H
s/p Cervical punch biopsy BMI: 20 kg/m2
Dr. Santos, 05/15 9.2 L 0.28 L 10.4 92 H 6L 2 529 H
(09/25/2023)
Odevilas/Tungcul, de 05/13 8.9 L 0.26 L 11.2 90 H 3 6 1L 447
GCS 8 (E3V1M5) Paracetamol 500mg tab 1
Paz, Ballesteros/ Reyes 05/10 11.3 L 0.34 L 10.5 90 H 4L 5 1L 513 H
Encephalopathy, multifactorial tab every 6 hours Fracture, closed, comminuted, displaced,
(TL)/ Tugado, Gallano/
probably secondary to 1. Tramadol 50mg TIV every 8 O+/NR subtrochanteric femur, left
Alzaga, Vito Fracture, closed,
Uremia from AKI, 2. Metabolic hours Urinalysis Superolateral dislocation, patella, left
comminuted, displaced,
from hyponatremia 2. Celecoxib 200mg cap 1 cap Date Sugar Protein WBC RBC Epithelial Bacteria Surgery 6/23
subtrochanteric femur, left
Structural from a. metastasis BID 06/21 NEG 2+ 39.9 1.5 44.2 533.2 Maximize medical management
Superolateral dislocation,
b, r/o CVD calcium carbonate + Vit D3 06/08 NEG 2+ 245.4 13.1 4.1 71.5 Please maximize full comfort measures
patella, left
200mg/tab, 2 tabs OD 05/23 NEG NEG 2-4 3-5 FEW FEW
(-) DOB/ SOB
AKI from 1. Dehydration 2. Morphine 10mg/tab,1 tab 05/19 NEG Trace 8-10 H 2-4 FEW FEW Surgery/Ortho Notes (06/22/24)
(-) fever, last episode:
Infection (complicated UTI) every 8 hours round the 05/13 NEG Trace 1-3 0-2 FEW FEW Dr. Lim updated
1725H 06/01, 39.0 ->
clock. Rescue dose of Coagulation studies Prognosis discussed with patient’s parties
Paracetamol 1 g TIV -> 37.3
Bacterial Vaginosis, resolved Morphine 10mg/tab, 1/2 Date PT % Act INR APTT Since no immediate surgical intervention warranted,
(+) foam boot traction in
tab as needed for patient. may go home once cleared by all services
place, left 06/13 13.6 88.3 1.22 40.5
Blood transfusion of 6 units Paracetamol 1g TIV every 4 Discussed with patient’s partner, maintain previously
05/25 13.4 90.1 1.2 39.8
pRBC for anemia moderate hours round the clock signed advanced directives, DNI
05/22 14.0 84/8 1.26 H 40.2
secondary to malignancy, Zolendronic acid 4mg by Maintain foam boot
corrected SIVPx 15mm 3x/week- 05/10 12.9 94.0 1.15 41.3
HOLD (06/03/24) Chemistry Anesthesia Notes (05/30/24)
Fracture, closed, comminuted, Enoxaparin 400 SQ once Date BUN Crea Mg Albumin Na K AST ALT HbA1c CL iCa P Total Ca Thank you for this referral
displaced, subtrochanteric daily – HOLD 272.18 125.86 L 32.56 12.19 103.0 Patient seen and examined
06/21 26.67 19.23
femur, left H History and PE done
06/18 19.31 181.08 122.00 L 5.40 H 1.44 H 1.44 Labs noted
0.86
Superolateral dislocation, PM H H Anesthesia plans, risk and complications explained to
patella, left 06/18 122.53 L 5.03 and fully understood by the patient
AM NPO 8 hours prior to wheel-in
Previous Emergency Low 06/13 5.42 42.25 129.27 L 3.8 IVF: PNSS 1L x KVO rate to hook prior to OR
Transverse Cesarean Section I 06/03 32.42 0.65 L 27.94 L 131.06 L 4.04 95.42 L 1.38 2.34 Medications:
for abruptio placenta over 05/30 132.83 1. Omeprazole 40mg IV once a day
GETA (5/22/23) 05/25 4.36 2. Paracetamol 1g IV 1 hour prior to OR
05/22 31.98 L 0.78 31.52 131.43 L 4.33 24.45 26.60 5.16% 3. Tramadol 50mg + 9ml PNSS via slow IV push every 8
05/15 44.98 L 131.21 L 4.20 hours as needed for moderate and severe pain.
Secure 2nd IV line (g18 or g 20) on the contralateral
05/14 0.59 L
arm then shift to helpock
05/13 5.11 37.86 L 128.55 L 4.67
Secure 2 units Prbc properly typed and crossmatched
05/10 5.98 44.23 L 33.44 L 129.04 L 5.37 H 55.98 H 44.92 H
prior to OR
Vaginal Discharge GS (05/24/24): SMEAR SHOWS PRESENCE OF GRAM NEGATIVE COCCOBACILLI, MODERATE LEUKOCYTES AND EPITHELIAL CELLS For serum Na correction (>= 135mmol/L – 145mmol)
Vaginal Discharge KOH (05/24/24): NEGATIVE prior to OR
ECG (05/24): Normal sinus rhythm Will refer this case to our service consultant
D-dimer (06/13): 1556.83 H Check CBG and VS prior to wheel-in. Inform at
Imaging local1416.
Plain cranial CT scan (06/18, OsMak) initial Anterior limb of right internal capsule, infarct vs mets Suggest sodium correction prior to OR, but if benefits
Abdominal xray (06/18, OsMak) The intestinal gas pattern is non-obstructive. outhweight the risk may proceed with contemplated
Considerable amount of fecal material is noted in the colon. rooms
Liver shadow appears enlarged.
There is interval progression in the previously noted pathologic fracture of the left proximal femur. IDS Notes (05/24/24)
IMPRESSION Noted urinalysis results, no symptoms of dysuria,
Fecal retention hematuria, flank pain
Hepatomegaly Fever may be attribute to known malignancy process
No active management Incidental note of left proximal femoral fracture IDS wise will not treat as CUTI
Chest xray (06/16, OsMak) - No distinct evidence of pulmonary embolism Respectfully signing out of this case.
Encephalopathy, - Minimal fibrosis or atelectasis, left lower lung
multifactorial probably - Trace pleural effusion, left Encephalopathy, multifactorial probably secondary
secondary to 1. Uremia - Calcified left hilar lymph nodes to 1. Metabolic from hyponatremia 2. Structural
from AKI, 2. Metabolic from - Multiple rib and vertebral lytic-sclerotic changes as discussed and hypoenhancing hepatic lesion, worrisome for from a. metastasis b, r/o CVD
hyponatremia 2. Structural metastatic disease
from a. metastasis b, r/o -The partly visualized prominent sized left kidney with calyceal fullness IM-Neuro (06/22)
CVD Chest xray (06/13, OsMak) No significant cardiopulmonary findings Referred to Dr. Padua for encephalopathy likely
(-) loss of consciousness Lucent lesions, right 8th lateral rib. Consider bone metastasis in light of patient’s known malignancy. metabolic – address underlying problem
(+) waxing and waning Chest xray (06/07, Osmak) No significant chest findings Scheduled for cranial MRI with contrast on JULY 18,
sensorium Bone Imaging (MMC, 5/7/24) Clinical Data: Patient was diagnosed with poorly differentiated carcinoma of the cervix (2023) and underwent 2024 9am, repeat creatinine prior for RCIN – c/o Dr.
(+) generalized body chemotherapy and radiotherapy. (+) left femoral fracture. Marquez
weakness Technical Report: Whole body scans in the anterior and posterior views were obtained 3 hours after injection of 466 For cranial CT scan on June 25, 8am once with RCIN
MBq (12.6 mCi) of Tc-99m MDP. Dual intensity images were produced and SPECT was performed from the head to Respectfully signing out of this case, refer back if
mid-thigh. warranted
Scintigraphic Findings:
Sodium bicarbonate There is satisfactory skeletal labeling. Both kidneys are visualized. IM Cardio (6/22)
AKI from 1. Dehydration 2. 650mg/tab 1 tab 3x/day Increased tracer accumulation in the proximal third of the left femur, corresponds to the known fracture. Increase carvedilol to 25mg/tab ½ tab 2x/day
Infection (complicated UTI) per NGT Foci of increased tracer uptake are seen in the following:
(-) decreased urine output Ketoanalogue + AA 1 tab - anterior segment of the 8th right rib AKI from 1. Dehydration 2. Infection (complicated
(+) edema on upper/lower 3x/day per NGT - posterior segment of the 7th left rib UTI
extremities Ceftriaxone 2g IV OD (D2) - T6 and T11 vertebra Referred to IM Nephro – Dr. Pagarigan informed
(+) vulvar swelling - sacrum IM Nephro (06/22)
- left ilium Diet: c/o NST
Referred for vaginal swelling The rest of the visualized skeletal structures show symmetrical and physiologic tracer distribution. IVF: PNSS 1L x 60cc/hour
(06/23, 1225H) warm Impression: Diagnostics:
compress, Suggest referral Increased osteoblastic activity in the areas described above is consistent with bone metastases. Serum Na once a day
to IM Nephro A pathologic fracture in the left femur is a consideration. BUN, Crea, Alb CBC 6/23/2024
Chest CT scan with IVF (MMC, 5/7/24) Lungs and large airways: Few subcentimeter non-calcified pulmonary and subpleural nodules in the lateral segment of Ideally for ABG
the right middle lobe, and superior segment of the right lower lobe, measuring none larger than 3 mm wide. Meds:
s/p BT of 6u pRBC - Subcentimeter calcified pulmonary nodule in the superior segment of the left lower lobe is non aied measuring 2 mm 1 – Sodium bicarbonate 650mg/tab 1 tab 3x/day per
wide NGT
- Small air cyst in the superior segment of the right lower lobe measuring 3 mm wide. 2 – Ketoanalogue + AA 1 tab 3x/day per NGT
Pleura: Pleural thickening in the left lower lobe 3 – START Ceftriaxone 2g IV OD
Heart and pericardium: Heart size is normal No pericardial effusion. Ideally for iFC for UO monitoring, noted refusal
Mediastinum and hila: No enlarged lymph nodes. Please do frequent diaper change if soaked
Anemia moderate Chest wall and lower neck: Unremarkable. Please weigh diaper for output monitoring
secondary to malignancy, Vessel: Unremarkable. Please collect urine CS prior to initiation of antibiotics
corrected Bones: Lytic lesions with soft tissue component in the vertebral bodies of T11 and T12, posterior aspects of the left 4 th,
(-) pallor 7th and 10th ribs, and lateral aspect of the right 8th rib Anemia moderate secondary to malignancy,
(-) DOB/SOB - Sclerotic foci in the vertebral bodies of T6 and T7 are seen. corrected
(+) hemoptysis, last episode, Metronidazole 500mg tab 1 - Schmorl’s node in the inferior endplate of T11. s/p BT of 6u pRBC
0810H, 1 tbsp tab every 12 hours x 7 days Others: The visualized liver parenchyma appears heterogeneous with vaguely-defined hypodensities.
Pink palpebral conjunctiva – Completed IMPRESSION: Bacterial Vaginosis, resolved
1995. Few non-specific, non-calcified pulmonary and subpleural nodules in the right middle and right lower For completion of antibiotics
lobes. Interval
follow-up is suggested to monitor stability or interval change. Gyne wise
Bacterial Vaginosis, 2. Subcentimeter calcified granuloma in the left lower lobe. DEFINITIVE PLAN:
resolved None for 3. Small air cyst in the right lower lobe. For palliative chemotherapy
(-) fever 4. Lytic lesions with soft tissue component in the vertebral bodies of T11 and T12, posterior aspects of the left 4 th, 7th Multidisciplinary conference done
(-) vaginal discharge and 10th ribs, and lateral aspect of the right 8th rib, worrisome for osseous metastases. PLAN: Palliative Chemotherapy
5. Non-specific sclerotic foci in the vertebral bodies of T6 and T7. Pre-family conference form questions of patient
6. Heterogeneous liver parenchyma with vaguely-defined hypodensities. Correlation with a dedicated contrast- reviewed and discussed among services
Gyne wise enhanced Please provide adequate pain relief.
(-) vaginal bleeding CT/MRI is suggested. Awaiting family conference
(-) hypogastric pain Xray of left femur (05/30/24 OSMAK) There is no significant change in alignment of the comminuted, minimally-displaced fracture of the left proximal femur,
Soft flabby abdomen, non- probable pathologic fracture secondary to bone metastasis. Previous plans:
tender, no palpable mass Minimal callous formation is noted. Ideally For repeat internal examination c/o Gyne Onco
The visualized joint spaces are preserved. once IM nailing done, then resume remaining 4
Gyne onco PE (03/26) Soft tissue appears unremarkable. brachytherapy sessions
IE: cervix 4-5 cm, smooth Decreased bone mineralization of the left femoral head is noted. WOF: vaginal bleeding, hypogastric pain
ectocervix with nodularities
CXR (05/19/24): No significant chest findings
on central portion Onco Notes (06/20)
CXR (05/13/24): No significant chest findings
RVE: shortened, thickened Case discussed with Dr. Pedlasa (IM Onco)
CXR (05/10/24): No significant chest findings
and fixed right parametria Advised relatives to secure scans prior initiation of
Pelvis AP / Left hip AP-L / Left knee AP-L Unchanged comminuted fracture, left proximal femur, probably pathologic chemo
Pad count: 0 (05/09/24) Noted plans for cranial CT with IVC suggesting to
Cervical Punch biopsy (09/25/2023): POORLY DIFFERENTIATED CARCINOMA. include pelvic and WAB
Ideally for palliative chemotherapy but will not be
feasible given patient present condition
For optimization prior chemotherapy
 Address hyponatremia, AKI, anemia
Appraised with prognosis and advanced directives
Since IM onco wise, there Is no active management
will not accept TOS
Suggesting NGT feeding

Cardio notes (06/20)

Noted onco plans, agree to optimize patient prior to
initiating palliative chemotherapy
Still suggesting NGT insertion
Tx: cont cardio meds and management

Clinical Nutrition 06/14)

Noted plans of management
For food recall for 3 days then refer to nutrition
consultant with latest height and weight

Palliative and hospice care (06/20)

Patient seen and examined
Noted plans of management
Tx:
Continue morphine drip as previously ordered
Still suggesting NGT insertion for ONS feeding
Suggest to give Lactulose once NGT is inserted
Please resume Pregabalin 75 mg/cap once NG
inserted
Psychosocial and emotional support reassessed

Pending:
[ ] Cranial MRI with contrast on JULY 18, 2024 9am,
repeat creatinine prior for RCIN – c/o Dr. Marquez
[ ] Cranial CT scan on June 25, 8am once with RCIN

ARI Bed 5 G2P2 (2002)

FRANCIA, LYNETTE BUENAVISTA Squamous cell carcinoma large cell keratinizing cervix stage IIB
65 s/p Cisplatin VI (October 27 2017, MMC)
YC S/P External Beam Radiation Therapy (TOMO) x 28 doses (October 27, 2017, MMC)
S/P High-Dose Rate (HDR) Brachytherapy x 4 doses
Date admitted 05/20/2024 Tumor recurrence (spine, paracaval and left common illac nodes)
Date referred: 05/20/2024 AKI on top of CKD sec to
1) Obstructive Uropathy from Cervical CA Stage II B
3771612 2) Infection (Complicated UTI)
Dr. Alfabeto/Tungcul, Go/ Reyes(TL)/ Pesigan, Posadas/Jasarino Complicated UTI
Hyperkalemia prob secondary to CKD
Hypovolemic hypoosmolar hyponatremia prob secondary to poor oral intake
Hematuria prob secondary to Cervical Ca with bladder extension
S/p Cystourethroscopy with removal of foreign body, calculus or ureteral stent from urethra or bladder; Cystoscopy, evacuation of blood clots, fulguration (Feb 3, 2024)
SLE, in flare SLEDAI 12
T/C Autoimmune hemolytic anemia
T/c G6PD deficiency
Hypertension Stage II
ICU psychosis, resolved
Bronchial Asthma, well controlled
s/p PTB treatment for 1 year (1994 PGH)
ICU 513 G2P1 (1011)
QUIJANO, ROSA GABINETE Endometrioid carcinoma, endometrium St. IB
77 Persistent Tumor Recurrence (2022, OSMAK)
YC
Previous Exploratory Laparotomy, Peritoneal Fluid Cytology
285568 Extrafascial Hysterectomy with Bilateral Salpingooophorectomy with Bilateral Pelvic Lymph Node Dissection, Paraaortic Lymph Node Evaluation Adhesiolysis (2017-06-21,
Date referred: May 21, 2024 OSMAK)
Date admitted: May 21, 2024 S/P Brachytherapy x 4(2017, Cardinal Santos)
Dr. Santos/Tungcul, Ballesteros, De Paz (TL)/Gallano, Tugado/Alzaga, Vito NED x 4 years
S/P Chemotherapy Paclitaxel x 3 (May-Jul, OSMAK 2022)
Infected Sacral Decubitus Ulcer, unstageable
Hypovolemic hypoosmolar hyponatremia sec to poor oral intake
Acute Respiratory Failure secondary to CAP HR
AKI secondary to 1.) Infection 2.) Dehydration from suboptimal intake on top of CKD Stage IIIB probably from HTNSS
Hypovolemic Hypoosmolar Hyponatremia probably secondary to dehydration
Hypokalemia secondary to AKI

Anemia secondary to 1) Chronic illness 2) AUB sec to Endometrioid carcinoma, endometrium, St. IB; Tumor Recurrence
Sacral Decubitus Ulcer, Stage III
Hypertension Stage II, controlled
s/p CVD Infarct, Left MCA Territory, NIHSS 17, modified Rankin Score 4 (moderately severe disability, rule out Brain Metastasis)
T/c Rectovaginal Fistulas/p Wound debridement sacral ulcer (4/14/2024)
s/p Transverse Loop Colostomy (5/10/24)

Prolonged intubation, Subglottic stenosis secondary to prolonged intubation

s/p Tracheostomy; Direct Laryngoscopy with Intralesional Steroid Injection (06/03/24)