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 11, 2024
(TUESDAY)

ADMISSIONS OB WARD LR / DR GYNE WARD PERIPHERALS REFERRALS

LRDR REQUISO, DANIELLE ENERIA
OB 3 BUAYA, MARY JOY BARREDA
OB 12 ABLANQUE, RIZA MAE DEDASE
OB 11 LAYUG, JAY CEL N/A
OB 17 AZARIAS, JESSAH GABATINO
Gyne 9 SAMBUENA, TERESITA UMALI
OB ER MASALON, JERICA LATAM
OB 1 GOMEZ, ALYANNA ADRIANNE VILLANUEVA Gyne 1 ESCIETE, MARIAFE GARA SARI 3 BED 3 LIPARDO, MARY GRACE CASTA 704 PICONES, JOSEL PASCUAL
OB 9 BALADIA, CRISCHELLE LAVA Gyne 2 HILARIO, AILEEN MENDOZA BED 1 IW PILAPIL, MILAGROS BALMORI
OB 20 PAULINO, CHERIZZE FACUNDO Gyne 3 ALTA, MARIA SALOME ASENETA ARI Bed 5 FRANCIA, LYNETTE BUENAVISTA
HR 1 DE LA CRUZ-GALICIA, LORIEDIN AVISO Gyne 4 ADRIATICO, ROWENA DE LA REA ICU 513 QUIJANO , ROSA GABINETE
HR2 MANIEGO, MARIANE MARTIREZ Gyne 5 LOMBOY, MICHELLE PANICAN ARI 2 Bed 5 LISONDRA, FLAVIANA CUISON
HR 3 GOYALA, MARITES ESPINAS Gyne 6 LOPEZ, QUEYZEE ROLDAN
HR 5 CABUENAS, JENELYN ABEÑON

ADMISSION
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES Remarks
LRDR G1P0 Pregnancy Uterine 38 BP 120/80 Light meals then NPO once CBC with PC DMPA
REQUISO, DANIELLE ENERIA 1/7 weeks AOG by HR 95 in active labor Date Hgb Hct WBC S L M E Plt
24 ultrasound cephalic in RR 20 IVF: PNSS 1L x 60cc/hr 06/12 12.2 0.35 7.5 47 40 10 3 192
YC beginning labor T 36.4
O+/NR
PROM x 4 hours
Urinalysis
06/12 0600H FD 300cc at the
06/12/2024 Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
ER Ampicillin 2g TIV now then
3932151 06/12 Neg Neg 3.5 0.4 20.6 9.4 Neg
every 6 hours until
Dr Calo/Tungcul/Ballesteros(TL) Ferritin (6/12/24 OSMAK): 58.79
OB Wise delivery
De Paz/Gauiran Pesigan/Jasarino 75gOGTT 4/12/24, K8 Biomedical Lab
(+) good fetal movement Hyoscine N-Butyl bromide OB Wise
Vito FBS 85.5
(+) watery vaginal discharge 2amp TIV now then 1amp PLAN: for augmentation of
(light green - 0440H) every 2 hours until 1st hr 168.84 labor
(-) bloody discharge delivery 2nd hr 147.06 Monitor VSq2, FHTq2 and
(+) perceived irregular uterine Evening primrose oil gel Imaging record
contractions cap, 2 cap q4 per vagina Modified BPS (6/11 OSMAK) Monitor progress of labor
SLIUP, Cephalic, 133bpm, AHL gr. 2-3, AFI 11:9 cm, SDP: 4.2cm, 8/8
until delivery PROD informed (Dr Ortiz)
LMP: August 11, 2023 (unsure) BPS Ultrasound 6/11/2024, Makati Life For complete perineal
SLIUP, 34w4d, 151 bpm, AHL gr 3, SVP 6.72 cm, 2743g, 6/8 (breathing 0)
AOG AOG 43w4d by LMP preparation
AOG 38 1/7 by UTZ WOF: severe hypogastric
(11/13/2023 7w6d) Tracing pain, profuse vaginal
Date Interpretation BFHT Variability Acceleration Deceleration Contraction bleeding, decreased fetal
Globular abdomen 06/12 AM movement, fetal
FH: 32 cm tachycardia/bradycardia
06/12 AM Moderate
FHT: 130s bpm CAT I 140-145bpm (+) (-) 3 strong
ER
IE: 3cm dilated, 30% effaced,
leaking BOW (light green),
cephalic, station -3
EFW 3100g by johnson's rule;
3000g by cupping method

Bishop’s score 2
OB 3 G1P1(1001) Pregnancy BP 100/60 DM diet CBC with PC EINC
BUAYA, MARY JOY BARREDA Uterine HR 96 D5LR 1L x 30gtts/min Date Hgb Hct WBC S L M E Plt IUD
21 Delivered term cephalic RR 20 06/11 13.7 0.40 9.3 75 14 9 2 208
NYC Live Baby Girl T 36.7
O+/NR
AS 9,9 BW 3.32kg BL 50cm
Urinalysis
06/11/2024 MI 40 weeks AGA I: 1190 (16hrs)
Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
3919699 Gestational diabetes O: 600 (16hrs)
06/11 Neg Neg 0.9 1.1 23.0 5.2 Neg
Dr Calo/Tungcul/Ballesteros(TL) mellitus, newly diagnosed
De Paz/Gauiran Pesigan/Jasarino Episode of tachycardia during 1058.5 +2 H
06/11 Neg Trace 12. 6 H 93.3 H 379.7 H
Vito By Normal spontaneous delivery as high as 120bpm H Gestational diabetes
delivery; right mediolateral Ferritin (6/11/24 OSMAK): 151.30 H mellitus, newly diagnosed
 episiotomy and repair Gestational diabetes mellitus, HBA1c (6/11/24 OSMAK): 5.53% CBG monitoring and control
under local anesthesia newly diagnosed 75g OGTT 5/18/24 at 35 6/7 weeks CBG TID ACHS
followed by IUD insertion (-) polyphagia No meds for now FBS 95.58 H For repeat 75g OGTT 4-6
(06/11/24) (-) polydipsia 1st hr 153 weeks postpartum
(-) polyuria 2nd hr 139.5 Referred to IM-Endo service
See table TFTS c/o Dr Pagarigan-awaiting
Date FT3 FT4 TSH notes
06/11 2.30 0.78 1.27

OB wise CBG monitoring OB wise

No profuse vaginal bleeding Cefuroxime 500mg/tab, 1 Date 0800H 1100H 1300H 1700H 2100H for possible discharge today
No severe hypogastric pain tab every 12 hours for 7 167 248  FD 300cc if endo cleared
Uterus well contracted days 06/11 88 92 98
PNSS 192
Mefenamic acid
500mg/tab,1 tab every 8
hours for pain
Ferrous sulfate
325mg/tab,1 tab twice a
day

OB 12 G2P2 (2002) Pregnancy BPR 110-220/80-120 NPO except meds CBC with PC NICU for
ABLANQUE, RIZA MAE DEDASE Uterine BP 110/80 IVF:MgSO4 drip: PNSS 1L+ Date Hgb Hct WBC S L M E Plt maternal
31 Delivered term cephalic HRR 113-121 MgSO4 20g to run illness:
06/12
NYC Live baby girl HR 104 100cc/hr in soluset for 24 Preeclampsia
AS 9,9 BW 2.69kg BL 52 cm RR 20 hours (TE 06/12 1800H) 06/11 11.9 0.35 16.7 79 15 5 1 281 with severe
MI 39 weeks AGA T 36.7 D5LR 1L x KVO while on A+/NR features
06/11/2024 Urinalysis
Chronic Hypertension with O2 sat at 10lpm 95% MgSO4 drip Implant
259639 Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
superimposed preeclampsia MAP 180/100 HOLD oxytocin drip for
Dr Ordono/ 06/11 Neg +2 H 0.6 1.0 8.4 2.7 Neg
Obese II now (06/12 0700H)
Tungcul/Ballesteros(TL) De
t/c URTI vs pulmonary I: 1600 (8hrs) (+) IFC Chemistry
Paz/Gauiran Pesigan/Jasarino
congestion O: 1750 (8hrs) (+) cardiac monitor Date BUN Crea AST ALT BUA Na K LDH
Vito
(+) O2 support at 10lmp 529.08 137.57 3.70 252.72
06/11 6.40 169.29 11.27 12.24
By Emergency Low via face mask H
Transverse Cesarean Pre-pregnancy weight: 71kg Coagulation studies
1738H/1848H
Section I under CSEA for Ht: 160cm Date PT %activity INR aPTT
800cc
Impending Eclampsia (June BMI: 30.5 (Obese II) 06/11 11.5 105.0 1.02 27.8
11, 2024) Ferritin (6/11/24 OSMAK): 68.32
06/11/24 1400H 170/110 COVID RAT (06/12): Negative
220/140 H5  12L ECG(06/12): Sinus tach. Normal variant t wave inversion at v1. Prolonged corrected qt. Chronic Hypertension with
210/120H10  180/120  Imaging superimposed preeclampsia
H10 160/80 Low lung volume For BP monitoring and
Chest xray initial c/o Dr Capuchino (06/12 OSMAK) control
Cannot rule out congestion or pneumonia
Last BP elevation 06/11 1500H Consider cardiomegaly For MgSo4 drip completion
180/120 DTR q2 while on Mg So4 drip

Referred at 06/12 0600H due

to desaturations as low as
89% O2 sat 10lpm 95%
Chronic Hypertension with
superimposed preeclampsia
(-) headache
(-) blurring of vision
(-) dizziness
(-) epigastric pain/RLQ pain
(-) nausea/vomiting
(-) chest pain
06/12 0200H at the ward: 1
episode of vomiting BP of
140/90 metoclopromide
t/c URTI
referred to IM-Pulmo and
Cardio c/o Dr Ramirez-
awaiting notes
Nifedipine 30mg/tab,1 tab
OD
STANDBY Nicardipine drip:
10 mg nicardipine + 90 mL
PNSS to start at 10 cc/hr
(titrate +/- 4 cc/hr every
30min) to achieve target
BP 187/107 (MAP: 166)

t/c URTI vs pulmonary

 congestion
(+) non-productive cough No meds for now
(+) blood-tinged expectoriate
(-) colds
(-) fever
(-) DOB/SOB
(+) crackles all over on OB wise
bilateral lung bases Continue present
management
Close monitoring for
Cefuroxime 500mg/tab,1 recurrence of desaturation
tab every 12 hours for 7 probably secondary to
OB wise days pulmonary congestion
No profuse vaginal bleeding Paracetamol + tramadol Awaiting repeat CBC result
No severe hypogastric pain tab,1 tab every 8 hours for High back rest
(-) flatus pain Complete bed rest without
(-) BM Ferrous sulfate bathroom privileges
325mg/tab,1 tab twice a VSq1 with O2 sat until stable
day STRICT I and O q shift

OB 11 G2P2(2002) Pregnancy BP 110/70 DM diet CBC with PC Baby at NICU

LAYUG, JAY CEL N/A Uterine HR 94 D5LR 1L x 30gtts/min Date Hgb Hct WBC S L M E Plt for maternal
25 Delivered term cephalic RR 20 06/11 11.2 0.33 11.0 76 6 1 - 192 illness-
YC Live Baby Girl T 36.7 Gestational
O+/NR
AS 9,9 BW 2.53kg BL 50 cm diabetes
Urinalysis
06/11/2024 MI 39 weeks AGA I: 1250 (16hrs) mellitus,
Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
119571 Gestational diabetes O: 900 (16hrs) insulin
06/11 Neg Neg 4.6 167.2 H 56.1 H 100.5 H Neg
Dr Ordono/ mellitus, insulin-requiring, requiring
Tungcul/Ballesteros(TL) De controlled Ferritin (6/11/24 OSMAK): 34.30 IUD
Paz/Gauiran Pesigan/Jasarino Asymptomatic bacteriuria Gestational diabetes mellitus, HBA1c (6/11/24 OSMAK): 5.87% Gestational diabetes
Vito insulin-requiring, controlled 75g OGTT (2/23/24) at 21w5d mellitus, insulin-requiring,
By Normal spontaneous (-) polyphagia No meds for now FBS 92.93 H controlled
delivery; right mediolateral (-) polydipsia 2nd hr 143.52 CBG monitoring and control
episiotomy and repair (-) polyuria CBG TID ACHS
under local anesthesia See table CBG monitoring For repeat 75g OGTT 4-6
followed by IUD insertion 1100 1700H 2100H weeks postpartum
Date 0800H 1300H
(06/11/24) Asymptomatic bacteriuria H
(-) dysuria Cefuroxime 500mg/tab, 1 06/11 78 74 96 79 104 IM-Endo notes (06/11)
(-) hematuria tab every 12 hours for 7 Thank you for this referral
(-) increased urinary frequency days Dr Amba update
(-) febrile episodes Noted status post NSD
Please get initial CBG of
OB wise neonate
No profuse vaginal bleeding Mefenamic acid If patient is NPO, CBG q4
No severe hypogastric pain 500mg/tab,1 tab every 8 If patient resume full DM
Uterus well contracted hours for pain diet, CBG TID ACHS
Ferrous sulfate monitoring
325mg/tab,1 tab twice a For 75g OGTT 6 weeks
day postpartum

Asymptomatic bacteriuria
Continue present antibiotics

OB wise
For possible discharge once
cleared by IM-Endo service
Referred back to IM-Endo c/o
Dr Ramirez awaiting notes

OB 17 G3P2 (2012) BP 130/80 Clear liquids CBC with PC -

AZARIAS, JESSAH GABATINO Complete abortion HR 92 D5LR 1L x 30gtts/min Date Hgb Hct WBC S L M E Plt
41 Non-septic, non-induced RR 20
NYC Pelvic inflammatory disease
Tubo-ovarian abscess, left
06/11/24 Bacterial Vaginosis
Anemia mild secondary to
Dr Canaveral/ acute blood loss
Tungcul/Ballesteros De r/o Acute Diverticulitis
Paz/Gavino(TL)/Gauiran Obese I
Pesigan/Jasarino Vito
Gyne 9 G2P2(2002)
T 36.7
I: 750 (8hrs)
O: 300 (8hrs)
HT: 161cm
WT: 73.5kg
BMI: 28.4 (obese I)
Anemia mild secondary to
acute blood loss
(-) dizziness
(-) generalized body weakness
(-) dyspnea
(-) pallor
Pink palpebral conjunctiva
Bacterial vaginosis
(-) vaginal discharge
(-) vaginal pruritus
Pelvic inflammatory disease
(+) hypogastric pain
(-) febrile episodes
(-) dysuria
(-) foul-smelling vaginal
discharge
r/o Acute Diverticulitis
(+) abdominal pain
(-) difficulty defecating
(-) febrile episodes
Gyne wise
No profuse vaginal bleeding
(+) hypogastric pain
LMP: April 8, 2024
Abdomen soft flabby, (+)
direct tenderness on
hypogastric and LLQ area
IE: cervix closed, (+) cervical
motion tendereness, uterus
not enlarged, (-) palpated
adnexal mass, (+) adnexal
tenderness, left
RVE: no skin tags, no anal
fissures, (+) good sphincteric
tone, no mass, free
parametria, no blood per
examining finger
Noted passage of blood clots
at 2300H and 0000H however
not referred approx. EBL 100cc
BP 130/90
06/11 10.5 L 0.34 L 15.4 `88 8 4 - 481
O+/NR
Urinalysis
Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
06/11 Neg Neg 6.5 531.2 H 26.7 11.7 Neg
06/11 Neg +1 H 22.1 H 32.7 H 54.4 H 122.4 Neg
Chemistry Anemia mild secondary to
acute blood loss
Date Crea ESR CRP
Continue present
>10.00
06/12 45.77 1 medications
H
Ferritin (6/11/24 OSMAK): 107.60
Ferrous sulfate 325mg/tab
Vaginal discharge GS (05/31 OSMAK): SMEAR SHOWS MODERATE GRAM POSITIVE LACTOBACILLI, FEW GRAM NEGATIVE BACILLI AND OCCASIONAL GRAM POSITIVE COCCI IN
1 tab 2x a day Bacterial vaginosis
SINGLY WITH MODERATE LEUKOCYTES AND EPITHELIAL CELLS
To complete antibiotics for
Vaginal discharge KOH 05/31 OSMAK): Ngeative
14 days
Imaging
Findings: Pelvic inflammatory disease
Uterus is anteverted and enlarged measuring 8.1 x 6.8 x 6.6 cm (volume of 189 mL). To complete antibiotics for
Myometrial echopattern is homogeneous. 14 days
No focal mass is seen.
Metronidazole 500mg 1 Endometrial lining is not thickened measuring 1.1 cm. r/o Acute Diverticulitis
tab every 12 hours for 14 There is a tubular structure arising from the right adnexa with internal low level
days (Day 10) floating echoes. Inferior to it is a normal-sized right ovary measuring 1.4 x 1.4 x 1.3 Surgery Notes (6/12)
cm (volume of 1.2 mL). May have trial of clear liquids
Another tubular structure is noted, arising from the left adnexa with internal low to Continue IV hydration
TVS UTZ, OSMAK, MAY 31, 2024 medium floating echoes. The left ovary is enlarged and seen adjacent measuring Provide adequate analgesia
4.5 x 5 x 2.1 cm (volume of 24.6 mL).
Doxycycline 100mg/tab Noted schedule of CT scan on
The cervix is normal in size measuring 4 x 2.6 x 3.7 cm. No focal lesion identified.
every 12 hours for 14 days 6/14 please facilitate
Fluid collections are seen in the perihepatic, perisplenic and pelvic spaces.
(Day 10) Serial abdominal exam
Cefoxitin 2gm TIV () ANST No immediate surgical
IMPRESSION:
every 6 hours (Day 1) intervention warranted
Findings suggestive of bilateral tubo-ovarian complexes. Cannot entirely rule out Dr Cuevas updated
ectopic pregnancy.
Enlarged anteverted uterus with non-thickened endometrium Gyne wise
Unremarkable sonogram of the cervix
No meds for now PLAN: for completion of IV
Ascites antibiotics for 14 days
Enlarged uterus 8.61 x 7.32 x 9.32 cm For serial abdominal exam q4
Thickened endo (3.76 cm) with minimal color flow (Color score 2) c/o OB ROD
NO GS at the time of exam Awaiting final result of TVS
RO 2.97 x 2.02 x 2.55 cm with follicles less than 10mm UTZ done by OB sono (06/11)
Right adnexa superior and lateral to the RO is an elongated cystic mass with Daily body and perineal
complete and incomplete septations 6.99 x 5.20 x 7.23 containing sonolucent fluid, hygiene
consider hydrosalpinx
TVS UTZ c/o OB sono (05/27, Balbido's) WOF profuse vaginal
Paracetamol 600mg TIV LO 2.99 x 1.61 x 2.24 with follicles less than 10mm bleeding, severe hypogastric
Impression:
every 6 hours as needed pain
for abdominal pain Enlarged uterus
Thickened endometrium Pending labs:
Consider retained products of conception [ ] TSR official TVS UTZ c/o OB
Normal sized ovaries sono result done 6/11/2024
Right adnexal mass consider hydrosalpinx [ ] WAB CT with IV contrast
on June 14, 2024 8am c/o Dr
Savaitnisagun
Low salt, low fat, high CBC with PC -
SAMBUENA, TERESITA UMALI Ovarian New Growth, left HR: 84 protein, DM diet Date Hgb Hct WBC S L M E Plt
45 probably non-benign RR: 20 Heplock
06/11 11.5 0.37 11.9 74 13 10 3 619 H
YC (positive cardiophrenic, T: 36.7
mesenteric, paracaval, O+/NR
95060 paraaortic and pelvic I: 200 (8hrs) Urinalysis
05/08/024 lymphadenopathy), poorly O: 300 (8hrs) Date Sugar Protein WBC RBC Epithelial Bacteria
Dr. Santos,Palomares/Tungcul, differentiated carcinoma Pigtail (right): 4 cc 06/12 Neg +1 H 1.3 0.7 12.5 2.3
Go (TL)/ Roque (patho), Reyes/
06/11 Neg +1 H 110.3 H 5.7 93.0 H 289.8 H
Pesigan, Posadas/ Jasarino s/p Diagnostic laparoscopy, Ht 154 cm
biopsy of uterine implants Wt 75 kg Chemistry:
under GETA (4/26/24) BMI 31.6 kg/m2 Date RBS Crea BUN Na K Ica Mg AST ALT Alb
06/11 6.14 52.27 3.85 133.12 L 4.18 1.14 0.85 23.90 9.72 25.35 L
CVD Infarct, right Aspirin 80mg tab, 1 tab Coagulation test
Pleural Effusion, left thalamocapsular area, NIHSS once a day CVD Infarct, right
Date PT %act INR APTT
probably paramalignant 12 Citicoline 500mg/tab, 2 thalamocapsular area, NIHSS
from poorly diff carcinoma (+) weakness of left upper and tabs twice a day to 06/11 11.3 106.8 1.00 26.6 12
lower extremities complete 6 weeks (until 12L ECG (06/11): Continue present
CVD Infarct, right (+)dysarthric but June 26) Pregnancy test (06/11) Negative medications
thalamocapsular area, comprehensible Atorvastatin 80mg tab 1 Ascitic fluid GS (04/13): NO MICROORGANISM SEEN Referred to IM-Neuro service
NIHSS 12 (-) LOC tab once a day Ascitic fluid CS (4/18): NO GROWTH AFTER 5 DAYS OF INCUBATION c/o Dr Ramirez
(-) facial asymmetry Piracetam 800mg 1 tab Ascitic fluid AFB (04/20): NO AFB SEEN
Diabetes Mellitus Type 2 every 8 hours as needed Tumor markers (04/05, Osmak)
Neuro PE for dizziness Ca 125 2607 H Pleural Effusion, left
Hypertension Stage ll GCS 15 Levetiracetam 500mg/tab, Ca 19-9 20.75 probably paramalignant
Best response: spontaneous 1 tab twice a day Ferritin (05/09): 682.2 H from poorly diff carcinoma
Hypoalbuminemia eye opening, dysarthric but Betahistine 24mg 1 tab CRP (05/09): > 10 H No active intervention for
comprehensible, follows twice a day Pleural fluid (05/10): Bloody, turbid, 50ml, WBC ct: 2380; RBC ct: 110700; total cell count: 113080 now
Hyponatremia secondary to commands Pleural fluid GS (05/10): No microorganism seen For referral to IR for pigtail
suboptimal intake Pleural fluid AFB (05/10): No AFB seen insertion c/o duty team
CN I: NA Fluid TPAG (5/11/24 HI PRECISION)
r/o Community acquired CN II, III: pupils equally Fluid Protein: 40.20 g/L IM-Pulmo Notes (ER level
pneumonia reactive to light Fluid Alb 18.40 g/L 6/11)
CN III, IV: intact EOMs Fluid Globulin 21.80 (L) Referred to Dr. Dizon
S/P Emergency CN V: (+) corneal reflex Fluid alb/glob ratio 0.84 Since just recently
Appendectomy (Rockey- CN VII: (+) left central facial Pleural fluid glucose 0.12mmol/L discharged. With unchanged
Davis) (04/24/2022) palsy Pleural fluid LDH: 1729.10 U/L (H) cxr, may transfer to gyne
s/p Cerebrovascular CN VIII: (+) intact gross hearing Immunohistochemistry results Cytokeratin 7: POSITIVE in tumor cells ward
accident (2006, 2012, 2024- CN IX and X: (+) gag reflex Cardinal Santos Cvtokeratin 20: NEGATIVE in tumor cells
OSMAK) CN XI: (+) weak shoulder May 21, 2024 PAX8: POSITIVE in tumor cells Diabetes Mellitus Type 2
s/p Ultrasound guided- shrug, left CA 125: POSITIVE in tumor cells CBG TID ACHS
pigtail catheter insertion for CN XII: (+) tongue deviated to GATA3: NEGATIVE in tumor cells Referred to IM-Endo c/o Dr
drainage of ascites the left CDX2: NEGATIVE in tumor cells Pagarigan-awaiting notes
(04/12/2024) Comment: The immunohistochemistry results support the diagnosis of high
s/p Thoracentesis,left No nuchal rigidity grade metastatic carcinoma compatible with gynecologic organ origin. Hypertension St II
(05/10/24) Please correlate clinically. Further immunostaining for p16, p53, WT-1 and BP monitoring and control
s/p Thoracic Drain (JP) Motor Napsin A can be considered to assess for possible high grade serous Referred to IM-Cardio c/o Dr
placement, Deloculation, RUE 5/5 | LUE 3/5 carcinoma if clinically indicated. Pagarigan-awaiting notes
Pleural wall biopsy, Left RLE 5/5 | LLE 2/5
(5/20/24) ULTRASOUND GUIDED PIGTAIL INSERTION 4/18/2024: CHRONIC INFLAMMATION WITH REACTIVE MESOTHELIAL CELLS.
Sensory WBC RBC TCC S L M Remarks Hypoalbuminemia
RUE 100 | LUE 30-50 Ascitic fluid 21789.20 21789.20 22743.80 34 64 2 MONONUCLEAR CELLS: 66.3% Referred to IM-Nephro c/o
RLE 100 | LLE 30-50 (04/20) POLYMORPHONUCLEAR CELLS: 33.7% Dr Pagarigan-awaiting notes
DONE USING SYSMEX UF- 4000
Pleural Effusion, left probably No meds for now Imaging
paramalignant from poorly CXR (06/11 OSMAK) Present study shows persistently hypoaerated lungs with bronchovascular crowding. Hyponatremia secondary to
diff carcinoma The inhomogeneous opacification of the left lung is again seen with no significant change from the prior. The left cardiac border, suboptimal intake
(-) cough hemidiaphragm and costophrenic angle remain obscured. Referred to IM-Nephro c/o
(-) dyspnea Heart size cannot be adequately assessed. Dr Pagarigan-awaiting notes
(-) chest pain The right hemidiaphragm and costophrenic angle remain intact.
(-) fever Bony thorax is unremarkable. r/o Community acquired
(+) decreased breath sounds The left-sided surgical chest drain tip is seen overlying the left 8th posterior intercostal space. pneumonia
on left mid-base IMPRESSION referred to IM-IDS c/o Dr
No meds for now Low lung volume Ramirez-awaiting notes
Diabetes Mellitus Type 2 Unchanged left-sided pleural effusion. Other underlying lung pathologies (e.g pneumonia) are not ruled out.
(-) polyphagia MRI Brain (06/02 OSMAK) FINDINGS:
(-) polyuria Carvedilol 12.5mg/tab, 1 There is an irregular enhancing T2W/FLAIR hyperintense lesion in the left inferior cerebellum and tonsil measuring approximately 4.8 x 4
(-) polydipsia tab 2x a day x 1.8 cm (APxWxCC). No restricted diffusion, areas of susceptibility, perilesional edema or frank mass effects noted. Gyne wise

Hypertension St II
(-) blurring of vision
(-) headache
(-) dizziness
(-) vomiting
Hypoalbuminemia
(-) edema
(-) fatigue
(-) DOB
(-) loss of appetite
Hyponatremia secondary to
suboptimal intake
(-) generalized body weakness
(-) dizziness
(-) headache
(-) restlessness
r/o Community acquired
pneumonia
(-) cough
(-) fever
(-) colds
(-) DOB
Gyne wise
(-) vaginal bleeding
(-) severe hypogastric pain
Soft flabby abdomen, no
muscle guarding
PREVIOUS GYNE PE:
IE: Vagina smooth, Cervix
smooth, corpus cannot be
assessed adequately but there
seems to be a vague mass
pprox. 10-12 wks size which
cannot be delineated from
uterus
RVE: Mass on the cul de sac
area approximately 8x9cm
posterior to the uterus,
Globular, smooth, closely
adherent to left pelvic wall
Abdominal girth: 114cm
Pad count: 0
Ivabradine 5mg 1 tab Small CSF attenuating foci with peripheral gliosis is seen in both corona radiata, both putamen, and left thalamus. T2W/FLAIR PLAN: for pigtail insertion
twice a day hyperintense signals are seen in the periventricular white matter of frontoparietal lobes. Definitive Plan: neoadjuvant
chemotherapy
Midline structures are in place. Ventricular volume is appropriate for age. CSF spaces are within normal limits. Monitor VS every 4 hours
Sella / suprasellar, pineal and cerebello-pontine angle regions are intact. Cavernous sinuses are symmetric. and record
The brainstem shows no abnormal signal changes. No abnormal meningeal enhancement. I and O q shift
Intact calvarium without abnormal marrow signal. Monitor JP drain output
Minimal fluid signals are seen in both ethmoid sinuses. The rest of the paranasal sinuses, orbits and included nasopharynx are grossly every 4 hours and record
No meds for now unremarkable. WOF: severe chest pain,
IMPRESSION DOB, hypotension, changes
- Enhancing irregular left cerebellar lesion with no significant mass effects or perilesional edema. Finding may relate to ischemic change in sensorium
(subacute infarct), metastatic/neoplastic process is not ruled out. Follow up is recommended
- Chronic lacunar infarcts, bilateral corona radiata, bilateral putamina, and left thalamus Pending Labs
- Non-specific white matter hyperintensities, which may relate to microvascular ischemic changes, migraine-vasopasm or demyelination [ ] Chest CT scan with IVC
No meds for now - Bilateral ethmoid sinus disease June 20, 2024 c/o Dr
CXR (05/31) OSMAK Present study shows persistently hypoaerated lungs with bronchovascular crowding. Catanaoan
There is interval decrease in the inhomogeneous opacification of the left lung. The ipsilateral cardiac border, hemidiaphragm and [ ] for repeat creatinine on
costophrenic sulcus remain obscured. June 17, 2024
Minimal hazy opacities in the right lower lung are not appreciated. [ ] Ca 125 on June 14, 2024
True heart size cannot be ascertained.
The right hemidiaphragm and costophrenic angle remain intact. GYNE ONCO Notes (06/11
Bony thorax is unremarkable. OPD)
There is a medium caliber chest tube overlying the left 8th posterior intercostal space. >Seen with Dr. Santos
IMPRESSION >Noted plans for admission
Low lung volume for pigtail insertion
No meds for now Regression of pulmonary congestion >For Neoadjuvant
Regression left-sided pleural effusion. Other underlying lung pathologies (e.g pneumonia) are not ruled out. Correlate clinically. chemotherapy
Plain cranial CT scan FINDINGS: >Suggest to inquire with IM
(05/08 OSMAK) A fairly-defined hypodensity is seen in the midbrain. service if patient can be
Well-defined hypodensities are seen at the right caudate body, bilateral corona radiata, bilateral lentiform nuclei, bilateral thalami and cleared for surgery after 3
left cerebellar hemisphere. cycles of chemotherapy
Paracetamol 500mg 1 tab An ill-defined small focal area of hyperdensity is seen in the right cerebral peduncle.
every 6 hours as needed Midline structures are in place.
for pain Ventricles are not dilated.
Tramadol 50mg/tab, 1 tab The cisterns, sulci and extraaxial spaces are within normal limits.
Q8 PRN for pain There is segmental calcification of the bilateral internal carotid arteries.
Sella / suprasellar, pineal and cerebello-pontine angle regions are preserved.
The rest of the brainstem and the rest of the posterior fossa structures are intact.
Intact bony calvarium.
Mucosal opacities are seen in some of the bilateral ethmoid air cells. The mastoid air cells are partially sclerosed bilaterally. The rest of
the paranasal sinuses, orbits and included nasopharynx are grossly unremarkable.
IMPRESSION
- Consider acute infarct, midbrain
- Small focal hyperdensities in the right cerebral peduncle, may be due to technical factors vs focal hemorrhage
- Chronic infarcts, right caudate body, bilateral corona radiata, bilateral lentiform nuclei, bilateral thalami and left cerebellar hemisphere
- Atherosclerotic vessel disease
- Mild bilateral ethmoid sinus disease
- Mastoid disease, bilateral
HBTP UTZ (04/11 OSMAK) Marked fluid collection in the perihepatic, perisplenic and pelvic spaces. The liver is normal in size and parenchymal echogenicity. There
are no focal mass lesions noted. The intrahepatic ducts are not dilated. The gallbladder is normal in size measuring 4.27 x 1.71 cm. Its
wall is not thickened measuring 0.21 cm. No pericholecystic fluid seen. An echogenic intramural focus with comet tail artifact is noted
within. An adherent echogenic focus is noted. The common duct (0.37 cm) is not dilated to the extent visualized. The visualized pancreas
is normal in size and echotexture. There are no focal lesions appreciated. IMPRESSION:
Massive ascites.
Gallbladder polyp and adenomyomatosis.
Unremarkable sonogram of the liver and visualized pancreas.
CT scan (04/10, OsMak) There is a large, lobulated, heterogeneously enhancing mass with foci of necrosis centered in the posterior aspect of the cervix
measuring 11.6 x 9.9 x 12.5 cm (ApxTxCC). The ovaries are not delineated. Inferiorly, it has a 4.8 x 3.6 x 5.4 cm cystic component
occupying the upper third of the vagina. Superiorly, the mass displaces the uterus and bilateral round ligaments anterosuperiorly.
Posteriorly, invasion of the mesorectum at approximately 11 to 3 o’clock and compression/infiltration of the rectum are seen. There is
also infiltration of the right distal ureter with mild upstream dilatation of the rest of its segments as well as the pelvocalyceal dilatation.
Multiple prominent lymph nodes are seen along the anterior cardiophrenic, mesenteric, paracaval, paraaortic, pelvic and bilateral
inguinal regions. The largest is seen in the right cardiophrenic measuring 0.9 x 1 cm. Massive ascites displacing the bowel segments
centrally is seen. Nodular thickening of the omentum is also noted. Multifocal areas of heterogeneous enhancement are seen along the
posterior peritoneal cavity situated along the anterior surface of the descending colon, at the hepatorenal recess and superficial to the
right ovarian vein at the L3-L4 level. The liver is not enlarged with smooth contour. Intrahepatic ducts are not dilated. Portal vein is
patent. No abnormal enhancement after contrast infusion. The normal-sized gallbladder exhibits no abnormal intraluminal densities.
 Fundic wall is 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. Segmental intimal wall calcifications and minimal peripheral focal thrombi formation are seen along the infrarenal aorta
and the left common iliac artery. Fluid-containing umbilical and left inguinal hernias are appreciated. The included esophagus, stomach
and the rest of the intestinal segments are grossly normal.
A focal soft tissue scar is evident in the right anterior lower hemiabdomen. Subjacent to this, there is an apparent protrusion of the
omentum through the anterolateral abdominal wall musculature. There atrophy of the bilateral gluteus maximus muscles. Small
degenerative endplate osteophytes are seen along the margins of the spine. Sacralization of the L5 vertebra is evident with complete
fusion of the bilateral sacral ala and enlarged transverse processes. Small sclerotic foci are noted on the left iliac wing and auricular
surface of the left acetabulum, likely bone islands.
A 0.2 cm solid parenchymal nodule is seen in the posterior basal segment of the right lower lobe. Subsegmental atelectasis or fibroses is
seen in the included lung bases. Moderate left-sided pleural effusion is seen with compressive atelectasis of the overlying lung segments.
Impression:
Large, lobulated, heterogeneously enhancing mass centered in the posterior aspect of the cervix with extensions and mass effects as
described. Consider malignancy arising from the cervix or ovaries; cannot exclude tuberculosis. Tissue correlation is recommended.
Prominent anterior cardiophrenic, mesenteric, paracaval, paraaortic and pelvic lymphadenopathy; likely metastatic in the presence of a
primary malignancy. Massive ascites with omental/peritoneal seeding, can be seen in carcinomatosis, less likely from abdominal
tuberculosis. Phrygian cap versus focal adenomyomatosis of the gallbladder. Mildly atherosclerotic infrarenal aorta and the left
common iliac artery. Fluid containing umbilical and left inguinal hernia. Omentum containing incisional hernia. Mild degenerative
changes of the spine. Lumbosacral transitional vertebra (Castellvi IIIb). Incidental lung findings as discussed.
TVS UTZ c/o OB sono (04/01, Uterus is 5.53 x 5.55 x 5.05 cm. Endometrium 0.22 cm hyperechogenic. Cervix 3.31 x 3.31 x 2.98 cm. RO 1.76 x 1.22 x 1.23 cm vol 1.4 ml.
Osmak) LO 6.27 x 5.52 x 5.06 cm vol 91.6 ml. Findings: (+) ascites (+) perihepatic ascites. Note of matted bowels suggestive of possible
carcinomatosis.
Posterior to the uterus is a solid irregular heterogenous mass, measuring 11.19x9.08x9.45cm (Vol 502.8ml), with color flow score: 3
(moderate) scattered, findings of a pelvoabdominal mass, with non-benign features, Gynecologic vs a GI pathology.
There seems to be a well-delineated ovarian tissue on the right adnexa, posterior to the posterior pelvoabdominal mass measuring:
1.76x1.22x1.23cm (vol 1.4ml) suggestive of a possible normal right ovary
Left ovary: The left ovary is cystically enlarged, unilocular, thick-walled with mixed echoes, measuring 6.27x5.52x5.06cm (vol 91.6ml),
with absence of color, findings suggestive of a Dermoid cyst, left by sonomorphologic features. IMPRESSION: Normal sized anteverted
uterus. Thin endometrium. Pelvoabdominal mass as described. Dermoid cyst, left. Ascites. Matted bowels *Suggest correlation of clinical
presentation and ancillary exams such as: serum tumor markers and CT imaging for full assessment.
TVS UTZ 1/8/2024, OSMAK Findings:
Uterus is anteverted, normal in size measuring 5.77 x 6.04 x 4.42 cm.
Myometrial echopattern is slightly heterogeneous.
The endometrial lining is partially delineated measuring 0.42 cm.
The left ovary is normal in size measuring 2.5 x 1.37 x 2.55 cm (volume of 4.57 mL).
The right ovary is not visualized.
There is an isoechoic focus seen posterior and slightly to the right of the uterus measuring 5.36 x 4.62 x 4.71 cm.
The partially delineated cervix measures 2.55 x 2.96 x 2.49 cm.
Minimal fluid is seen in the posterior cul-de-sac.
Impression:
FOR REPEAT ULTRASOUND
Above findings may be suggestive of adenomyosis
Non visualized right ovary.
Isoechoic mass posterior and slightly to the right of the uterus; may be adnexal in origin (IOTA Simple Rules M1) or rectal.
Partially delineated cervix
Minimal posterior cul-de-sac fluid
Unremarkable sonogram of the left ovary
HISTOPATH (04/26)
A AND B. PELVIC AND ABDOMINAL WALL IMPLANTS: BIOPSY
-- POORLY-DIFFERENTIATED CARCINOMA
COMMENT: RECOMMEND IMMUNOSTAINS FOR CK7, CK20, GATA3, CA-125, AND CDX2 AS INITIAL PANEL.
Intraoperative findings (04/26)
Minimal ascites noted. No omental involvement initially seen. Liver was smooth, no adhesions. Stomach and diaphragm smooth. No bowel involvement initially seen. At the
pelvic area, uterus was seen with multiple miliary nodules scattered on the uterine fundus. Multiple miliary nodules were also seen on the anterior abdominal wall.
The uterus was small, covered with miliary lesions and adherent to the anterior abdominal wall. Note of caseous mass on the adhesion near the right medial ligament. Uterus is
also adherent to the bilateral enlarged ovaries.
The left ovary is enlarged; measuring approximately 5 x 5 cm, appearing solid.
The right ovary is likewise enlarged; measuring approximately 3 x 3 cm.
Both ovaries are posterior to the posterior wall of the uterus and omentum. Omentum near pelvic organs had no miliary lesions.
Estimated blood loss: minimal

CBG monitoring
0500H

06/11 120
OB ER G1P1(0100) Delivered to a BP 100/70 DAT with SAP CBC with PC -
MASALON, JERICA LATAM stillborn preterm baby boy HR 95 Heplock Date Hgb Hct WBC S L M E Plt
14 BW 550g RR 20
06/12 8.8 L 0.28 L 14.9 79 15 4 2 569
NYC Anemia moderate T 36.6x
O+/NR
secondary to 1) acute blood
RPR (06/12 OSMAK): NR
06/12/2024 loss 2) nutritional
Urinalysis
3932390 Anemia moderate secondary Anemia moderate secondary
Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
Dr s/p Non-institutional to 1) acute blood loss 2) Ferrous sulfate to acute blood loss 1) acute
Odevilas/Tungcul/Ballesteros(TL) delivery (Palanan 24/7, nutritional 325mg/tab,1 tab twice a 06/1 Neg +1 H 3.3 34.0 H 11.0 11.3` Trace blood loss 2) nutritional
De Paz/Gauiran Pesigan/Jasarino 06/12/24) (-) pallor day Ferritin (6/12/24 OSMAK): No active intervention for
Vito Teenage pregnancy (-) dizziness Reticulocyte count (6/12/24 OSMAK): 2.7 H now
{-) generalized body weakness 12L ECG (6/12/24 OSMAK): NSR; NSSTWC For repeat CBC after 12 hours
Pink palpebral conjunctiva Coagulation studies post-delivery (6/12 1600H)
Date PT %act INR aPTT TSR PBS result (09/12)
OB wise Cefuroxime 500mg/tab,1 06/12 13.1 92.7 1.17 36.5
No profuse vaginal bleeding tab every 12 hours for 7
No severe hypogastric pain days OB Wise
Uterus well contracted Metronidazole For observation for now
500mg/tab,1 tab every 12 Referred to Pedia service c/o
hours for 7 days Dr Pua for teenage
(+) well contracted uterus, Mefenamic acid pregnancy
enlarged to 2-3 months AOG 500mg/tab, 1 tab every 8 For referral to WCPU c/o
cervix open around 3cm, no hours for pain duty team
lacerations, no hematoma, no For complete perineal
packing preparation
WOF: severe hypogastric
pain, profuse vaginal
bleeding, hypotension,
tachycardia

LR DR
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES Remarks
HR 1 G1P0 Pregnancy Uterine 36 BP 110/60 DM diet, NPO once in active CBC with PC -
DE LA CRUZ-GALICIA, LORIEDIN weeks AOG cephalic in HR 81 labor Date Hgb Hct WBC S L M E Plt
AVISO preterm labor RR 20 Heplock 06/10 13.4 0.39 12.8 78 15 6 1 203
30 Gestational Diabetes Mellitus, T 36.6
O+/R
NYC newly diagnosed O2 98%
Urinalysis
Bacterial vaginosis
Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
3932306 Chronic Hepatitis B infection, I: 900 (8hrs) Gestational Diabetes Mellitus,
06/10/2024 low infectivity O: 600 (8hrs) 06/10 Neg Neg 0.5 6.1 20.3 3.1 Neg newly diagnosed
Dr. Palomares/Tungcul, Ferritin (06/10/24, OSMAK): 45.37 For 7pt CBG monitoring
Ballesteros(TL)/ Gavino/ de Guia, Gestational Diabetes Mellitus, Insulin sliding scale: Regular Imaging Referred to IM-Endo for
Posadas/Tiongson newly diagnosed insulin SLIUP Cephalic 35 3/7 weeks AOG EFW 2672g FHR 130 clearance c/o Dr Ramirez-
BPS UTZ (06/10/24 OSMAK)
(-) polyphagia 110-150: 2 units Fundal placenta, grade II AFI 9.7 cm SDP 5 cm BPS score 8/8 awaiting notes
(-) polydipsia 151-200: 4 units SLIUP Cephalic 32w1d 145 bpm 2017g AFI:13.9 SDP: 3.84
BPS UTZ (05/13/24, Precious Ultrasound and Diagnostic)
(-) polyuria 201-250: 6 units Posterior High-lying Placenta Grade II-III BPS 8/8 IM Endo notes (06/10)
See CBG table 251-300: 8 units SLIUP 22 2/7 weeks AOG Breech 145 bpm START Insulin sliding scale
>300 10 units CAS (03/09/24) Normohydramnios 498g Posterior HL gr I CBG every 4 hours – not carried
NO SONOLOGIC EVIDENCE OF FETAL ANOMALY SCAN out, still for 7pt
75g OGTT (05/04, Megason) @ 21w6d CBG targets 70-110 mg/dL
FBS 99 H Refer back once at OB ward
1st hour 167.4
Bacterial vaginosis Metronidazole 500 mg/tab 1 2nd hour 153 H
(-) foul smelling discharge tab every 12 hours for 7 days Hba1c (06/10): 5.11
(-) whitish vaginal discharge (Day 1) Vaginal discharge GS (06/10/24): GRAM POSITIVE LACTOBACILLI WITH MANY LEUKOCYTES, EPITHELIAL CELLS AND PRESENCE OF OCCASIONAL GRAM NEGATIVE Bacterial vaginosis
BACILLI. Completion of antibiotics
Vaginal discharge KOH (06/10/24): Negative
Chemistry:
Chronic Hepatitis B infection, Date AST ALT Chronic Hepatitis B infection,
low infectivity No meds for now low infectivity
06/11 37.03 H 27.80
(-) jaundice
(-) RUQ pain
IM-Gastro Notes (06/12)
(-) tea colored urine Hepatitis profile (06/11/24)
For HBV DNA
HbsAg REACTIVE
If for discharge, no objections
Anti-HAV NONREACTIVE Contact precaution if for
OB wise Ferrous sulfate 325mg/tab 1
Anti-HAV IgM NONREACTIVE discharge
 Good fetal movement tablet once a day Anti-HCV NONREACTIVE Refer back once with HBV DNA
(-) watery vaginal discharge Multivitamins 500mg/tab 1 Anti-HBc IgG REACTIVE Signing out
(-) bloody vaginal discharge tablet once a day
(-) perceived irregular uterine Calcium carbonate Anti-HBc IgM NONREACTIVE
contractions 500mg/tab 1 tablet 2x/day HbeAg REACTIVE
Isoxsuprine 10mg/tab 1 tab Anti-HBs NONREACTIVE OB wise
G1P0 3x daily for 7 days
Anti-Hbe REACTIVE For discharge today once cleared
LMP: Oct 4 , 2023 Dexamethasone 6mg TIM
by IM-Endo
36 weeks AOG by LMP every 12 hours to complete
CBG monitoring PROD informed (Dr. Ortiz), with
36 3/7 weeks AOG by UTZ (Nov for 4 doses
Date 0500H 0800H 1100H 1400H 1700H 1900H 2100H availability of incubator
17, 6w5d) (2 out of 4 given)
06/11 120 H 179 H 119 H 119 124 H 149 H 154 H For NST BID
1st dose: 06/10 1410H
Strict FHT q4 and record
Globular abdomen 2nd dose: 06/11 0200H
Tracing Fetal kick monitoring
FH: 31cm 3rd dose: 06/11 1400H
For complete perineal
EFW 4th dose: 06/12 0200H Date Interpretation BFHT Variability Acceleration Deceleration Contraction
preparation
- Johnson’s rule: 2945 g 06/12 AM Reactive 150-155 Moderate (+) (-) No contraction IE only if with indication
- Cupping method: 3000 g
06/11 PM Moderate
FHT: 140s Reactive 135-140 (+) (-) No contraction
post terb
IE: cervix 3 cm dilated, 30%
effaced, intact BOW, cephalic, 06/11 PM Cat I 130-135 Moderate (+) (-) 2 moderate
station -3 06/11 AM Reactive 130-135 Moderate (+) (-) No contraction
06/10 PM Reactive 130-135 Moderate (+) (-) No contraction
06/10 AM Reactive 130-135 Moderate (+) (-) No contraction
06/10 AM Moderate
Reactive 130-135 (+) (-) No contraction
Post terb
06/10 AM Moderate 2 moderate to strong
Cat I 140-145 (+) (-)
OB OPD contractions in 10min

OB Ward
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES Remarks
OB 1 G1P1 (1001) Pregnancy uterine BP 100/60 DAT CBC with PC DMPA
GOMEZ, ALYANNA ADRIANNE Delivered term cephalic HRR 90-110 Heplock Date Hgb Hct WBC S L M E Plt EINC
VILLANUEVA Live baby boy HR 110 06/12
21 AS 9,9 BW 2.97 kg BL 53 cm MI RR 20 s/p BT of 9.5 L 0.28 L 15.0 74 18 6 2 287
YC 39 weeks AGA T 36.7 2u
Blood transfusion of 2 units
06/11
06/09/24 pRBC for Anemia moderate I: 2310
s/p BT of 8.8 L 0.26 L 23.8 H 83 12 5 - 318
3913998 secondary to acute blood loss O: 1600
1u
Dr Odevilas/ Tungcul Go/Roque Anemia moderate secondary to
Reyes(TL)/Gauiran By Normal Spontaneous Anemia moderate secondary 06/10 9.7 L 0.29 L 25.2 H 90 5 5 - 404 acute blood loss
Tugado/Alzaga Delivery; Right Mediolateral to acute blood loss s/p BT 2u pRBC 06/09 11.9 0.35 9.7 60 30 8 2 347 s/p BT of 2u pRBC
Episiotomy with repair under (-) pallor Diphenhydramine 1amp TIM A+/NR
EBL 1600 local anesthesia (06/10/24) (-) dizziness 30mins prior to BT -given Urinalysis
(-) generalized body weakness Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
G1P1 (1001) pink palpebral conjunctiva 06/09 Neg Neg 6.2 3.9 11.0 12.3 Neg
s/p NSD Day 2 Ferritin (6/9/24 OSMAK): 25.38 OB wise
Blood transfusion of 2 units For possible discharge today
pRBC for Anemia moderate Continue present management
secondary to acute blood loss OB wise
No profuse vaginal bleeding Cefuroxime 500mg tab 1 tab
No severe hypogastric pain every 12 hours x 7 days
Uterus well contracted Mefenamic acid 500mg/tab 1
tab every 8 hours for pain
Ferrous Sulfate 325mg tab 1
tab 2x a day
OB 9 G1P1 (1001) Pregnancy Uterine BPR 130-140/80-100 DASH CBC IUD
BALADIA, CRISCHELLE LAVA Delivered term cephalic BP 140/80 MgSO4 drip (completed Date Hgb Hct WBC S L M E Plt NICU well for
16 Live baby boy PR 92 06/09 12nn) 06/08 11.4 0.33 14.2 87 11 2 1 271 maternal risk
YC AS 7,9 BW 2.63 kg, BL 52 cm, MI RR 20 06/08 13.5 0.39 12.7 23 7 6 0 325 factor –
40 weeks, AGA T 36.8 B+/NR preeclampsia
165325 Preeclampsia with severe Urinalysis A 0, 1
06/08/24 features I: 2050 P 2, 2
Date Sugar Protein WBC RBC Epithelial Bacteria
Dr. Bautista/ Tungcul/ Gestational diabetes mellitus, O: 1700 G 1, 2
06/08 NEG NEG 0.6 0.5 10.8 6.5
Gavino(TL)/ Gallano, Posadas/ diet controlled A 1, 2
Coagulation Test
Tiongson Bronchial asthma not in acute Last BP elevation: R 2, 2
exacerbation, moderate, poorly 06/08 0638H160/110 Date PT % Act INR APTT
0919H/1037H controlled (triage)-> 200/120 -> H5, 06/08 11.4 105.9 1.01 26.7
800cc Teenage pregnancy MgSO4 4g LD -> 140/70 -> 75g OGTT (3/22/24)@ 27 weeks AOG
160/100 -> H10 (0713H) FBS 92.34 H
By Emergency LTCS I under CLEA 1st hr 104.4
for Impending Eclampsia with Gestational diabetes 2nd hr 113.4
IUD insertion (June 8, 2024) mellitus, diet controlled 24H urine CHON (06/11 OSMAK): 235.69 Gestational diabetes mellitus,
(-) polyphagia Chemistry: diet controlled
No medications for now
G1P1 (1001) s/p E LTCS I under (-) polydipsia Na K Cl For 75g OGTT 4-12 weeks post op
Date BUN Crea BUA LDH AST ALT
CLEA Day 4 (-) polyuria
Preeclampsia with severe See CBG table 06/08 2.23 47.95 300.8 135.4 3.92 103.58 278.22 13.28 7.73
features CBG monitoring
Gestational diabetes mellitus, Date 0500H 1100H 1700H 2100H
diet controlled Preeclampsia with severe 06/11 DISCONTINUED Preeclampsia with severe
Bronchial asthma not in acute features 06/10 97 81 96 106 features
Nifedipine 30mg/tab 1 tablet
exacerbation, moderate, (-) headache 06/09 98 89 120 116 For BP monitoring and control
once a day
controlled (-) dizziness 06/08 83 89 90 96
MgSO4 4g SIVP as LD-given
Teenage pregnancy (-) blurring of vision Imaging Ophtha Notes (6/9/24)
(-) Vomiting Seen and examined
CXR(6/8/24 OSMAK) There are no active parenchymal opacities in both lungs.
Noted written clearance for
Pulmonary vascular markings are within normal limits. dilatation from main service
The heart is magnified. DFE done
Both hemidiaphragms and costophrenic angles are intact. No management warranted
Bony thorax is unremarkable. ophtha-wise for now
Impression: Signing out of service
Magnified heart Refer back once with new
ophthalmologic concerns
Will update CIC

Bronchial asthma not in acute

Bronchial asthma not in exacerbation, moderate,
acute exacerbation, controlled
Prednisone 20 mg/tab twice a
moderate, poorly controlled Referred back to Dr Pua for
day for 3 days (Day 1 + 1)
Clear breath sounds clearance -awaiting notes
Salbutamol + ipratropium
(-) DOB/SOB
bromide nebule every 6 hours
(-) fever Pedia (6/11/24)
Budesonide rapinhaler 160
(-) cough Diet c/o main service
mcg 1 puff twice a day for 3
Maintain on heplock
months
Diagnostics: none for now
Therapeutics:
1 Continue prednisone as
ordered
2 Continue Salbutamol +
ipratropium bromide
nebulization interval without fail
as ordered
3 Continue Budesonide
rapinhaler 160 mcg 1 puff twice a
day for 3 months
Continue monitoring
Still with wheezes, for
observation for 24hours as per
 OB Wise Cefuroxime 500mg tab 1 tab pedia pulmo, prior to clearance
No hypogastric pain every 12 hours x 7 days for discharge
No profuse vaginal bleeding Paracetamol + Tramadol tab 1
(+) flatus tab every 8 hours for pain OB Wise
(+) BM Ferrous Sulfate 325mg tab 1 For possible discharge once
tab 2x a day cleared by pedia service

OB 20 G5P1 (1031) Pregnancy Uterine BP 90/60 DAT with SAP CBC with PC -NA
PAULINO, CHERIZZE FACUNDO 25 2/7 weeks AOG cephalic in HR 98 Isoxuprine drip:– Date Hgb Hct WBC S L M E Plt
36 threatened preterm labor RR 20 DISCONTINUED 6/8 2200H 06/1
YC Acute gastroenteritis with no T 36.7 IVF2: PNSS 1L x 60cc/hr – 10.5 L 0.29 L 8.8 61 27 8 4 245
2
signs of dehydration, resolved O2: 99% HOLD
06/1
06/05/2024 Anemia mild secondary to (+) O2 support PRN 9.5 L 0.27 L 6.1 61 27 8 4 205
1
105026 probably physiologic anemia in I: 1700
06/0
Dr. Irabon, Castro/Tungcul/ pregnancy O: 2500 9.0 L 0.26 L 5.3 67 17 14 2 135 L
9
Gavino, Reyes (TL) /Posadas, Multiple electrolyte imbalance
06/0
Tugado/Tiongson, Jasarino (Hypokalemia, Hyponatremia) Pre-pregnancy weight: 62 kg 8.5 L 0.24 L 6.2 86 8 6 144 L
8
secondary to GI losses, resolved Ht: 160cm
Bacterial vaginosis, completed BMI: 24.2 (overweight) 06/0
9.9 L 0.28 L 9.4 83 11 5 1 147 L
treatment 7
Poor OB History – Recurrent Last febrile episode: 06/0
11.6 0.33 14.4 82 11 6 1 231
Pregnancy Loss 06/09 0000H Temp of 38.4  5
Mixed Hemorrhoids Paracetamol 600mg TIV  O+/NR
Phlebitis 36.8 Urinalysis
Low lying placenta Date Sugar Protein WBC RBC Epithelial Bacteria
Pleural effusion (minimal, left) Acute gastroenteritis with no 06/07 NEG NEG 0.3 0.2 4.7 3.3 Acute gastroenteritis with no
Elderly gravid signs of dehydration, 06/05 Neg Trace 2.2 0.8 37.8 38.8 signs of dehydration, resolved
Overweight resolved ORS volume per volume Chemistry: Discontinue IVF
(-) epigastric pain replacement-Discontinued Date BUN Crea Na K Cl Mg AST ALT
Previous LTCS I for unrecalled (-) nausea (06/09) 3.58 0.71
06/10
indication (2015, PGH) (-) vomiting Ranitidine 150 mg/tab 1 tab
(-) recurrence of loose stools every 8 hours as needed for 06/09 135.49 3.27 L 0.76
(-) dry lips epigastric pain- Discontinued 06/08 2.34 49.26 133.47 L 3.28 L - 29.06 16.49
(-) sunken eyeballs (06/09) 136.00 4.28 101.12
06/05
Last episode of vomiting
06/04 1800H Coagulation studies
Last episode of loose stools Date PT % Activity INR APTT
06/05 0130H 06/08 13.1 92.7 1.17 34.5
Last BM: 06/09 Troponin I 6/6: 0.16ng/mL
Reticulocyte count 6/8: 3.3% (H)
Multiple electrolyte Ferritin 06/05 172.20H
imbalance (Hypokalemia, 75g OGTT (05/31, Makatilife) at 23 weeks
Hyponatremia) secondary to KCl 750 mg/tab 2 tabs now FBS 88 Multiple electrolyte imbalance
poor intake, corrected then 1 tab every 4 hours – 1st hr 145 (Hypokalemia, Hyponatremia)
(-) weakness completed 14 cycles 2nd hr 123 secondary to poor intake,
(-) vomiting/diarrhea Vaginal GS/KOH 06/05 Negative; SMEAR SHOWS PREDOMINANCE OF GRAM NEGATIVE COCCOBALLI WITH FEW LEUKOCYTES AND MANY EPITHELIAL CELLS. corrected
Urine CS (06/06, health): E.coli 10,000cfu/ml No active management
Sensitive Intermediate resistant
IM Nephro (06/10)
Cefotaxime Noted labs
Levofloxacin KCl 750 mg/tab 2 tabs now then 1
Nitrofurantoin tab every 4 hours for 4 doses
SMX-TMZ then repeat K and Mg
Ampicillin/sulbactam Nephro-wise no objection if for
Amikacin
Cefazolin Tetracycline discharge
Amoxicillin/clavulanic acid
Ciprofloxacin ampicillin Noted K correction c/o main
Tobramycin
Anemia moderate secondary Cefixime service
to probably infection Ceftriaxone
(-) pallor Imipenem Anemia moderate secondary to
(-) PPC None for now Ticarcillin/clavulanic acid probably infection
(-) DOB/ SOB Fosfomycin No active management
12L ECG (6/6: sinus tachycardia (PR 115)
Bacterial vaginosis, Thyroid function test (06/06, OsMak)
completed treatment Metronidazole 500mg/tab 1 TSH 2.0 Bacterial vaginosis, completed
(-) foul smelling discharge tab every 12 hours for 7 days- FT3 0.69 L treatment
(-) whitish vaginal discharge completed FT4 0.70 No active management
Fecalysis
Mixed Hemorrhoids
(-) tender non reducible mass
at 12’o clock position
(-) anal itching
(-) rectal bleeding
Phlebitis
(-) warm to touch and
tenderness on IV access, left
Pleural effusion (minimal,
left)
(-) DOB/SOB
(-) cough
(-) orthopnea
Clear breath sounds
OB wise
Good fetal movement
(-) watery vaginal discharge
(-) bloody vaginal discharge
(-) perceived irregular uterine
contractions
G5P1 (1031)
LMP: 12/17/23
AOG:
25 2/7weeks by LMP
24 3/7 weeks by UTZ (3/20/24
12w5d)
FH 23cm
FHT 130s
IE: cervix closed
None for now
Paracetamol 300mg TIV every
6 hours for temp >37.8 C PRN
Ceftriaxone 2 g TIV OD (day
2)-DISCONTINUED (06/11)
Multivitamins 1 tab once a
day
Multivitamins + AA tab, 1 tab
twice a day
Ferrous Sulfate 325mg/tab, 1
tab once a day
Calcium carbonate 500
mg/tab 1 tab 2x daily
Micronized progesterone for
BID per vagina until 36 weeks
Dexamethasone 6 mg TIM
every 12 hours for 4 doses –
completed: 6/6 2215)
Dydrogesterone 10mg/tab 1
tab every 8 hours for 7 days -
completed (06/11)
Isoxsuprine 10mg /tab, 1 tab
3x daily for 7 days – HOLD
Date Consistency WBC RBC Others
06/04 Watery 0-1 0-1 NO INTESTINAL PARASITE SEEN
Mixed Hemorrhoids
Dengue Serology (06/09, Life)
No active management
NS1 Negative
IgG Negative SURGERY ER notes (4/6/2023)
IgM Negative Case referred to Dr Atazan
No immediate surgical
Imaging intervention warranted at time of
Cervical length and Amniotic fluid sludge negative exam
amniotic fluid sludge Cervical shape and length: T-shaped, long (2.66cm) and closed Avoid straining, lifting heavy
initial c/o OB sono object and prolonged
Chest xray (6/8/24 Previous study dated April 19, 2021 was review. standing/walking
OSMAK) The lungs are hypoaerated with bronchovascular crowding. For hot sitz bath at home TID 10-
There is minimal haziness in the left lower lung. 15mins
The heart is magnified. If ok with OB (if w/o
The left costophrenic sulcus is indistinct. contraindication), to start
Both hemidiaphragms and the right costophrenic angle are intact. Hisperidin-Diosmin 500mg tab 1
Bony thorax is unremarkable. tab TID x 5 days – not started by
IMPRESSION: main service
Minimal haziness in the left lower lung, may be due to vascular crowding. Please correlate clinically No objection if for discharge
Minimal pleural effusion versus thickening, left
Pelvic with Cervical The cervix measures 4.7 x 2.8 x 2.8 cm (CcxAPxW). Y-shaped funneling of the cervix is noted, with funnel length of 3.4 cm, Phlebitis
Length (06/05/2024) funnel width of 1 cm, and functional cervical length of 1.3 cm (percentage funneling = 70%). No active management
SLIUP, cephalic, 24 3/7 weeks, 727 grams, 147 beats/minute, Placenta maturity is grade 0 located at the anterior lower
portion of the uterus, 1.5 cm away from the internal os, DVP 2.3cm IM IDS (06/10)
IMPRESSION: Patient seen and examined
Cervical funneling, as detailed Will attribute febrile episode to
Single live intrauterine pregnancy, cephalic in presentation compatible with 24 weeks and 3 days gestational age by fetal phlebitis
biometry with good cardiac and somatic activities. Will not treat as pneumonia since
Normohydramnios with no cough, colds with clear
Grade 0 anterior low-lying placenta breath sounds on auscultation
EFW: 727 grams Continue monitoring CBC for now
EDD by ultrasound: September 22, 2024
CAS, Makati Life 05/29 SLIUP, Breech, 23w2d, 149 bpm, AHL gr 1, SDP 5.57 cm, 593 g, No gross fetal anomaly
Stool charting:
discontinued Pleural effusion (minimal, left)
06/05 0130H 1 loose bowel movement No active management for now
IM-Pulmo notes (06/09/24)
Dr Dizon updated
CXR finding not infectious in
origin
Agree to shift to heplock for now
No active management
Signing out
OB wise
PLAN: For possible pessary
placement
For referral back to Perinatology
Service
For daily CBC monitoring to
observe trends
Monitor vsq4, FHT q4
PROD informed (Dr. Abis)
WOF: severe hypogastric pain,
profuse vaginal bleeding, dec.
FHT, regularly perceived
contractions
PERINATOLOGY NOTES (6/10/24)
Referred back to Dr. Castro
Noted CBC trends
Noted ongoing K correction
Please facilitate cervical length
 monitoring- tentative sched
06/11/24 c/o OB sono
For canvassing of pessary c/o
patient – amenable
WOF: decreased fetal movement,
watery/bloody vaginal discharge,
recurrence of fever, vomiting,
perceived uterine contractions

Pending:
[/ ] For confirmation of cervical
length; for amniotic fluid sludge
c/o OB Sonologist – TSR result
[ ] For canvassing of pessary c/o
patient – amenable
[x] For APAS workup (still for LOA
approval)-refused with form
HR 2 G2P1 (1001) PU 25 4/7 weeks BP 110/60 DAT; NPO for 10-12 hours for CBC with PC -
MANIEGO, MARIANE MARTIREZ AOG cephalic not in labor HR 92 FBS Date Hgb Hct WBC S L M E Plt
21 Acute pyelonephritis RR 20 Heplock 06/11 12.1 0.37 21.1 H 86 7 7 293
T 36.8
O+/NR
3924494 Previous appendectomy (2017,
Ferritin (06/10/24, OSMAK): 78.07
06/10/2024 Sta. Ana Hospital) I:2100 (16hrs)
Urinalysis
Dr. Palomares/Tungcul, de Paz O:1000 (16hrs)
Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
(TL)/Gavino/ de Guia,
Posadas/Tiongson Pre-pregnancy weight: 57kg 06/11 Neg Trace 122.7 H 1.2 20.3 7330.8 H 2+
Wt: 81kg Chemistry:
Ht: 167.6cm Date BUN Crea Hba1c Na K
BMI: 20.5 (N) 06/11 2.69 51.91 4.79 133.52 L 4.48
Vaginal discharge GS (06/11/24): SMEAR SHOWS PREDOMINANCE OF GRAM POSITIVE LACTOBACILLI WITH FEW LEUKOCYTES AND MANY EPITHELIAL CELLS
Vaginal discharge KOH (06/11/24): Negative
Acute pyelonephritis Imaging Acute pyelonephritis
(-) dysuria - Bilateral moderate hydronephrosis For repeat UA after D3 of
(-) urgency Ceftriaxone 2g IV OD (Day 1) KUB UTZ 06/11/24 antibiotics (06/13/24)
- Underdistended urinary bladder
(-) frequency Paracetamol 300 mg TIV Pelvic Utzi 06/11 c/o Dr. San Pedro SLIUP cephalic 27w2d 148bpm EFW 1058g SDP 8.23 AHL, g1 TSR urine CS (06/10)
(-) right flank pain every 6 hours for 24 hours
TVS UTZ (02/12, Osmak) Findings:
(-) fever then as needed for fever IM Nephro notes (06/11)
Thank you for this referral
Within an enlarged ante uterus, measuring 8.07 x 7.81 x 6.68, is a single
06/11 0900H Referred to Dr Vega
gestational sac measuring 4.34 x 1.87 x 4.36. An embryo is seen with a
39.4 -> Paracetamol 600 mg Continue ceftriaxone for now c/o
crown rump length of 1.81 cm compatible with 8 weeks and 2 days age of
TIV -> 37.0C main service
gestation.
06/12 referred for low back Noted awaiting urine CS result
pain 8/10  paracetamol Continue hydration
Good cardiac activity noted at 168 beats/min.
300mg TIV
Yolk sac is seen with a diameter of 0.3 cm.
OB wise
Minimal subchorionic hemorrhage is seen (approximately 0.97 cc).
OB wise For medical management
Good fetal movement Multivitamins 500mg/tab 1 PROD informed (Dr. Almario)
Cervix is long and closed, measuring 4.16 x 3.74 x 2.78. No focal lesions
(-) watery vaginal discharge tab once a day Monitor vsq4, FHTq4 and record
identified or funneling noted.
(-) bloody vaginal discharge Ferrous sulfate 325mg/tab 1
(-) perceived irregular uterine tab once a day
The right ovary is normal in size measuring 2.63 x 1.36 x 2.22 (4.14 cc).
contractions Calcium 500mg/tab 1 tab 2x a Pending labs
The left ovary is likewise normal in size measuring 2.12 x 2.08 x 1.52 cm
day [ ] for FBS (June 13, 2024 AM
(3.51 cc).
G2P1 (1001) [ ] for 75g OGTT as OPD basis
LMP: November 14, 2023 [ ] For CAS – to secure sched next
No evidence of adnexal mass.
AOG: 30 weeks week (will inform Dr. Gallano)
25w4d AOG by UTZ
No definite evidence of fluid seen in the posterior cul-de-sac.
(02/12; 8w2d)
Impression:
Slightly globular abdomen
Single live intrauterine pregnancy compatible with 8 weeks and 2 days age
(+) Kidney punch, right
of gestation by crown lump length.
Minimal subchorionic hemorrhage.
FH: 22 cm
Normal sized ovaries.
FHT: 150s
Normal cervix. No evidence of adnexal mass.
IE: cervix closed
 No evidence of posterior cul-de-sac pathology.
Within an enlarged anteverted uterus, measuring 7.3 x 5.7 x 6.5 cm, is a
single gestational sac measuring 0.72 x 0.58 x 0.94 cm with a mean sac
diameter of 0.75 cm compatible with 5 weeks and 3 days age of gestation.
No embryo seen. No yolk sac appreciated.
No subchorionic hemorrhage is seen.
Cervix is long and closed, measuring 2.7 x 2.3 x 2.9 cm. No focal lesions
identified or funneling noted.
The right ovary is normal in size measuring 1.6 x 1.1 x 2 ( 1.9 ml).
The left ovary is likewise normal in size measuring 3.4 x 2.2 x 2.4 (9.5 ml).
A cystic focus is seen within the left ovary measuring 1.4 x 1 x 1 cm.
TVS UTZ (1/18/24, OSMAK)
No evidence of adnexal mass.
No definite evidence of fluid seen in the posterior cul-de-sac.

Remarks:
Consider early intrauterine pregnancy compatible with 5 weeks and 3 days
age of gestation by mean sac diameter. Follow-up after 2 weeks is
suggested for viability of pregnancy.
Normal sized ovaries with probable corpus luteum on the left.
Normal cervix. No evidence of adnexal mass.
No evidence of posterior cul-de-sac pathology.
HR 3 G2P1 (1001) Pregnancy Uterine BP: 100/60 DM diet with SAP CBC with PC N/A
GOYALA, MARITES ESPINAS 32 6/7 weeks AOG by HR: 92 Date Hgb Hct WBC S L M E Plt
26 ultrasound cephalic in RR: 20
06/03 12.2 0.36 9.0 74 17 6 3 215
YC threatened preterm labor T: 37.2
Gestational Diabetes Mellitus, O2: 98% A+/NR
06/03/24 diet controlled Urinalysis
3930475 CAP MR with MDRO I: 2250 Date Sugar Protein WBC RBC Epithelial Bacteria
Dr. Calo/ Tungcul, Go/ Gavino Bronchial asthma not in acute O: 2400 06/03 NEG NEG 1.0 0.1 11.6 4.6
(TL), Reyes/ Gallano, Gauiran/ Exacerbation, moderate, poorly 06/03 NEG NEG 6.2 H 18.6 H 64 H 321.7 H
Kadappurath controlled Ferritin (06/03/24) 13.95 Gestational Diabetes Mellitus,
Bacterial Vaginosis, completed Pre-pregnancy weight: 38kg HbA1c (06/03/24): 4.25% diet controlled
treatment Ht: 145 cm 75gOGTT (05/22/24) Megason at 30 weeks AOG For CBG monitoring and control
BMI: 18.5 (N) FBS 108.54 H For 7 point CBG monitoring
1sthr 150.3 For strict fetal kick monitoring
Gestational Diabetes 2ndhr 113.22
Mellitus, diet controlled Vaginal Discharge GS (06/03/24): SMEAR SHOWS PREDOMINANCE OF GRAM POSITIVE LACTOBACILLI, MODERATE LEUKOCYTES, MODERATE EPITHELIAL CELLS AND
(-) polyphagia OCCASIONAL GRAM NEGATIVE BACILLI
None for now
(-) polydipsia Vaginal KOH (06/03/24): NEGATIVE
(-) polyuria Procalcitonin (06/06): 0.06
See CBG table Imaging
Hemithorax (06/10/24) Findings: CAP MR with MDRO
Radiograph study dated June 4, 2024 was reviewed. Bronchial asthma not in acute
There is hypoechoic hepatization involving the right lung with areas of punctate Exacerbation, moderate, poorly
hyperechogenicities representing static air bronchograms. controlled
There is no fluid collection appreciated in both hemithoraces. Referred back to IM Pulmo c/o Dr
CAP MR with MDRO Ramirez for clearance prior to
Bronchial asthma not in Impression: discharge
SHIFTED Ceftazidime 2g TIV
acute exacerbation, Consider right lower lung consolidation and/or atelectasis
every 12 hours (D3+1
moderate, poorly controlled BPS UTZ (06/10/24) SLIUP cephalic 32w3d 154 bpm 1989 g AHL gr 2 AFI 10.2 cm SDP 4 cm 8/8 IM Pulmo (06/11)
completed) to cefixime
(-)wheezes, Chest xray (06/04/24) Unchanged consolidation Pneumonia with atelectatic component, right lower lung Patient seen and examined
400mg/tab,1 tab OD for 4
(-) cough BPS UTZ (06/03/24) SLIUP, cephalic, 31w1d, 146bpm, 1771g, AFI: 11.75 SDP: 4cm, AHL grade 2, 8/8 Ideally for chest CT with IVC for
more days
(+) decrease breath sounds, Pelvic UTZ (05/14/24, Osmak) SLIUP, Breech, AOG 27w3d, EFW 1055g, FHR 148bpm, SDP 5.03cm, Placenta AHL gr I further evaluation of
Budesonide + Formoterol
right basal lobe Tracing consolidation noted in CXR and
160mcg/4.5mcg 2 puffs twice
(-) DOB/ SOB hemithorax utz however
a day Date Interpretation BFHT Variability Acceleration Deceleration Contraction
(-) fever currently G1P0 31 weeks AOG
(-) desaturations 06/12 AM Reactive 140-145 bpm Moderate (+) (-) No contraction Continue Ceftazidime for now c/o
06/11 PM Reactive 140-145 bpm Moderate (+) (-) No contraction IM-IDS
06/11 AM Reactive 145-150 bpm Moderate (+) (-) No contraction
IM-IDS notes (06/11/24)
06/10 PM Reactive 140-145 bpm Moderate (+) (-) No contraction
Conferred with Dr Santos
06/10 AM Reactive 140-145 bpm Moderate (+) (-) No contraction May send home with cefixime
06/09 PM Reactive 155-160 bpm Moderate (+) (-) No contraction 400mg/cap, 1 cap OD for 4 more
06/09 AM Moderate days
Reactive 140-145 bpm (+) (-) No contraction
post-terb
Bacterial Vaginosis, Bacterial Vaginosis, completed
Metronidazole 500mg tab 1 06/09 AM CAT 1 145-150bpm Moderate (+) (-) 2 moderate contractions
completed treatment treatment
 (-) foul smelling vaginal tab every 12 hours x 7 days- 06/08 PM Reactive 140-145 bpm Moderate (+) (-) No contraction No active management
discharge completed 06/08 AM Reactive 140-145 bpm Moderate (+) (-) No contraction
(-) fever OB Wise
(-) hypogastric pain 06/07 PM Reactive 140-145 bpm Moderate (+) (-) No contraction For possible discharge once
06/07 AM Reactive 140-145 bpm Moderate (+) (-) No contraction cleared by all services
OB Wise 06/06 PM Reactive 150-155 bpm Moderate (+) (-) No contraction For control of bronchial asthma,
Good fetal movement Multivitamins 500mg/capsule treatment of CAP MR
06/06 AM Reactive 140-145 bpm Moderate (+) (-) No contraction
(-) bloody vaginal discharge 1 cap once daily For IE once with indication
(-) whitish vaginal discharge Multivitamins + Amino acid 1 06/05 PM Reactive 145-150 bpm Moderate (+) (-) No contraction Monitor vsq4, I & O qshift
(-) perceived uterine cap once daily 06/05 AM Reactive 140-145 bpm Moderate (+) (-) No contraction NST BID, FHTq4 and fetal kick
contractions Ferrous sulfate 325mg/cap 1 06/04 PM Reactive 140-145 bpm Moderate (+) (-) No contraction monitoring
cap once daily PROD informed Dr. Carandang
06/04 AM Reactive 145 bpm Moderate (+) (-) No contraction
G2P1 (1001) Calcium tab 1 tab 2x daily (with 1 incubator available c/o
LMP: Nov 6, 2023 Isoxsuprine 10mg tab every 8 06/03 PM Reactive 155 bpm Moderate (+) (-) No contraction Dr. Carandang)
AOG: 31 weeks hrs x 7 days-completed CBG monitoring
AOG: 32 6/7 weeks (02/20: 16 (06/11) Date 0500H 0800H 1100 1400H 1700H 2000H 2100H
6/7 weeks) Dexamethasone - completed 64 101 89 109 83 83 61 -
06/11
(06/08/24; 0800H) 75
FH 27cm 06/10 69 101 107 116 88 125 84
FHT 140s bpm 06/09 70 72 80 89 77 69 73
IE: parous introitus, vagina 06/08 130 84 80 98 110 117 98
admits 2 fingers with ease, 06/07 107 132 87 127 106 152 159
cervix closed 06/06 80 73 82 81 98 94 101
06/05 82 78 127 122 92 95 92
06/04 74 82 89 102 118 98 116
06/03 - - - - 128 74 82
HR 4 G3P2 (2002) Pregnancy Uterine BPR 110-120/60-80 LSLF diet CBC/PC n/a
CABUENAS, JENELYN ABEÑON 28 4/7 weeks AOG by LMP BP 110/60 Heplock Date Hgb Hct WBC S L M E Plt
32 breech not in labor HR 89 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 36.0 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: 2200 05/08 11.1 0.32 11.1 67 25 7 1 269
Dr. Palomares, Castro/Tungcul, infection, high infectivity O: 2000
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 04/29 12.2 0.36 9.3 75 16 6 3 280 Chronic Hypertension
Gallano*/Alzaga, Kadappurath t/c Anxiety disorder (-) BOV Methyldopa 250mg 1 tab BID 04/20 11.2 0.34 9.0 67 24 7 2 277 For BP monitoring and control
Vaginal Candidiasis, resolved (-) headache ISDN 5mg/tab, 1 tab SL as B+/R
(-) dizziness needed for chest pain Urinalysis
(-) chest pain Date Sugar Protein WBC RBC Epithelial Bacteria
(-) DOB/SOB
05/11 Neg Neg 0-2 0-2 Mod Rare
(-) vomiting
05/03 neg neg 0.9 0.4 13.7 27.7 Deep Vein Thrombosis
Deep Vein Thrombosis 04/29 Neg Neg 2.1 0.9 26.5 40.9 Well’s score 5
Well’s score 5 04/24 Neg Neg 3.1 0.5 51.2 233.1 H VTE score 1
VTE score 1 Enoxaparin 8000 units SC 2x a Chemistry: Anesthesiology notes (06/09)
(+) swelling of the leg and day Referred last night at 6pm via
Date BUN BUA Crea Na K T Ca Mg AST ALT Trop I FBS HBA1c
thigh, left phone call by Dr Pesigan
(-) direct tenderness 06/11 2.43 43.76 133.62 L 3.90 12.20 15.45 No clinical referral sheet as of
(-) warm to touch, left leg 46.22 134.97 L 4.05 0.80 now, still awaiting
05/30 2.27
(-) red/discoloration on the Noted history and labs
affected leg 05/15 2.62 46.02 134.63L 3.9 0.73 Please secure 1u pRBC properly
(-) shortness of breathing 05/08 2.61 45.74 typed and crossmatched and 1u
(-) pain on deep breathing pRBC as standby for possible OR
(-) pain/tenderness on the 05/05 75.06 4.94 use
affected leg when 04/29 2.76 50.52 131.9 L 3.93 2.34 0.68 Please secure second IV line on
standing/walking contralateral arm then heplock if
04/20 2.25 325.07 46.27 10.58 12.59 0.37
(-) sensory loss for OR
(+) good lower extremity Coagulation studies Please discontinue enoxaparin 24
pulses (posterior popliteal, Date PT % Activity INR APTT hours prior to OR
posterior tibial, dorsalis pedis 06/10 12.0 100.8 1.07 27.3
2+) Referred back to Dr Dalmacion
05/08 12.0 100.8 1.07 26.3
(clinical referral given)
04/20 11.7 103.3 1.04 24.9 L
D-dimer (03/01/24): >3000 (H) Surgery (06/12/24)
Hepatitis profile (04/05/24) Continue present management

Chronic Active Hepatitis B
infection, high infectivity
Hepatitis A infection
(-) icteric sclerae/jaundice
(-) abdominal pain
known Hep B since 2011
t/c Anxiety disorder
(-) difficulty of sleeping
(-) palpitation
(-) DOB
(-) chest pain
05/11 0830H DOB (no
triggering factors)
Vaginal Candidiasis, resolved
(-) white frothy discharge
(-) perceived uterine
contractions
(-) foul smelling discharge
OB wise
Good fetal movement
(-) perceived uterine
contractions
(-) watery/bloody vaginal
discharge
G3P2 (2002)
LMP: November 25, 2023
AOG:
28 4/7 weeks by LMP
27 6/7 weeks (02/14; 10w6d)
FH 26cm
FHT: 140 bpm
IE: cervix closed, uterus
enlarged to AOG
No meds for now
12L ECG
Vaginal GS/KOH 05/03/2024: Positive;
Vaginal GS/KOH 05/03/2024 SMEAR SHOWS PREDOMINANCE OF GRAM POSITIVE LACTOBACILLI WITH MANY LEUKOCYTES, MANY EPITHELIAL CELLS AND
PRESENCE OF FUNGAL ELEMENTS
Imaging
None for now
Metronidazole + Miconazole
750/200mcg/tab, 1 tab once
a day before bedtime
(completed 05/13)
Multivitamins + amino acid
tab 1 tab 2x daily
Ferrous sulfate 325mg/tab 1
tab twice a day
Calcium 500mg/tab 1 tab 2x a
day
Dexamethasone 6mg TIM
every TIM for 4 doses-
completed(06/10 1300H)
Nifedipine 10mg/tab, TID for
48 hours – completed
Isoxuprine 10mg/tab, 1 tab
every 8 hours x7 days-
completed
HbsAg REACTIVE Provide adequate analgesia
Anti-HAV REACTIVE Still for IVC filter insertion at
institution
Anti-HAV IgM NONREACTIVE
Anti-HCV NONREACTIVE IM Vascular (06/11/2024)
Anti-HBc IgG REACTIVE Patient seen and examined
Continue Enoxaparin 8000 units
Anti-HBc IgM NONREACTIVE
SC 2x a day
HbeAg REACTIVE Continue application of
Anti-HBs NONREACTIVE compression stockings (12 hours
Anti-Hbe NONREACTIVE on, 12 hours off)
Chronic Active Hepatitis B
04/26 Normal sinus rhythm
infection, high infectivity
04/23 Normal sinus rhythm Hepatitis A infection
For HBV DNA viral load c/o
outside institution -refused,
waiver secured
Pelvic UTZ c/o SLIUP, 25w2d, Breech, 127bpm,SDP: 5.69, 777g, Fundal Grade II placenta GASTRO 04/25/2024
OB Sono Impression: Known to service from previous
(06/03/24) *Estimated fetal weight is below the 10th percentile of the established gestational age, suggest serial growth monitoring. admission
*Fetal face cannot be fully assessed due to unfavorable fetal position Still for HBV DNA
Venous duplex Vein diameter (cm): Left No medications for now
Scan Greater saphenous vein (above knee): 0.22 Contact precaution
(05/31/24 Greater saphenous vein (below knee): 0.19 No active gastro management,
OSMAK) Greater saphenous vein (ankle): 0.15 respectfully signing out of this
Lesser saphenous vein: 0.26 case
Saphenofemoral junction: 1.31 Refer back once with HBV DNA
The left common femoral vein, superficial femoral vein, deep femoral vein and popliteal veins are now partially compressible. The left result
saphenofemoral junction and greater saphenous vein are now compressible with intraluminal medium level echoes. The left posterior tibial Thank you
and peroneal veins are now compressible.
No significant varicosities seen. t/c Anxiety disorder
The lesser saphenous vein again has thickened walls with calcifications. MHU (05/29)
The previously noted cobblestoning along the subcutaneous region of the popliteal region extending to the ankle is no longer evident. Patient comfortable, no pain at
Impression the moment
- Interval regression of findings suggestive of venous thrombosis, as detailed above. Continue management
- Unchanged thickened wall with calcifications, left lesser saphenous vein.
- Resolution of subcutaneous edema, popliteal down to the ankle region
Vaginal Candidiasis, resolved
CAS (05/13 SLIUP, 22w4d, breech, AHL grade I, 150bpm, SDP 2.89cm, 547g
No active management
OSMAK) The estimated fetal weight is below the 10th percentile of the established gestational age, suggest serial growth monitoring.
Limited congenital anomaly scan showed no gross congenital anomaly seen at the time of scan (Face not fully assessed due to unfavorable
fetal position); Suggest re-evaluation of the fetal face.
Chest xray No significant chest findings
(05/11)
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 OB wise
(04/24) Definitive plan:
Pelvic UTZ SLIUP cephalic 17w1d 174 g 147 bpm SDP 3.8 cm AHL gr 1 For readmission to PGH at 36
(04/01) weeks for possible IVC filter
insertion (for reassessment if still
Chest xray no active parenchymal opacities in both lungs.
warranted)
(04/04) Pulmonary vascular markings are within normal limits.
For vacuum delivery, but for
The heart is not enlarged.
delivery anytime if with
Both hemidiaphragms and costophrenic angles are intact.
fetomaternal indication such as
Bony thorax is unremarkable.
recurrent severe hypertension,
Impression: No significant chest findings
progressive renal insufficiency,
Venous duplex The left common femoral and proximal superficial femoral, visualized deep femoral, as well as the popliteal, posterior tibial and peroneal persistent thrombocytopenia,
Scan veins are non-compressible now with intraluminal hyperechoic component and with absent color flow upon Doppler interrogation. The left pulmonary edema, eclampsia,
(03/23/24) saphenofemoral junction and proximal greater saphenous vein are now also non-compressible and with intraluminal hyperechoic foci and suspected abruptio placenta,
with absent color Doppler flow. severe fetal growth restriction,
The rest of the greater saphenous vein is non-dilated and compressible. No significant varicosities seen. BPS 4/10 or less on at least 2
The lesser saphenous vein again has thickened walls with calcifications. occasional 6 hours apart,
There is further decrease in the degree of cobblestoning of the subcutaneous region of the popliteal region down to the ankle. recurrent variable or late
Impression: decelerations
- Interval evolution of findings suggestive of venous thrombosis, as detailed above. For BPS + doppler velocimetry
- Thickened wall with calcifications, left lesser saphenous vein. (Dr. Gallano informed)
 - Regression of subcutaneous edema, popliteal down to the ankle region For dexamethasone completion
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 For NST BID
Monitor vsq4, FHTq6 and record
(03/16/2024) 6.03 cm, consider myoma uteri
Apply compression stockings at
Venous duplex The left common femoral and entire superficial femoral and visualized deep femoral veins, as well as the popliteal, posterior tibial and all times
Scan peroneal veins are non-compressible with absent color flow upon Doppler interrogation. The proximal segment of the left saphenous vein is PROD informed (Dr. Calacday)
(03/09/24) partially to non-compressible with thickened walls. Wall calcifications are seen in the lesser saphenous veins. AROD informed (Dr. Concepcion)
There is also no noted vascular flow in the visualized left external iliac vein. WOF: severe hypogastric pain,
The greater saphenous vein is non-dilated and compressible. No significant varicosities seen. No significant venous blood flow reflux seen profuse vaginal bleeding, chest
on maneuvers. pain, DOB/SOB, decreased fetal
There are unenlarged left inguinal lymph nodes with intact fatty hila. movement
There is cobble stoning of the subcutaneous region of the proximal left thigh down to the distal leg. Please measure calf
- Consider venous-occlusive disease or thrombosis, left common femoral, entire superficial femoral, visualized deep femoral, popliteal, circumference, thigh
posterior tibial, peroneal and proximal lesser saphenous veins. circumference daily and record
- Consider venous-occlusive disease or thrombosis, left external iliac vein.
- Wall calcifications, left lesser saphenous vein. Perinatology notes (06/10/24)
- Subcutaneous edema, proximal left thigh down to the distal leg Referred back to Dr. Castro
- Unenlarged left inguinal lymph nodes Still for BPS + Doppler
TVS UTZ Uterus is anteverted and enlarged measuring 9.63 x 8.79 x 1.67 cm. Myometrial echopattern is homogeneous. A hypoechoic focus velocimetry
(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) Still awaiting surgery notes for
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 reassessment
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 Noted ongoing Dexamethasone
cardiac activity noted at 171 beats/min. completion
There is no subchorionic hemorrhage. Continue present management,
Cervix is long and closed measuring 4.37 x 4.55 x 3.65 cm with no demonstrable lesions. medications and monitoring
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 WOF: decreased fetal movement,
vasculature measuring 1.27 x 1.14 x 1.51 cm. watery/bloody vaginal discharge,
The left ovary is obscured by bowel gas. nausea, vomiting, headache, BOV
No definite lesion in both adnexa.
No definite evidence of fluid seen in the posterior cul-de-sac. Pending labs:
IMPRESSION: [ ] For 2D echo at Makatilife on
Single live intrauterine pregnancy compatible with 10 weeks and 6 days age of gestation by crown-rump length. July 9,2024
EDD: September 5, 2024 [ x] HBV DNA-refused
Unremarkable sonogram of the cervix. [ ] To retrieve duplex scan result
Normal-sized right ovary with physiologic cyst. Non-visualized left ovary done at PGH
No evident posterior cul-de-sac fluid. [ ] Ideally for 75g OGTT at 24-28
weeks - GA not amenable since
Tracing the patient is admitted
Date Interpretation BFHT Variability Acceleration Deceleration Contraction [ ] For pelvic ultrasound after 2
weeks (6/17/24) – still to
06/12 AM Reactive 140-145 Moderate (+) (-) No contractions
coordinate
06/11 PM Reactive 140-145 Moderate (+) (-) No contractions [ ] For BPS + doppler velocimetry
06/11 AM Reactive 145-150 Moderate (+) (-) No contractions (Dr. Gallano informed)
06/10 PM Reactive 140-145 Moderate (+) (-) No contractions
*Still processing aid from other
06/10 AM Reactive 145-150 Moderate (+) (-) No contractions
government institution for
06/09 PM Reactive 135-140 Moderate (+) (-) No contractions guarantee letter
06/09 AM Reactive 140-145 Moderate (+) (-) No contractions DSWD P5000
06/09 PM Reactive 145-150 Moderate (+) (-) No contractions PCSO-rejected
Office of VP- awaiting
Bong Go- not available,
LEFT Mid-Calf Mid-Thigh
Enoxaparin
06/11 39 59
06/10 39 60
06/09 39 60
06/08 39 61
06/07 40 60
06/06 39 60
06/05 40 60
06/04 39 63
06/03 38 63
06/02 38 63
06/01 38 63
05/31 39 63
 05/30 39 63
05/29 36 63
05/28 37 62
05/27 38 63
05/26 39 62
05/25 39 63
05/24 38 63
05/23 39 63
05/22 38 62
05/21 38 62
05/20 37 61

GYNE WARD

PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES

Gyne 1 Nulligravid BP 120/80 Soft diet CBC with PC

ESCIETE, MARIAFE GARA Ovarian new growth, right PR 70 Heplock Date Hgb Hct WBC S L M E Plt *Endorsed patient by Dr. Binay
52 probably benign RR 20 *with reserved blood products
NYC Ovarian Torsion, right T 37.2 06/11 12.0 0.36 10.4 84 12 3 1 192 c/o Dr. Binay -2 crossmatched
Myoma Uteri c/o Maam Me-ann available
06/04/24 Blood transfusion of 1u pRBC I: 2410 06/09 10.7 L 0.31 L 5.4 57 33 8 2 214 *secured waiver that specimen
3931955 for anemia mild probably O: 1450 is for send out and is well
Dr. Palomares/Tungcul, secondary to suboptimal 06/08 11.4 0.34 5.9 55 36 7 2 228 explained to patient and
Go*/Reyes (TL)/Gallano, intake, corrected HT: 157cm relative
06/07 11.7 0.34 6.1 58 32 8 2 212
Gauiran/Kadappurath WT: 45kg
BMI: 18.3 (underweight) 06/05 11.3 0.33 6.7 59 33 7 1 199
1308H/ 1528H s/p Total Abdominal
EBL 300 cc Hysterectomy, Bilateral Anemia mild probably 06/04 12.6 0.37 9.7 70 23 7 0 258 Anemia mild probably
salpingoophorectomy under secondary to suboptimal O+/NR secondary to suboptimal
CLEA (06/10/2024) intake, corrected s/p BT of 1u pRBC Urinalysis intake, corrected
Day 2 (-) pallor Diphenhydramine 1am TIM prior s/p BT of 1u pRBC
Date Sugar Protein WBC RBC Epithelial Bacteria
(-) dizziness to BT- given no active management for now
06/05 NEG NEG 0.6 0.4 41.6 1.5
(-) generalized body
06/04 NEG Trace 8.0 H 0.8 55.5 H 61.7 H
weakness
Pink palpebral conjunctiva Chemistry
Date BUA HbA1c AST ALT Na K Crea BUN
06/09 138.88
Asymptomatic bacteriuria 06/09 Asymptomatic bacteriuria
(-) dysuria Standby Paracetamol 06/08 139.27 For completion of antibiotic
(-) hematuria 500mg/tab 1 tab every 4 hours 06/05 247.46 5.07 23.08 19.34
(-) fever as needed for temp >37.8c 06/04 133.30 L 3.86 93.84 H 4.09
Coagulation studies
Date PT % Activity INR APTT
Gyne Wise 06/05 11.2 107.7 0.99 37.5 Gyne Wise
(-) Severe hypogastric pain Cefuroxime 500mg/tab, 1 tab Pregnancy Test (06/04/24): NEGATIVE For possible discharge once
(-) Profuse vaginal bleeding every 12 hours for 7 days COVID 19 RAT (06/04/24): NEGATIVE with BM and without
(+) Flatus Celecoxib 200mg/tab,1 tab 12L ECG (06/04/24): sinus bradycardia complications
(-) BM every 12 hours for pain Tumor Markers (06/05/2024):
Ferrous sulfate 325mg/tab,1 tab Ca-125: 15.43 Surgery Notes at ER level
twice a day Ca-19-9: 9.92 (06/04/24)
Papsmear (06/06): MILD TO MODERATE INFLAMMATION CONSISTENT WIH ACUTE CERVICOVAGINITIS Thank you for this referral
Vaginal Discharge KOH 06/04/24) NEGATIVE patient seen and examined
Vaginal Discharge SGS (06/04/24) SMEAR SHOWS OCCASIONAL GRAM POSITIVE LACTOBACILLI WITH OCCASIONAL LEUKOCYTES AND EPITHELIAL CELLS History and PE reviewed
Xray – CHEST/ABDOMEN Chest: will refer to service consultant
(6/04/24) There are no active parenchymal opacities in both lungs. Diet and IVF as ordered
Pulmonary vascular markings are within normal limits. no immediate surgical
The heart is not enlarged. intervention warranted at time
Both hemidiaphragms and costophrenic angles are intact. of exam
Bony thorax is unremarkable. For serial abdominal exam
Impression: will ff up patient
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.

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 G2P2 (2002) BP 110/70 Diet: 1350 (SF 30) with PF 1.5 CBC with PC
HILARIO, AILEEN MENDOZA Pelvoabdominal mass HR 89 Using regular diet divided into 3 Date Hgb Hct WBC S L M E Plt
44 probably uterine in origin, RR 20 meals and 2 snacks with the ff 06/08 s/p
NYC probably malignant T 36.5 (1.5) CHON 68 g 270 kcal 9.9 L 0.30 L 12.3 76 10 12 2 465
BT of 4u
Hypovolemic shock (resolved) CHO 160 650
06/08 8.4 L 0.26 L 13.5 H 82 7 10 1 460
05/29/2024 secondary from severe I: 1225 CHO 160 650
05/30
3931666 anemia probably secondary O: 1100 Fats 50 430
S/p BT of 11.1 0.34 22.7 H 86 7 6 1 393
Dr Calo/ Tungcul/Gavino(TL)/ to chronic blood loss Boost optimum 2 scoops
De Guia Gauiran/Kadappurath Blood transfusion of 4 units Ht: 157cm beneprotein 2 times a day as 3u pRBC
Tiongson pRBC for anemia very severe Wt: 45kg snacks – HOLD (06/05) 05/30
prob secondary to 1) Chronic BMI: 18.3 (underweight) Heplock s/p BT of 9.1 L 0.30 L 20.7 H 84 9 6 1 400
blood loss 2) Chronic disease 2u pRBC
(malignancy) 3) Nutritional 05/29 5.2L 0.19L 18.9H 80 12 7 1 544H Hypovolemic shock (resolved)
Transaminitis from Ischemic Hypovolemic shock O+/NR secondary from severe anemia
Hepatopathy (resolved) secondary from s/p BT of 4units pRBC Urinalysis probably secondary to
Infectious Diarrhea severe anemia probably Carvedilol 6.25mg/tab,1 tab 2x a Date Sugar Protein WBC RBC Epithelial Bacteria 1) Chronic blood loss
Complicated UTI, corrected secondary to day 2) Chronic disease (malignancy
Hypoalbuminemia 1) Chronic blood loss Diphehydramine 50mg IV 30 06/01 Neg Trace 1-2 51-75 H Few Few 3) Nutritional
Multiple electrolyte 2) Chronic disease minutes prior to BT-given s/p BT of 4units pRBC
05/29 Neg Neg 15-20 H 0-2 Few Few
imbalance (Hypovolemic, (malignancy) Paracetamol 300mg IV 30
Hypoosmolar, Hyponatremia 3) Nutritional, minutes prior to BT-given Chemistry: IM-Cardio Notes (06/11)
and hypokalemia) secondary (-) hypotension Calcium gluconate 10% 10cc Date BUN Crea Na K AST ALT Cl iCa Mg Phos Trop I Albumin AST ALT START carvedilol 6.25mg/tab,1
to poor oral intake, corrected (-) loss of consciousness SIVP post BT of 3u PRBC – given 06/1 69.98 H 29.45 H tab 2x a day
Underweight (-) DOB/SOB STANDBY Norepinephrine 16mg 2 No recurrence of hypotension,
(-) tachycardia + D5W 500mL to run at 06/1 33.57 L cardio signing out
(-) slight pallor 18cc/hr(0.2mcg/kg/min) to 0
(-) generalized body regulate at increments of +/- 06/0 134.86 L 3.84 IM Hema 06/04
weakness 3cc/hr every 15 minutes to 9 Elevated platelet count can be
(-) dizziness maintain BP =90/60mmHg (max: 06/0 133.19 L 3.48 68.56 H 29.81 attributed to possible
pink palpebral conjunctiva 54 ugtts/min) 8 L malignancy
Last hypotension: 05/29: 06/0 134.78 L 4.00 97.42 0.83 1.08 25.72 L Monitor CBC for now, no hema
70/40  Norepinephrine 7 referral warranted
110/70 06/0 133.52 L 4.56 1.15 0.82 0.86
2.00 22.51
5
Transaminitis from Ischemic 06/0 132.41 L 24.84 L
Hepatopathy 5 Transaminitis from Ischemic
(-)change in sensorium Hepatopathy
06/0 129.47 L 3.56 105.61 H 28.78 0.78 1.39
(-) jaundice Essential Phospholipid caps, 2 2.16 28.36 L GASTRO NOTES (06/11)
4
(+) intermittent abdominal caps 3x/day Continue Essential
06/0 129.51 L 4.9 94.91 L 0.81 1.79 26.34 L
pain aminoleban sachet, 1 sachet 3x 2.08 L 28.24 L phospholipids TID
3 H
(-) chest pain a day START aminoleban sachet, 1
06/0 134.74 4.90 0.75 0.96
(-) DOB/SOB sachet 3x a day
2
(-) vomiting
06/0 3.40 130.04 H 34.92 H
Infectious diarrhea 1 L
(-) loose stools Ciprofloxacin 500mg tab 1 tab 05/3 136.44 3.14 0.75 0.63 L Infectious diarrhea
2.12 L 28.85 L
(-) tenderness on every 12 hours to complete 7 1 L Stool charting
hypogastric area days (Day 5) 05/3 138.21 3.73 0.77 17.16 L
(-) weakness Racecadotril 100mg/tab 1 tab 0 Gastro Notes (06/10)
every 8 hours until 2 formed 05/2 130.25L 3.19L 16.66 L Continue Ciprofloxacin 500mg
06/09 1300H: watery stools stools 9 tab 1 tab every 12 hours to
at 3x greenish, rotten egg Probiotics sachet 1 sachet once 05/2 125.02 L 2.68 120.91 H 36.72 H 94.57 L 1.01 0.83 0.96 0.31 complete 7 days
1.84 34.43
smell, associated with a day 9 L Updated service consultant
abdominal pain Oresol volume per volume Coagulation studies Dx: repeat AST, ALT on next
replacement Date PT % Activity INR APTT extraction -done
HNBB 10mg TIV every 8 hours 05/08 13.3 91.0 1.19 33.8
05/30 15.2 H 75.6 1.37 H 39.4
05/30 17.0 66.2 1.55 39.0 Hypoalbuminemia
Hypoalbuminemia Human Albumin 20% vial/ vial 05/29 18.2 61.6 H 1.67 37.1 Refer back to IM Gastro service
(-) edema every 12 hours for 3 days Tumor markers c/o Dr Ramirez regarding latest
(-) fatigue (completed 06/10 0800H) Date CA 125 CA 19-9 albumin and liver enzyme
(-) DOB result-awaiting notes
05/30 32.22 13.41
(-) loss of appetite
Reticulocyte count (05/29 OSMAK): 5.2H
Gastro Notes (06/07/24)
PBS (05/30/24)
For Human Albumin 20% vial/
Platelet: SLIGHTLY INCREASED
vial every 12 hours for 3 days
RBC: MODERATE MICROCYTOSIS,HYPOCHROMIA WITH ANISOCYTOSIS AND POIKILOCYTOSIS ( TARGET CELLS,BURR CELLS,FEW SPHEROCYTES).
Multiple electrolyte
WBC: NO ABNORMAL CELLS SEEN
imbalance (Hypovolemic, Multiple electrolyte imbalance
CRP (05/29 OSMAK): >10.00 H
Hypoosmolar, (Hypovolemic, Hypoosmolar,
Ferritin (05/29 OSMAK): 43.97
Hyponatremia and Glutaphos tab 1 tab 3x/day Hyponatremia and
12L ECG (05/29 OSMAK): NSR
hypokalemia) secondary to KCl 750mg/tab 2 tabs PO every 4 hypokalemia) secondary to
Fecal occult blood (05/29 OSMAK): Negative
poor oral intake, corrected hours x 2doses only – given poor oral intake, corrected
BEDSIDE PT (5/29/24): NEGATIVE
(-) chest pain
Fecalysis
(-) DOB/SOB IM-Nephro notes (06/10)
Date WBC RBC Other
(-) dyspnea Diet c/o NST
(-) anorexia NO INTESTINAL watery Noted repeat labs
06/09 40-50 5-10
(-) diarrhea PARASITE SEEN Since within normal results of
NO INTESTINAL Na, K, respectfully signing out,
06/04 >100 10-15 watery
Cranial nerves PARASITE SEEN refer back if warranted
II, III: (+) 3mm EBRTL Imaging
III, IV, VI: (+) EOMs, primary CECT of the Abdomen CLINICAL DATA: 5-month history of gradually enlarging pelvoabdominal mass with unintentional weight loss NST Notes (06/02)
gaze midline OSMAK COMPARISON: None Revise diet to 1350 (SF 30) with
V: V1-V3 intact 06/07/24 TECHNIQUE: Multiple axial images of the abdomen and pelvis were obtained with oral, rectal and intravenous contrast. PF 1.5
VII: No facial asymmetry FINDINGS: Using regular diet divided into
VIII: (+) gross hearing meals and 2 snacks with the ff
IX, X: Can swallow A 11.1 x 14.3 x 13.7 cm (ApxWxCC) lobulated, heterogeneously enhancing mass with areas of necrosis and internal air (1.5) CHON 68 g 270 kcal
XI: Good shoulder shrug pockets arising from the pelvic region extending into the peritoneal cavity. It is compresses on the urinary bladder, CHO 160 650
XII: tongue midline intimately related to its superoposterior wall with no distinct fat planes. It severely compresses on the rectosigmoid and CHO 160 650
descending colon but maintains fair planes of differentiation. It is also seen mildly compressing some of the small bowels Fats 50 430
Motor (jejunum) and left common iliac vein, also maintaining good planes of differentiation. The uterus and ovaries are not Continue ORS with beneprotein
RUE 5/5 LUE 5/5 clearly delineated. Minimal fluid collection is seen in the pelvic space. Start 24 hour food recall c/o
RLE 5/5 LLE 5/5
Sensory
RUE 100% LUE 100%
RLE 100% LLE 100%
Complicated UTI, resolved
(-) dysuria
(-) fever
(-) chills
(-) increased urine
frequency
Gyne wise
No profuse vaginal bleeding
No severe hypogastric pain
G2P2 (2002)
LMP: Last week of March
2024
PMP: Unrecalled
PMP: Unrecalled
soft flabby abdomen,
palpable hypogastric mass
from below the umbilicus to
hypogastric area, 13x9cm
size, nonmovable with direct
tenderness on palpation
SE: Cervix flushed to the
vault, no mass, no erosions,
no bleeding per os
IE: cervix flushed to the
vault, closed, uterus cannot
be palpated due to enlarged
mass
dietary
The liver is enlarged with a span of 16.3 cm. Diffuse decrease of parenchymal attenuation with smooth borders is noted.
Intrahepatic ducts are not dilated. The main portal vein is patent but dilated with a maximum diameter of 1.6 cm. No
abnormal enhancement after contrast infusion. Complicated UTI, resolved
For antibiotic completion
The spleen is enlarged measuring 4.6 x 11.9 x 10.1 cm with an index of 553. The splenic veins are dilated. No distinct mass
or abnormal parenchymal enhancement observed. IM-IDS notes (06/04)
Ceftriaxone 2g TIV once a day The normal-sized gallbladder exhibits no abnormal intraluminal densities. Wall is not thickened. Common duct is not Continue Ceftriaxone 2g TIV OD
(completed) dilated. until Day 7, IDS respectfully
The pancreas is normal in size and configuration. Pancreatic duct is not dilated. signing out
The adrenal glands are normal without undue enhancement.
Both kidneys are normal in size and exhibit symmetrical parenchymal enhancement. A few non-enhancing hypodense
foci are seen in the left kidney with the largest measuring 1.7 x 1.5 x 1.6 cm located in its interpolar region. A non-
No meds for now enhancing hyperdense focus is likewise seen in the superior pole of the left kidney measuring 1.2 x 1.2 x 1.1 cm. No Gyne wise
evidence of opaque lithiasis or hydronephrosis. For possible endometrial biops
The appendix is not dilated. The included esophagus, stomach and intestinal segments are grossly normal. For referral to gyne onco in Jun
Prominent and enlarged lymph nodes are seen in the left paraaortic, mesenteric, and right iliac chains, with the largest 13,2024 – rotator informed (Dr
detected in the right iliac chain measuring 1.8 cm along its short-axis diameter. Pesigan)
Minimal osteophytes are seen along the margins of the visualized spine. Sclerotic foci are seen in the T9 and L5 vertebral Daily body and perineal hygien
bodies. The lumbar lordosis is straightened. Monitor vs q4
Diffuse subcutaneous stranding densities are noted. Strict I and O
Reticulonodular densities are seen in both visualized lower lobes. WOF: severe abdominal pain,
nausea and vomiting, DOB/SOB
Impression: chest pain, weakness
- Large and enhancing pelvoabdominal mass with areas of necrosis, extension and mass effects, as detailed. Neoplasm is
the primary consideration. Tissue correlation is advised IM Pulmo (05/29)
- Hepatosplenomegaly with signs of portal hypertension. Please correlate with pertinent parameters Referred to Dr. Arguila
- Peritoneal and pelvic lymphadenopathies Cleared for regular ward
- Minimal pelvic ascites Respectfully signing out
- Left renal cysts (Bosniak I and II)
- Diffuse subcutaneous edema SURGERY Notes (06/10)
- Degenerative osseous changes Dr. Gomez updated
- Sclerotic foci, T9 and L5 vertebral bodies, may represent bone islands, however, metastatic process is not entirely ruled Noted plans for chest CT with
out if with proven malignancy. Follow-up is suggested IVC
- Straightened lumbar lordosis likely due to muscle strain noted OB plans for endometria
- Reticulonodular densities, both lower lobes. Consider an inflammatory/infectious process. Please correlate clinically biopsy
UTERUS: 20.72x12.18x10.98cm Suggest CA 19-9 and CEA
TVS shows an enlarged uterus, heterogenous, with irregular solid components, with moderate color on color flow Noted plans for referral to gyne
mapping onco
ENDOMETRIUM not delineated For referral to surg onco (Dr.
CERVIX: 3.38x2.78cm Lay-lay)
TVS UTZ c/o OB sono (05/31/24 OSMAK)
RO: not seen
LO: not seen Urology (06/04)
Impression: referred back to Dr Tadeo for
Pelovoabdominal mass probably uterine in origin, t/c a non-benign pathology WAB CT result
Endometrium and bilateral ovaries not visualized Noted WAB CT with triple
Both kidneys are normal in size with smooth and regular contour. The cortico-medullary pattern in both sides is intact. contrast on 6/7-done
The right kidney measures 10.2 x 5.1 x 3.7 cm with cortical thickness of 1.0 cm. The left kidney measures 10.3 x 5.3 x 4.2 No immediate surgical
cm with cortical thickness of 0.9 cm. There is no evidence of hydronephrosis, lithiasis or mass noted in both kidneys. The intervention
KUB UTZ urinary bladder is adequately distended. Its wall appears to be thickened measuring 0.7 cm. An indwelling foley catheter Please refer back once with
OSMAK balloon is seen within.There is incidental note of increased hepatic parenchymal echogenicity with minimal fluid in the WAB CT scan results
(5/30/24) perihepatic space. Dr. Zalueta updated
Impression: Provide adequate analgesia
Minimal perihepatic ascites. Incidental note of hepatic steatosis. Unremarkable ultrasound of both kidneys. Nonspecific
urinary bladder wall thickening. Correlate clinically. Pending Labs
Focused scanning of the hypogastric/pelvic region shows an ill-defined, heterogeneous mass with internal calcifications [ ] For Chest CT scan with IVC
and with moderate vascularity upon Doppler interrogation, measuring approximately 11.4 x 12.6 x 10 cm. It has apparent (on June 14, c/o Dr. Capuchino
extension into the superoposterior portion of the urinary bladder. The right ovary is normal in size measuring 2.8 x 2 x 2.6 [x] Urine CS – not amenable
Focused ultrasound of hypogastric /pelvic With refusal form
cm (volume of 7.6 cc). No focal lesions seen. The left ovary is not visualized.
region (05/29/24 OSMAK) [x] Blood CS x 2 sites – not
IMPRESSION:
Pelvoabdominal mass with possible urinary bladder extension. Pelvic MRI is recommended for further evaluation. amenable
Normal sonogram of the right ovary. Non-visualized left ovary With refusal form
Chest / Abdomen xray (05/29/24 OSMAK) Chest: [x] repeat ABG not amenable
An ovoid opacity is noted in the left upper lung. Pulmonary vascular markings are within normal limits. The heart is not With refusal form
enlarged. Both hemidiaphragms and costophrenic angles are intact. Bony thorax is unremarkable. [ ] for CA 19-9 and CEA on Jun
Impression: 14, 2024
Consider pulmonary granuloma, left upper lung
 *Patient and relative amenable
Abdomen: for surgical procedure
The bowel gas pattern is within normal limits. Considerable amount of fecal material is noted in the colon.
There are no abnormal intra-abdominal calcifications. The soft tissues do not appear unusual. Advance directives (05/29/24)
The visualized bones are intact. Yes to all
Impression:
Fecal retention

Stool charting
06/11 2 loose stools
06/10 2 loose stools
06/09 3 watery stools
06/05 4 loose stools
Gyne 3 G3P2(2012) BPR 120-130/70-80 DAT with SAP CBC with PC
ALTA, MARIA SALOME Endometrial Endometrioid BP 130/80 Heplock Date Hgb Hct WBC S L M E Plt
ASENETA Carcinoma FIGO Grade 2 HR 65 06/11 10.3 L 0.29 L 17.8 H 81 12 5 2 200 06/07 – 1st session in HD
63 Stage IB RR 20 06/08 – 2nd session in HD
06/04 13.2 0.39 13.1 81 11 7 1 457
YC Anemia mild secondary to T 37.1 06/11 – 3rd session in HD
B+/NR
malignancy
Urinalysis
06/04/2024 AKI St III probably secondary I: 700
190223 to acute pyelonephritis O: 1000 Date Sugar Protein WBC RBC Epithelial Bacteria
Dr. Alfabeto/Tungcul/ Gavino, Post-operative ileus 06/04 Neg 2+ 29.5H 5.6 154.9 65.1
Roque (TL) /Posadas, t/c Acute pyelonephritis Ht: 155.2cm Chemistry:
Tugado/Tiongson, Jasarino from t/c partial gut Wt: 63.6kg Date BUN Crea BUA Na K Mg Cl Phos AST ALT HbA1c
obstruction BMI: 26.1 (Obese I) 06/11 4.04 80.85 138.54 3.03 L 0.59 L 0.86
0948H/ 1248H Acute gastroenteritis, no
EBL: 450 cc signs of dehydration, Referred for episode of 06/11 11.16 150.35 H 141.53 3.40 L 0.61 L 1.10
resolved upper back pain at 06/11 06/07 35.09 H 687.30 H 141.09 4.03 0.89 2.34 H
Diabetes Mellitus type II 1230H  Paracetamol
06/06 34.00 H 738.84 H
Hypertension Stage II 500mg/tab
Multinodular toxic goiter, 06/06 33.77 H 789.30 H 136.67 4.03 0.92
clinically and biochemically Anemia mild secondary to 06/05 30.36 H 756.67 H Anemia mild secondary to
euthyroid malignancy Ferrous sulfate 325mg/tab,1 tab malignancy
Multiple electrolyte (-) dizziness twice a day 06/05 27.04 H 734.44 H 132.83L No intervention for now
imbalance (Hypokalemia , (-) generalized body 06/04 22.57 H 704.29 H 4.55 93.56L 28.24 40.80 5.40
hypomagnesemia) secondary weakness
05/28 5.12 59.82 423.49H 139.34 3.93 105.09 34.53 51.98
to suboptimal intake (-) pallor
Pink palpebral conjunctiva Coagulation studies
s/p Ultrasound-guided IJ Date PT % Activity INR APTT Acute gastroenteritis with no
catheter insertion, Right Acute gastroenteritis with 06/04 12.6 96.2 1.12 32.3 signs of dehydration, resolved
(6/6/2024) no signs of dehydration, Thyroid Function tests For observation of recurrence o
s/p Exploratory Laparotomy, resolved Date FT3 FT4 TSH loose stools
Peritoneal fluid cytology, (-) epigastric pain None for now 05/28 2.80 1.23 2.90
Extrafascial hysterectomy, (-) nausea Fecalysis
bilateral (-) vomiting Date WBC RBC Other Others
salpingoophorectomy, (-) recurrence of loose stools 06/04 0-2 0-2 NO INTESTINAL PARASITE SEEN BUDDING YEAST CELLS – MODERATE
Bilateral lymph node (-) dry lips 12L ECG (06/04/24 OSMAK): NSR, normal axis, no hypertrophy, no ischemic changes
dissection under CLEA (-) sunken eyeballs Pregnancy Test (5/28 OSMAK): negative
(5/30/2024) last episode: 06/05 0530H, Ferritin (06/04 OSMAK): 710.80H
Day 13 semiformed Hepatitis profile (06/07)
AKI St III probably secondary t
s/p Ultrasound Guided IJ AKI St III probably acute pyelonephritis
Catheter insertion, right secondary to acute
TEST NAME OBSERVED VALUE NORMAL RANGE
under MAC pyelonephritis None for now IM Nephro (06/11/24)
(-) fever HEPATITIS PROFILE Referred to Dr Javellana agree
(-) edema [HbsAg] 0.48 < 1.0 with plans
(-) DOB/ SOB [HbsAg Remarks] NONREACTIVE Since with good urine output,
(-) dysuria with decreasing crea trends,
(-) hematuria [Anti-HCV] 0.09 < 0.9 HOLD HD after 3rd initiation
[Anti-HCV Remarks] NONREACTIVE Monitor creatinine trends ever
[Anti-HBc IgG] 2.03 1.00 3 days for 14 days
Monitor I and O
[Anti-HBc IgG Remarks] NONREACTIVE
Refer
[Anti-HBs] <2.00 < 10
[Anti-HBs Remarks] NONREACTIVE Urology 06/07/24)
Retrograde pyelography not
 Imaging indicated for now
Findings: No immediate surgical
Post-surgical changes are seen mid-lower abdomen. The uterus is surgically absent. There are small non-enhancing fluid intervention
collections (some with small air locules) seen in the mid pelvic region (adjacent the vaginal stump) and along the left lower Repeat KUB UTZ after 1 week t
abdomen / pelvic side wall. rule out hydronephrosis
The stomach is under distended (NGT noted). The large bowel loops appear grossly unremarkable. There are dilated jejunal bowel Continue present management
segments with no distinct transition point (maximal transverse diameter of 3.5 cm). There is also mild wall thickening of some Dr. Cuaresma updated
small bowel loops in the left abdomen. The appendix is not dilated. There is a small fat-containing umbilical hernia.
The liver is normal in size with smooth margins. No enhancing focal masses seen. There is no intrahepatic or extrahepatic biliary
ductal dilatation. There are no calcified intraluminal filling defects seen in the gallbladder. The gallbladder wall does not appear
thickened IM Cardio (6/8)
The spleen appears unremarkable. Noted s/p access creation,
There is fatty degeneration of the pancreas. The pancreatic duct is not dilated. respectfully signing out
The adrenal glands are unremarkable.
Both kidneys are normal in size and position. Minimal nonspecific bilateral perinephric stranding densities are seen. The Multiple electrolyte imbalance
pelvocalyceal systems and ureters are not dilated. There is no evidence of mass or lithiasis. (Hypokalemia ,
Multiple electrolyte The urinary bladder is under distended with an indwelling Foley catheter in place. hypomagnesemia) secondary
imbalance (Hypokalemia , There are no enlarged peritoneal / retroperitoneal lymph nodes to suboptimal intake
hypomagnesemia) KCL tab, 1 tablet every 8 hours Segmental calcifications are seen along the abdominal aorta and some of its branches. Ongoing K and Mg correction
secondary to suboptimal for 3 doses (TE 06/12 1200H) WAB CT scan with IVC (6/8/24) Osteophytes are seen along the margins of the visualized spine. There is multilevel facet arthrosis. Sclerotic foci are seen in the For repeat and Mg (06/12
intake MgSo4 1g. in 250cc D5W to run right ilium, greater and lesser trochanter of the right femur, and left acetabulum, representing bone islands. There is corduroy 1300H)
(-) weakness for 12 hours (TE 06/12 0900H) appearance of the T8 and T9 vertebral bodies.
(-) dizziness Reticulonodular and ground glass densities are seen in the visualized middle lobe segments and lingular segments. Linear IM Nephro (06/11/24)
(-) palpitations densities are seen in the visualized middle lobe segment and left lower lung segments. Correct K: KCL tab, 1 tablet
every 8 hours for 3 doses
IMPRESSION: Correct Mg: MgSo4 1g. in 250c
- S/P TAHBSO. Note of non-enhancing small fluid collections (some with air locules) in the mid pelvis / left pelvic side, may still be D5W to run for 12 hours
post-surgical in origin Repeat K and Mg post
- Ileus correction
- Note of mild wall thickening of several small bowel loops in the left hemiabdomen, may be inflammatory in origin Monitor I and O
- Small fat-containing umbilical hernia Refer
- Fatty degeneration of the pancreas
- Minimal nonspecific bilateral perinephric fat stranding, may relate to an inflammatory process. Correlate clinically. Post-operative ileus
Post-operative ileus - Atherosclerosis t/c Acute pyelonephritis
t/c Acute pyelonephritis - Degenerative changes of the spine from t/c partial gut obstructio
from t/c partial gut Cefuroxime 750mg IV q8 (Day - Consider vertebral hemangiomas, T8 and T9 referred back to Dr Copuyoc fo
obstruction 7+2) - Reticulonodular and ground-glass densities, middle lobe and lingula. Consider Koch’s vs non-Koch’s pneumonia Subsegmental final diagnosis of PGO-awaiting
(-) Abdominal pain Metronidazole 500mg IV q8 atelectasis versus fibrosis, middle lobe and left lower lobe notes
(-) Nausea and vomiting (Day 7+1) Previous study dated June 7, 2024 was reviewed.
(-) Anorexia Omeprazole 40mg IV q12h Correlation with CECT of the Whole Abdomen done June 8, 2024 was done.
(-) loose stools Present study shows further decrease in the caliber of the gas-filled small and large bowel segments. No differential air-fluid SURGERY 06/11
Last BM: 06/08 0600H levels noted. Diet and IVF c/o main service
No organomegaly appreciated. Facilitate KUB UTZ as scheduled
The rest of the soft tissue do not appear unusual. refer
Abdomen Upright-Supine (6/9/24)
Osteophytes are seen lining the margins of the visualized spine.
Partially visualized feeding tube is noted along the left upper quadrant. Diabetes Mellitus type II
Retained contrast media is seen along the large bowel segments. IM-Endo notes (06/09)
IMPRESSION: Patient seen and examined
Non-specific non-obstructive bowel gas pattern Continue insulin Glulisine slidin
Diabetes Mellitus type II Degenerative changes of the visualized spine scale
(-) polyphagia Insulin Glulisine sliding scale SC Consider decreased degree of small bowel obstruction
(-) polydipsia 180-220 4u Abdominal Xray (06/07/24) IM NST 06/09
Degenerative osseous changes
(-) polyuria 220-260 6u Consider decreased degree of small bowel obstruction Continue current diet for now
See CBG table 261-300 8u Degenerative osseous changes
>300u 10u, refer to IMROD Chest/ Abdominal X-ray official (06/06) Hypertension Stage II
Unchanged degree of small bowel obstruction For BP monitoring and record
Degenerative osseous changes Continue antihypertensive med
Hypertension Stage II KUB UTZ (06/06, OsMak) Findings – patient’s stocks
(-) headache Metoprolol 100mg/tab, 1/2 tab Both kidneys are normal in size with smooth and regular contour and increased parenchymal echogenicity.
(-) dizziness OD The cortico-medullary pattern in both sides is intact.
(-) nape pain Amlodipine 10mg/tab, 1 tab OD The right kidney measures 10.3 x 4.8 x 5.6 cm with cortical thickness of 0.9 cm.
(-) chest pain Atorvastatin 20mg/tab,1 tab OD The left kidney measures 9.9 x 5 x 4.2 cm with cortical thickness of 0.7 cm. Multinodular Goiter clinically
(-) DOB/SOB There is no evidence of hydronephrosis, lithiasis or mass noted in both kidneys. and biochemically euthyroid
(-) chest pain The urinary bladder is underdistended with a volume of 98 ml, precluding optimal evaluation. A Foley catheter balloon is noted IM ENDO (6/9/24)
(-) orthopnea within. Repeat TFT (FT3, FT4, TSH) afte
Impression: 6 weeks (July 10, 2024)
Multinodular Goiter, - Underdistended urinary bladder with Foley catheter
clinically and biochemically No meds for now - Normal sized kidneys with sonographic signs of parenchymal disease. Correlate clinically.
euthyroid Unchanged Ileus
(-) palpitations Abdominal Xray 06/05 Still considering SBO
(-) tremors Bowel diameter: 6cm Gyne Wise
(-) chest pain Previous study dated June 2, 2024 was reviewed. For discharge today
(-) DOB/SOB The dilated gas-filled small bowels are again seen. Definitive plan: For vaginal
Obliquely oriented rows of small gas bubbles are seen. brachytherapy; possible EBRT
Gyne Wise Few differential air-fluid levels are identified. For gradual diet progression, fo
No hypogastric pain None Rectal gas is apparent. monitoring of creatinine trends
No profuse vaginal bleeding Flank stripes and psoas shadows are intact. hemodialysis c/o Nephro servic
(+) well coaptated post-op There are no abnormal intra-abdominal calcifications. VSq4h for now
scar The soft tissues do not appear unusual. Incentive spirometry 10-15x
No erythema or discharge Abdominal Xray 6/4 Dr. Catanaoan /hour q waking hours
Osteophytes line the visualized lumbar spine and bilateral anterior superior iliac spines.
Impression: Encourage careful ambulation,
Abdominal girth: Consider beginning small bowel obstruction. Close follow-up is suggested deep breathing exercises
06/11 106 cm Degenerative osseous changes Apply compression stockings q
06/10 105 cm -------------- hours on/off
06/09 106cm Follow-up study was done on June 5, 2024 showing no significant change in the dilated gas-filled bowels. The rest of the WOF: severe hypogastric pain,
06/08 109cm abdominal findings are unchanged. profuse vaginal bleeding
06/07 104cm Bowel diameter: 5.8cm
06/06 104cm Previous study dated May 28, 2024 was reviewed.
The lungs are hypoaerated with bronchovascular crowding. IM-Notes (06/12)
06/05 102 cm
The heart is magnified. Noted plans for discharge
Calcifications are seen along the aortic walls. No objections IM wise
Both hemidiaphragms and costophrenic sulci are intact. endo and nephro signing out
CXR 06/04 Osteophytes are seen lining the margins of the visualized spine. THM
There is an interval placement of a feeding tube with its tip within the gastric bubble. 1) KCL 750mg/tab,1 tab TID x 5
Impression: days
Low lung volume 2) Amlodipine 50mg/tab, 1 tab
Atheromatous aorta OD
Degenerative osseous changes of the visualized spine 3) Metoprolol 50mg/tab,1 tab
The gas-filled small bowels are dilated with maximum diameter of 5.1 cm. No differential air-fluid levels identified. BID
Rectal gas is apparent. 4) Atorvastatin 40mg/.tab,1 tab
Flank stripes and psoas shadows are intact. ODHS
There are no abnormal intra-abdominal calcifications. Referred to Dr Jaellaran
Abdomen supine-upright 06/02/2024, (nephro) suggesting removal of
The soft tissues do not appear unusual.
OSMAK IJ cath prior to discharge
Osteophytes line the visualized lumbar spine and bilateral anterior superior iliac spines.
Impression To resume metformin at OPD
Ileus. Short interval follow-up is recommended. with stable creatinine
Degenerative osseous changes
Clinical data: Known case of endometrial cancer; for metastatic work-up Pending:
Comparison: None [ ] TSR urine CS c/o ACE patero
Findings: (06/10)
The liver is normal in size with increased parenchymal echogenicity. [ ] Repeat TFT (FT3, FT4, TSH)
There are no focal mass lesions noted. after 6 weeks (July 10, 2024)
The intrahepatic ducts are not dilated. [ ] KUB UTZ after 1 week (June
The gallbladder is normal in size measuring 5 x 2.3 cm. 13,2024, 9-10 AM) c/o Dr
Its wall is not thickened measuring 0.2 cm. No pericholecystic fluid seen. Obsum
There are no intraluminal echoes or focal lesions noted. [X] Ideally for ABG – refused
The common duct is not dilated to the extent visualized measuring 0.3 cm.
The visualized pancreas and spleen are normal in size and echotexture.
WAB UTZ 05/29/2024 There are no focal lesions appreciated.
Both kidneys are normal in size with smooth and regular contour.
The cortico-medullary pattern in both sides is intact.
The right kidney measures 10 x 5.4 x 3.3 cm with cortical thickness of 0.8 cm.
The left kidney measures 9.5 x 4.2 x 3.8 cm with cortical thickness of 0.7 cm.
There is no evidence of hydronephrosis, lithiasis or mass noted in both kidneys.
The urinary bladder is under-distended with volume of 15 mL.
There are no intraluminal echoes or focal mass seen.
Impression
Mild fatty liver
Underdistended urinary bladder
Unremarkable sonogram of the gallbladder, visualized pancreas, spleen and both kidneys
Chest x-ray (05/28 OSMAK) Previous study dated March 8, 2024 was reviewed.
Present study shows no active parenchymal opacities in both lungs.
Pulmonary vascular markings are within normal limits.
Heart is enlarged.
 Some calcifications are seen along the walls of the aorta.
Both hemidiaphragms and costophrenic angles are intact.
Osteophytes line the margins of the visualized spine.
Impression:
Cardiomegaly
Atherosclerotic aorta
Thoracic spondylosis
The uterus is anteverted with smooth contour and homogeneous echopattern measuring 5.05 x 5.31 x 2.69 cm.
The cervix measures 2.86 x 2.52 × 1.93 cm with homogeneous stroma and distinct endocervical canal.
The endometrium measures 1.43 cm, with mixed echogenicity, heterogenous, midline echo not defined, irregular endometrial-
myometrial junction, strong color on Doppler (color score 4).
The right ovary measures 1.50 x 1.10 x 0.97 cm (vol: 0.87 ml) with several follicles less than 1 cm in diameter.
The left ovary measures 1.47 x 1.35 x 0.68 cm (vol: 0.71 ml) with several follicles less than 1 cm in diameter.
Transvaginal/Transabdominal UTZ
There is no fluid in the posterior cul-de-sac.
(1/11/24) – Makatilife
Impression:
NORMAL-SIZED, RETROVERTED UTERUS WITH A THICKENED ENDOMETRIUM WITH STRONG FLOW ON COLOR MAPPING
SUGGESTIVE OF ENDOMETRIAL PATHOLOGY.
ATROPHIC OVARIES.
NO UTERINE OR ADNEXAL MASS.
NO FLUID IN THE POSTERIOR CUL-DE-SAC.

CBG monitoring
Date 0000H 0400H 0800H 1000H 1200H 1600H 2000H
06/09 DISCONTINUED
06/08 89 94 102 - 86 83 88
06/07 96 97 96 - 90 83 84
06/06 92 97 97 - 105 84 94
06/05 - - 130 109 103 85 83

Intraoperative findings:
IE under anesthesia: Normal external genitalia, smooth vagina, cervix 2x2 cm, no adnexal masses, intact rectovaginal septum, bilateral parametria smooth and pliable.
There was no ascites. 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 no palpable pelvic or paraaortic nodes.
The uterus measured 6.0 x 5.5 x 3.0 cm, with a smooth and tan serosal surface. The cervix was not dilated and uneffaced with a smooth ectocervix.
The right ovary was atrophic; measuring 2.5 x 1.5 x 1.0 cm; the left ovary is likewise atrophic measuring 2.0 x 1.0 x 1.0cm
The right fallopian tube measured 7.0 x 0.5 x 1.0 cm
The left fallopian tube measured 6.0 x0.5 x 0.5 cm.
The right and left pelvic lymph nodes, were noted to be several pieces of yellow tan, fibrofatty tissue. The right pelvic lymph nodes measured 5.0 x 4.0 x 1.0 cm. The left pelvic lymph nodes
measures5.0 x 4.0 x 1.0 cm.
Noted with 3 subcentimeter myoma nodules on the anterior mid portion, right lateral anterior portion, and right lateral portion of the uterus

Histopathology findings (06/05/2024)

SPECIMEN: UTERUS; RIGHT AND LEFT FALLOPIAN TUBE; RIGHT AND LEFT OVARIES; RIGHT AND LEFT PELVIC LYMPH NODES
A,B AND C. S/P HYSTERECTOMY, BILATERAL SALPINGO-OOPHORECTOMY AND LYMPH NODE DISSECTION
-- ENDOMETRIAL ENDOMETRIOID CARCINOMA, NOT OTHERWISE SPECIFIED, FIGO GRADE 2
-- TUMOR INVADES ONE-HALF (50%) OF MYOMETRIAL THICKNESS
-- MYOINVASIVE LOWER UTERINE SEGMENT INVOLVEMENT PRESENT
-- TUMOR DOES NOT INVADE THE STROMAL CONNECTIVE TISSUE OF THE CERVIX
-- LYMPHOVASCULAR INVASION NOT IDENTIFIED
-- ALL MARGINS NEGATIVE FOR CARCINOMA
-- ALL 6 REGIONAL LYMPH NODES (3 RIGHT PELVIC, 3 LEFT PELVIC), NEGATIVE FOR TUMOR CELLS
-- NEGATVE FOR TUMOR INVOLVEMENT: RIGHT AND LEFT PARAMETRIA; RIGHT AND LEFT FALLOPIAN TUBES
-- ADENOMYOSIS
-- SUBSEROUS AND INTRAMURAL LEIOMYOMAS
-- CHRONIC CERVICITIS
PERITONEAL FLUID: CYTOLOGY AND CELL BLOCK
-- NEGATIVE FOR MALIGNANT CELLS
-- REACTIVE MESOTHELIAL ATYPIA PRESENT
Gyne 4 G3P3 (3003) BPR 110-120/60-70 TCR 1500kcal (SF 25x60) using CBC with PC
ADRIATICO, ROWENA DE LA Poorly differentiated BP 110/60 ensure gold, divided into 6 equal Date Hgb Hct WBC S L M E Plt
REA carcinoma with mucinous HR 100 feedings via NGT 06/08 s/p
59 features, cervix stage IIB RR 20 Macros: BT of 3u 10.2 L 0.31 L 35.2 H 89 H 4 7 0 187 *2u FFP secured c/o Maam
NYC Menopause x 9 years T 37.3 CHON 60g 240kcal pRBC Diane
Blood transfusion of 3 units O2 sat 97% CHO 189 >86kcal
06/04 9.4 L 0.29 L 41.3 H 89 H 5 5 6 152
05/28/2024 pRBC for anemia severe Fats 56g 50kcal
101224 secondary to malignancy, I: 1930 IVF: Heplock 06/02 11.1 0.34 39 H 88 H 5 7 227
Dr Alfabeto/ Tungcul corrected O: 1100 Limit fluid intake to <1.2L/day 06/01 10.4 L 0.32 L 34.1 H 87 H 6 7 - 196
Ballesteros(TL)/Gavino/ De Hyponatremia, probably (+) cardiac monitor 05/29
Guia Gauiran/Kadappurath secondary to suboptimal Ht: 157cm (+) O2 support FM @ 10 LPM s/p BT of 11.8 0.36 36.4 H 90 H 5 5 271
Tiongson intake Wt: 45kg (+) IFC 2u pRBC
Hypokalemia, BMI: 18.3 (underweight) 05/28 7.5 L 0.23 L 39.9 H 87 H 8 5 - 388
Hypomagnesemia secondary
O+/NR
to suboptimal intake, Last febrile episode 06/10
Urinalysis
corrected 0030H  37.7  TSB 
Pleural effusion (bilateral) 37.4 Date Sugar Protein WBC RBC Epithelial Bacteria
probably secondary to 1) t/c 06/03 NEG Trace 2.0 2.8 32 8.8 Anemia severe secondary to
parapneumonic process Anemia severe secondary 05/28 Neg Neg 15-18 H 2-4 Few Moderate malignancy, corrected
2) paramalignant process to malignancy, corrected TFTs s/p BT of 3u pRBC
Subclinical Hypothyroidism (-) hypotension Date FT3 FT4 TSH
t/c fever of malignancy (-) dizziness 06/03 0.66 L 0.47 L 3.41
Asymptomatic bacteriuria, (-) generalized body Coagulation studies ``````
resolved weakness s/p BT of 3u pRBC Date PT % Activity INR APTT
Hyperglycemia secondary to (-) pallor Pre-BT meds:
06/03 15.3 H 74.9 1.38 H 54.1 H
infection slightly pale palpebral 1) Diphenhydramine 50mg TIV-
05/29 15.8 H 71.6 1.43 H 53.0 H
Hyperbilirubinemia conjunctivae given
Chemistry:
2)Paracetamol 300mg TIV
s/p Cervical punch biopsy Regulate IVF to KVO during BT- RBS LDH Total Globulin A/G BUA Na K Mg P Tca Pho Alb Trop ALT AST
Date BUN Crea
(03/21/2024) given Protein Ratio s I
Furosemide 40mg TIV post BT- 9.06 23.86
06/12
given
388.66 11.58 132.72 3.83
Hypoalbuminemia Calcium gluconate 10% 10cc 06/11 53.44 Hypoalbuminemia
H H L
(-) edema SIVP post BT of 3u PRBC-given
(-) fatigue 10.01 132.02 3.31 0.81 0.80 23.33 IM NST notes (06/10)
06/10 53.93
(-) DOB H L L L If with electrolytes within
(+) loss of appetite 127.68 2.54 0.64 normal value will adjust diet
06/09 11.68H 60.06
L L L
11.69 240.95 50.75 L 27.90 0.82 22.85
06/06
Hyponatremia, probably H L
136.56 3.94 23.96 15.08 Hyponatremia, probably
secondary to suboptimal 06/02 2.76 50.23
L secondary to suboptimal intak
intake Human albumin 20% 1 vial 2x a
Hypokalemia,
Hypokalemia, day for 3 days – completed 133.42 3.22 0.20
06/01 Hypomagnesemia secondary
Hypomagnesemia L L
to suboptimal intake, correcte
secondary to suboptimal 3.37
05/31
intake, corrected L
IM Nephro (06/12)
(-) chest pain 134 L 3.10 19.22
05/30 hyponatremia dilutional from
(-) DOB/SOB L L
volume overload
(-) dyspnea KCL 750mg/tab, 2 tabs every 4 134.57 2.83 0.83 1.82 1.13 17.59
05/29 Hypoalbuminemia sec to 1)
(-) anorexia hours for 6 doses - completed L L L L nutritional 2) malignancy
Mg So4 drip: 1g in 250cc D5W 05/28 129.67 2.14 0.78 Ideally for NGT feeding for
Cranial nerves x24hrs - completed PM L L nutritional build-up-patient
II, III: (+) 3mm EBRTL Omeprazole 40mg TIV OD 125.20 2.44
05/28 2.86 42.08 amenable
III, IV, VI: (+) EOMs, primary Furosemide 40mg/tab, 1 tab L L Shift diet to TCR 1500kcal (SF
gaze midline every 8 hours for 3 doses - Bilirubin studies 25x60) using ensure gold,
V: V1-V3 intact completed Total Direct Indirect
Date divided into 6 equal feedings vi
VII: No facial asymmetry
NGT
VIII: (+) gross hearing 90.94 H 84.42 H 6.52
06/11 Macros:
IX, X: Can swallow
CHON 60g 240kcal
XI: Good shoulder shrug FBS (06/11): 6.24 -> 112.32 CHO 189 >86kcal
XII: tongue midline Hba1c (06/10): 5.41 Fats 56g 50kcal
PBS (04/30/2024 OSMAK): CBG q8 prefeeding
Motor Platelets: Moderately increased For NGT feeding after procedur
RUE 5/5 LUE 5/5 RBC: Mild microcytosis. Hypochromia with anisocytosis. Resume furosemide 40mg TIV
RLE 5/5 LLE 5/5 WBC: No abnormal cells seen. q12 after albumin 1 vial infusio
12L ECG (05/28 OSMAK): ECG Normal sinus rhythm, left axis deviation, no chamber enlargement, no T wave inversion V2-V4 No objection for thoracic drain
Sensory 12L ECG (05/31 OSMAK): Incomplete bundle branch block, left axis deviation insertion
RUE 100% LUE 100% 12L ECG (06/11 OSMAK): sinus tachycardia, t-wave inversion v1-v4, left axis deviation, poor r wave progression
RLE 100% LLE 100% Urine CS 05/30, HealthSTAT No growth after 24 hours of incubation
Urine GS 05/30 , HealthSTAT Pus cells 0-1; EC 0-1; No microorganisms seen
Pleural effusion (bilateral) Blood CS 05/30, HealthSTAT No growth after 5 hours of incubation
probably secondary to 1) ABGs
t/c parapneumonic process pO2 HCO3 BE SO2
Date pH pCO2
2) paramalignant process
(-) DOB/SOB 05/31 7.55 45 105 39.4 15.2 99
(-) pleuritic chest pain
(-) cough
(-) night sweats
(-) weight loss
Decreased breath sounds
bilateral bases
Decreased vocal fremitus
Last desaturation episode:
06/03 0015H 87% -> 95% 
FM @ 10 lpm  91%
(0255H)
Subclinical Hypothyroidism
(-) palpitation
(-) heat intolerance
(-) increase in weight
Asymptomatic bacteriuria,
resolved
(-) dysuria
(-) hematuria
(-) increased urinary
frequency
(-) fever
(-) chills
t/c fever of malignancy
no recurrence of fever
no chills
no generalized body
weakness
Last febrile episode 06/04,
1545, given Paracetamol
37.1
Imaging
CXRi (06/12 OSMAK) c/o Dr Arellano
Meropenem 1g TIV every 8
hours (Day 7)-completed 06/11
Furosemide 40mg TIV q12h
Hemithorax Ultrasound (June 2, 2024
WAB and chest CT SCAN with IV contrast
Metoprolol 50 mg/tab 1 tab BID
Fosfomycin 3g/sachet in ½ glass
of water as single dose- given
Paracetamol 600mg TIV q6 PRN
for pain/fever
Ultrasound Guided Thoracentesis
OSMAK
(06/06/24)
Chest Xray initial (6/5) on day 3 of
Meropenem – c/o Dr. Rafael
OsMak)
CXR (06/01/24 OSMAK)
(05/30/24 OSMAK)
Progression of pulmonary congestion
Bilateral pleural effusion, slight progression on the left, unchanged on the right
Scanning of the left hemithorax shows free fluid collection measuring approximately 665 ml.
Marking was done at the left mid to lower posterior chest wall.
Asepsis/antisepsis, local anesthesia infiltration and thoracentesis performed by IM ROD.
After insertion of thoracentesis needle, tip was noted to be inside the hemithorax but with no output.
Another attempt of thoracentesis was done; needle observed to enter hemithorax initially but no output was observed.
Procedure was eventually deferred.
Progression of bilateral pleural effusion, no changes in pulmonary congestion Pleural effusion (bilateral)
There is evidence of free fluid collection in both hemithoraces with an approximate volume of at least 273.11 ml on the probably secondary to 1) t/c
right and 752.35 ml on the left. parapneumonic process
There is no evid ence of septations. 2) paramalignant process
Atelectasis of the underlying lung is present. Immediate plan: For pleural
IMPRESSION catheter insertion (with pleura
Bilateral pleural effusion, minimal on right, moderate on left biopsy) c/o Surgery service,
Pulmonary congestion. Concomitant pneumonia cannot be ruled out awaiting final OR schedule
Progression of bilateral pleural effusion Referred back to Surgery (Dr.
Atheromatous aorta San Andres) for Thoracic Drain
Findings: insertion scheduling and
Multiple, varisized non-calcified, non-enhancing pulmonary nodules are seen in the apical and posterior segments of the approved MARF
right upper lobe, apicoposterior, anterior and lingular segments of the left upper lobe and in the visualized segments of
both lower lobes. The largest on the right is located in the posterior segment of the upper lobe measuring 0.8 x 0.6 x 0.9
cm (ApxWxCC), while the largest on the left is in the superior lingular segment measuring 0.6 x 0.9 x 0.9 cm. IM MRA/Pulmo notes (06/11)
Moderate amount of fluid is noted in both hemithoraces with atelectasis of the adjacent lung segments. Noted plans for thoracic drain
Reticular and ground-glass densities are seen in the apicoposterior and lingular segments of the left upper lobe and in insertion
the superior segment of the left lower lobe. Linear densities are also seen in the medial segment of the right middle MRA: intermediate risk
lobe, superior lingular segment of the left upper lobe and superior segment of the right lower lobe. Pulmo-no objection for
Mediastinal structures are in place. The heart is slight enlarged, with minimal pericardial fluid The aorta and great procedure
vessels are normal in course and caliber. Small intimal calcifications line the aorta.
Trachea and mainstem bronchi are patent with no endobronchial lesion. Surgery/TCVS Notes (06/10)
Prominent lymph nodes are seen in the left infraclavicular, paraesophageal and paratracheal regions with the largest on Still for thoracic drain Insertion
the infraclavicular region measuring 0.9 cm at its shortest diameter. + pleural biopsy left
Sclerotic foci are seen in the T6 vertebra, left humeral head, 3rd left posterior rib and 7th left lateral rib, likely bone Still awaiting MRA clearance
islands. Small osteophytes line some of the visualized spine. please facilitate electrolyte
correction
Impression: To secure 2u FPP for procedure
- Multiple non-calcified pulmonary nodules in both lungs. Consider metastasis. Interval follow-up is suggested. surgery-done
- Moderate bilateral pleural effusion with passive atelectasis
- Reticular and ground-glass densities in the left upper and lower lobes, may be infectious/inflammatory in etiology Anesthesiology notes (06/11)
- Subsegmental telectasis versus fibroses, both lungs Thank you for this referral
- Paraesophageal, paratracheal and left infraclavicular lymphadenopathy Patient seen and examined
- Mild cardiomegaly History and PE done
- Minimal pericardial effusion Ancillaries noted
- Atherosclerotic vessel disease Anesthesia plans, risks, and
- Mild degenerative osseous changes complications explained and
-------------------------- understood by relative
CECT of the ABDOMEN: NPO 8hrs prior to OR
FINDINGS: Meds:
The cervix and the lower uterine segment are enlarged exhibiting irregular contour with heterogenous enhancement. It Omeprazole 40mg TIV OD once
is intimately related to the urinary bladder anteriorly and posteriorly to the rectosigmoid colon. A small, subserosal, on NPO
round, heterogeneously enhancing lesion is seen in fundal region measuring 0.9 x 0.9 x 0.9 cm. Endometrium is fluid For CBG and vital signs 30 mins
filled. Both ovaries are not clearly delineated. prior to OR
There is circumferential wall thickening of the rectum with a maximum thickness of 1.6 cm. Perirectal stranding densities Inform AROD at local 1416 prio
are noted. The included esophagus, stomach and the rest of the intestinal segments are grossly normal. to wheel in to OR
Prominent to enlarged, enhancing and necrotic lymph nodes are seen in the right retrocrural, peripancreatic, aortocaval, Will refer to our service
paraaortic, mesorectal and bilateral common and internal iliac chains. The largest is seen in the aorto-caval region consultant
measuring 3.9 x 3.4 x 4.6 cm. Refer accordingly
Fluid is seen in the perihepatic, perisplenic, bilateral paracolic and pelvic regions.
The liver is not enlarged with smooth contour. Intrahepatic ducts are not dilated. Portal vein is patent. No abnormal Subclinical Hypothyroidism
enhancement after contrast infusion. IM Endo (06/10)
The gallbladder is normal in size. Mutiple calcific densities are seen aggregately measuring of 2.5 cm. Wall is not Referred to Dr. Ambra
thickened. Minimal pericholecystic fluid is noted. Common duct is not dilated. Repeat FT3, FT4, TSH after 6
The pancreas is normal in size and with normal configuration. Pancreatic duct is not dilated. weeks
The spleen and adrenal glands are normal without undue enhancement. Tx:
Both kidneys are normal in size and exhibit prompt and bilateral nephrogram. Non-enhancing, fluid attenuating foci are Start Metoprolol 50 mg/tab 1

Hyperglycemia secondary
to infection
(-) decrease in sensorium
(-) DOB
Hyperbilirubinemia
(+) jaundice
(-) abdominal pain
(-) pale stools
(-) change in sensorium
Icteric sclerae
Gyne wise
No profuse vaginal bleeding
No severe hypogastric pain
Menopause x 9 years
Soft flabby abdomen
Abdominal girth: 99cm
PE with Dr. Alfabeto (05/30)
Cervix is converted into
8x8cm exophytic and friable
mass, extending to the
middle third of the vagina
anteriorly and on the right
Corpus small, no adnexal
masses, bilateral parametria
nodular medially with
clearance
Pad count: 0
seen in the left kidney with the largest in the superior pole measuring 2.9 x 2.5 x 2.6 cm. No evidence of hydronephrosis tab BID
or opaque lithiasis. Ureters are not dilated.
The urinary bladder is underfilled with Foley catheter balloon seen within.
Sclerotic foci are seen in the bilateral ilium, right acetabulum, bilateral femoral heads and proximal left femur, likely
bone islands. Small marginal osteophytes line some of the visualized spine. Asymptomatic bacteriuria,
Linear subcutaneous hyperdensities are seen in the chest wall, abdominal wall, and proximal thighs. resolved
Insulin Glulisine sliding scale Impression: No active management for now
CBG - Irregular, thickened and heterogenous enhancing cervix and lower uterine segment; known case of cervical carcinoma
181-220: 2u - Circumferential rectal wall thickening, may be extension of malignancy versus infectious/inflammatory in etiology.
221-260: 4u Colonoscopy is suggested for further evaluation.
261-300: 6u - Diffuse retroperitoneal and pelvic lymphadenopathy, likely metastatic
>300 8u and refer - Ascites
- Cholecystolithiases with minimal pericholecystic fluid
- Left renal cysts (Bosniak I) t/c fever of malignancy
- Mild degenerative osseous changes
- Anasarca IDS (06/10)
There is evidence of fluid collection in both hemithoraces with an approximate volume of at least 389 mL on the right Still for pleural catheter
and 453 mL on the left. insertion
There is no evidence of septations. Please facilitate pleural fluid
No meds for now Hemithorax UTZ (05/29) studies
Atelectasis of the underlying lung is seen.
Impression Continue Meropenem 1g TIV
Bilateral minimal pleural effusions, more on the left q8h to complete 7 days
Bilateral pleural effusion. Other underlying lung pathologies (eg. Pneumonia) are not ruled out. No objections for procedure
Chest x-ray (05/28/24 OSMAK) No objections for THOC
Atherosclerotic aorta
Findings:
Uterus is anteverted, normal in size measuring 5.5 x 3.5 x 5.3 cm. Hyperglycemia secondary to
Myometrial echopattern is homogeneous. infection
Ferrous Sulfate 325mg/tab, 1 Endometrial lining is not thickened measuring 0.17 cm. Fluid is seen within the endometrium. IM Endo (06/11/24)
tab twice a day-HOLD Cervix is enlarged measuring 5.7 x 5.1 x 5.4 cm. No objections for thoracic drain
Mefenamic Acid 500mg/tab, 1 A large heterogenous predominantly hypoechoic mass is seen encompassing the cervix measuring 5.4 x 4.7 x 4.8 cm. It insertion
tab every 8hrs as needed for shows increased vascularity upon Doppler interrogation. Target CBG for inpatient is 140
pain Tranexamic Acid TVS UTZ (03/25/24 OSMAK) The right ovary is not visualized. 180
500mg/tab, 1 tab every 8 hours The left ovary is normal in size measuring 2.2 x 1.8 x 2.2 cm (volume of 4.5 cc)
as needed for vaginal bleeding No definite evidence of fluid seen in the posterior cul-de-sac. Hyperbilirubinemia
IMPRESSION IM- Gastro Notes (06/11/24)
- Normal-sized uterus with non-thickened fluid filled endometrium. On WAB CT 5/31, noted
- Enlarged cervix with heterogenous mass, worrisome for a neoplastic process. Tissue correlation is suggested. multiple calcific densities
- Normal sized right ovary aggregately measuring 2.5cm
- Non visualized left ovary Since with epigastric
S/P CERVICAL PUNCH BIOPSY (04/24/24 OSMAK) tenderness, icteric sclerae,
suggesting surgery evaluation,
-- POORLY DIFFERENTIATED CARCINOMA WITH MUCINOUS FEATURES
HBTP UTZ to see if with
cholecystitis and CBD dilation
Ultrasound guided thoracentesis (06/06, OsMak)
Scanning of the left hemithorax shows free fluid collection measuring approximately 665 ml.
Marking was done at the left mid to lower posterior chest wall.
Asepsis/antisepsis, local anesthesia infiltration and thoracentesis performed by IM ROD.
After insertion of thoracentesis needle, tip was noted to be inside the hemithorax but with no output.
Another attempt of thoracentesis was done; needle observed to enter hemithorax initially but no output was observed. Gyne wise
Procedure was eventually deferred. Definitive Plan: For possible
chemotherapy with concurrent
CBG monitoring pelvic EBRT with brachytherapy
Date 0500H 1100H 1700H 2030H For referral to Anes service onc
with final OR schedule for
6/11 105 115 117 117
surgery
6/10 - 117 124 108
For referral back to MRA servic
6/9 252 174 132 129
for clearance once electrolyte
6/8 120 173 117 120 corrected
6/7 127 125 100 132 Pad count qshift
Monitor vsq2
6/6 235 137 133 125 Monitor I&O q shift
6/5 190  WOF: severe hypogastric pain,
referred to profuse vaginal bleeding
Endo
Pending:
[ ] Sputum GS CS (for send out)
amenable for send out to GA;
 still unable to collect sample
[ ] for repeat ABG – for send
out, refused, with form
[ ] HBTP UTZ on June 14, 2024
AM to call first prior c/o Dr
Catanaoan

CLEARANCE UPDATE
(referred all to Dr Pagarigan)
[/] IM Cardio/MRA
[/] IM Pulmo
[/] IM Endo
[/] IM Gastro

Advanced directives: YES TO

ALL (06/02/2024)
Gyne 6 Nulligravid BP 120/80 DAT with SAP CBC with PC
LOPEZ, QUEYZEE ROLDAN AUB- O HR 78 IVF: PNSS 1L x KVO while on BT Date Hgb Hct WBC S L M E Plt
37 PCOS RR 20 06/11
NYC Blood transfusion of 4 units T 36.8 s/p BT of 9.5 L 0.29 L 9.3 75 16 7 2 265
pRBC for Anemia severe 4u pRBC
06/10/2024 secondary to acute blood loss I: 1400
06/10
3932261 PCOS O: 2000
s/p BT of 6.3 L 0.20 L 11.2 79 13 7 1 294
Dr Santos/ Tungcul Go/Roque Obese II
2u pRBC
Reyes(TL)/Gauiran Ht:155cm
06/09 5.0 L 0.16 L 8.4 74 16 8 2 329
Tugado/Alzaga Papillary thyroid Wt:87kg
microcarcinoma, low risk BMI: 36.1 (Obese II) O+/NR
s/p total Thyroidectomy Urinalysis
(2010, PGH) Anemia severe secondary Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte
to 1) acute blood loss 2) s/p BT of 4u pRBC 06/09 Neg Neg 0.4 0.2 5.5 1.5 Neg Anemia severe secondary to 1
Iron deficiency anemia Diphenhydramine 50mg TIV 30 06/09 Neg +2 H 157.3 H 176.7 H 182.6 H 3666.7 H +1 H acute blood loss 2) Iron
(-) dizziness mins prior to BT – given 06/09 Neg +1 H 147.0 H 35.0 H 115.7 H 1735.9 H +2 H deficiency anemia
(-) generalized body Calcium gluconate 10% 10cc Chemistry: s/p BT of 4u PRBC
weakness SIVP post BT of 3u PRBC - given Date BUN Crea BUA Na K Cl AST ALT TSR PBS result (done 06/09)
(-) pallor
06/09 3.23 93.77 H 476.77 H 137.79 3.50 100.49 22.67 27.76
(-) DOB/SOB
Pink palpebral conjunctiva Coagulation studies
Date PT % Activity INR APTT
Papillary thyroid 06/09 12.8 94.8 1.14 33.5
microcarcinoma, Low risk Thyroid function tests (06/10/24)
(-) palpitations Date FT3 FT4 TSH Papillary thyroid
(-) tremors levothyroxine 125 mcg/day 06/10 1.90 L 1.44 2.53 microcarcinoma, Low risk
(-) chest pain Ferritin (6/9/24 OSMAK): 18.00 L Continue previous meds for
(-) heat intolerance Reticulocyte count (05/09 OSMAK): 4.8 H now
(-) sudden weight loss Direct COOMBs Test (05/09 OSMAK): Negative Referred back to IM Endo c/o D
Indirect COOMBs Test (05/09 OSMAK): Negative Ramirez for clearance prior to
Pregnancy test (06/09/24): Negative discharge-awaiting notes
Fecal occult blood (06/09 OSMAK): Negative
12L ECG (6/9/24 OSMAK): Sinus rhythm, normal axis, LVH, no ischemia IM Endo Notes (06/10)
Imaging Noted >10 year history of
Chest xray (06/09/24 OSMAK) No acute parenchymal opacities reported no signs of recurrence
and with initial TG levels at low
normal values consider patient
as low risk papillary thyroid
microcarcinoma
Target: TSH level of 0.5-2.0
IU/ml
Increase levothyroxine from
112.5 mcg/day to 125 mcg/day
Repeat serum TSH after 6 week
May continue Calcium
supplementation

Gyne wise
Gyne wise For possible discharge today
No profuse vaginal bleeding Awaiting final result of TVS UT
No severe hypogastric pain Ferrous Sulfate 325mg/tab, 1 c/o OB sono rotator as OPD
 (+) vaginal spotting
LMP 5/29-6/8
PMP 5/4-10/2024
PMP 4/12-18/2024
Abdomen flabby soft non-
tender, (-) muscle guarding
(-) rebound tenderness
tab twice a day basis
Mefenamic Acid 500mg/tab, 1 Pad count q shift
tab every 8hrs as needed for Complete bed rest without
pain bathroom privilege
Tranexamic Acid 1g TIV every 8 WOF: severe hypogastric pain,
hours as needed for vaginal profuse vaginal bleeding
bleeding

SE: Cervix pink, no mass, no

erosions, minimal bleeding
per OS

IE: Cervix 2x2 cm, smooth,

closed, (-) CMT, uterus
cannot be fully palpated due
to flabby abdomen, (-) AMT

RVE: free bilateral

parametria

Pad count: 1 minimally

soaked diaper

GYNE 5 G2P2 (2002) BP 140/80 DAT with SAP CBC with PC

LOMBOY, MICHELLE PANICAN Squamous cell carcinoma of HR 84 PNSS 1L x KVO Date Hgb Hct WBC S L M E Plt
43 the cervix St IIB RR 20 06/11
YC Blood transfusion of 3u pRBC T 36.8 s/p BT of 9.8L 0.30L 10.9 79 9 6 6 287
for anemia severe secondary 3u
06/09/2024 to malignancy I: 2000
06/10
56374 Leiomyoma uteri O: 1700 8.9 L 0.27 L 10.5 74 11 7 8 305
Stat CBC
Dr Alfabeto/Tungcul Ovarian new growth, left
06/10
Go(TL)/Roque Reyes/Gauiran Ht:150cm
s/p BT of 9.5 L 0.29 L 10.6 78 7 7 8 322
Tugado/Alzaga Urinary tract infection Wt:72.5kg
2u pRBC
Obese II BMI: 32.2 (Obese II)
06/09 7.7 L 0.24 L 9.9 64 18 9 9 359
S/p Cervical punch biopsy Anemia severe secondary s/p BT of 3u PRBC O+/NR
(01/12/2024) to malignancy Diphenhydramine 50mg TIV 30 Urinalysis Anemia severe secondary to
(-) dizziness mins prior to BT- given Date Sugar Protein WBC RBC Epithelial Bacteria Leukocyte malignancy
(-) generalized body Calcium gluconate 10% 10cc 06/09 Neg +2 H 49.9 H 3568.3 H 28.5 303.0 H +2 H s/p BT of 3u pRBC
weakness SIVP post BT of 3u PRBC- given Chemistry:
(-) pallor Date BUN Crea BUA Na K Cl AST ALT
(-) DOB/SOB 424.78 H 136.02 3.58 105.15 12.62 5.75
06/09 2.60 51.06
pink palpebral conjunctiva
Coagulation studies Urinary tract infection
Urinary tract infection Date PT % Activity INR APTT Increased oral fluid intake
(-) dysuria Ceftriaxone 2g TIV OD (Day 2) 06/09 12.3 98.4 1.09 30.3 TSR urine CS c/o GA (done
(-) hematuria Ferritin (6/9/24 OSMAK): 52.51 06/10)
(-) increased urinary Pregnancy test (06/09/24): Negative For repeat urinalysis after day 3
frequency 12L ECG (6/9/24 OSMAK): Non-specific STT wave changes on lead III and V1 of antibiotic-(3rd dose will be
(-) fever Tumor markers (04/12/24) given at 1200H June 12, 2024)
CA-12-5: 619.70 U/L H
CA-19-9: 14.67 U/mL
Imaging
Chest xray (06/09/24 OSMAK) Cardiomegaly
Findings:
The liver is normal in size with slightly increased parenchymal
echogenicity.
There are no focal mass lesions noted.
Gyne wise Ferrous Sulfate 325mg/tab, 1 The intrahepatic ducts are not dilated. Gyne wise
(-) profuse vaginal bleeding tab twice a day Whole Abdomen UTZ (03/06/24) The gallbladder is normal in size measuring 5.23 x 2.25 cm. Definitive plan: for radiotherap
(-) severe hypogastric pain Paracetamol + tramadol tab, 1 Its wall is not thickened. No pericholecystic fluid seen. For possible discharge once
(+) vaginal spotting tab every 8hrs as needed for There are no intraluminal with ok urinalysis result
pain echoes or focal lesions noted. LOA still for approval
LMP: 05/04-present Tranexamic Acid 1g TIV every 8 The common duct is not dilated to the extent visualized, measuring 0.5 Monitor 4h, I&O q shift
PMP: April 23-26 hours for 2 more days cm. Complete bed rest for now
PMP: Feb 24-26 The visualized pancreas and spleen are normal in size and echotexture. Pad counting q shift
PMP: Jan 25-29 There are no focal lesions appreciated. WOF: severe hypogastric pain,
PMP: Dec 1st week (lasted Both kidneys are normal in size with smooth and regular contour. profuse vaginal bleeding
for 3 weeks) The cortico-medullary pattern in both sides is intact.
PMP: Nov 1st-3rd week The right kidney measures 10.8 x 6.1 × 4.3 cm with cortical thickness of 0.8
PMP: Oct 4-6 cm.
PMP: Sep 5-8 The left kidney measures 11 x 4.6 x 4.4 cm with cortical thickness of 0.8
cm.
Soft flabby abdomen There is no evidence of hydronephrosis, lithiasis or mass noted in both
kidneys.
SE: Cervix 5x5 cm, nodular, The urinary bladder is adequately distended.
scanty bleeding per os Its wall is not thickened.
IE: Cervix 5x5 cm, friable There are no intraluminal
Involvement of echoes or focal mass seen.
middle 1/3 anteriorly Pre-void: 195 ml
upper 1/3 posterior of the Post-void: Scant
vaginal canal Incidental note of a heterogeneous focus in the cervical region, which
apparently extends into the lower uterine segment. The endometrium has
RVE: bilateral parametria normal thickness with endometrial fluid and small hyperechoic focus
nodular but free projecting within.

Pad count: 1 diaper Impression:

minimally soaked Mild fatty liver
Unremarkable sonogram of the gallbladder, visualized pancreas, spleen,
both kidneys and urinary bladder.
Heterogeneous focus in the cervical and lower uterine segment; likely the
patient’s known pathology.
Endometrial fluid and probable endometrial polyp. Suggest dedicated
study for further evaluation.
Findings
Liver: Normal size and attenuation. Contour is smooth and no focal lesions
are dernonstrated. No dilated intrahepatic bile ducts.
Gallbladder: Normal size and wall thickness. No lithiasis is demonstrated.
Pancreas, spleen and adrenal glands: Unremarkable with no evident focal
lesions.
Stomach and bowel loops: Lack of oral and rectal contrast precludes
optimal evaluation. Non-obstructive bowel pattern is seen.
Kidneys and ureters: Normal in size and confiquration. No evidence of
lithiasis or hydronephrosis. The ureters are not dilated.
Urinary bladder: Well distended and unremarkable.

Uterus and adnexa: Poorly defined mass in the cervix with apparent
extension to the lower uterine endometrial cavity fluid is seen. A
hypoenhancing mass is also noted in the right lateral uterine wall
WAB CT Scan (03/13/2024, Makati Life Medical Center)
measuring 3.2 x 3.9 cm (AP/T). There is a multiseptated cystic mass in the
left adnexal region measuring 4.1 x 2.7 x 5.6 cm (AP/TICC, likely ovarian in
origin.
Ascites, mesenteric thickening, or enlarged lymph nodes: None.
Vascular, osseous, and soft tissue structures: Tiny sclerotic focus in right
femoral head, likely a bone island.

Impression:
Poorly defined mass in the cervix with apparent extension to the lower
uterine segment and moderate endometrial cavity fluid is seen. This is
consistent with the clinically known cervical malignancy.
Hypoenhancing mass in the right lateral uterine wall, may represent
uterine myoma
Multiseptated cystic mass in the left adnexal region, likely ovarian in
origin. Correlate with transvaginal ultrasound for further evaluation.
Tiny sclerotic focus in right femoral head, likely bone island
 Uterus 4.5 x 3.93 x 3.85
Endometrium: 0.69
homogenous, hypoechoic, midline echo well defined, regular
endomyometrial junction
Cervix 2.2 x 1.95 x 2.69
RO 2.54 x 1.39 x 1.71
TVS UTZ c/o OB SONO (Jan 12, 2024)
LO 1.5 x 1.3 x 1.7

IMPRESSION:
Normal retroverted uterus
Intact endometrium
Normal ovaries

Cervical punch biopsy (01/12/24 OSMAK): SQUAMOUS CELL CARCINOMA, NOT OTHERWISE SPECIFIED (NOS).

PERIPHERALS
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES
SARI 3 BED 3 Nulligravid BPR 140-160/80-90 Renal diet CBC with PC
LIPARDO, MARY GRACE AUB-A,M,O BP 150/90 IVF: PNSS 1L x KVO while on BT Date Hgb Hct WBC S L M E Plt
CASTA Blood Transfusion of 1 unit pRBC HR: 65 (+) cardiac monitor
06/10
38 for Anemia severe secondary to 1) RR: 20 (+) O2 support at 4LPM via nasal *IFC refused
s/p BT
NYC malignancy 2) chronic blood loss T: 36.8 cannula 7.4 L 0.21 L 10.8 88 6 5 1 268 With 1u pRBC c/o Ma’am Sarah
of 2u
ESRD sec to HTN NSS vs DKD Type O2: 99 (+) IFC
pRBC
3890682 2 Diabetes Mellitus, controlled
06/08/2024 Hypertension Stage II, controlled I: 1640 06/08 4.9 L 0.14 L 8.5 84 10 5 1 343
Dr. Odevilas/ Tungcul, Proliferative diabetic retinopathy, O: 0 A+/NR
Ballesteros, De Paz (TL)/ De both eyes Vitreous hemorrhage, Urinalysis
Guia, Pesigan/ Jasarino, Vito left eye Ht 5’2’’ Date Sugar Protein WBC RBC Epithelial Bacteria
t/c Hospital Acquired Pneumonia Wt 84kg
s/p Panretinal photocoagulation, BMI 33.8 Chemistry:
right eye Date BUN Crea Na K Cl AST ALT
Anemia severe secondary to 06/1 6.45
1) malignancy 2) chronic s/p BT of 2 unit pRBC 0 H Anemia severe secondary to 1) malignancy 2) chronic blood loss
blood loss Diphenhydramine 50mg IV 30 06/1 6.78 s/p BT of 2u pRBC
(+) slight pallor minutes prior to BT – given 0 H Give Furosemide 40mg IV after each aliquot with BP precaution
(+) slightly pale palpebral Paracetamol 300mg IV 30
06/0 2,184.72 7.17 97.04 L 9.17 8.25
conjunctiva minutes prior to BT – given 37.79 H 129.33 L
8 H H
(-) easy fatiguability Calcium gluconate 10% 10cc
05/1
(-) dizziness SIVP post BT of 3u PRBC 10.52 H 739.08 H
8
Furosemide 40mg IV after each
05/0
aliquot with BP precaution 22.23 H 1292.64 H
9
Reticulocyte count (06/08/24): 2.3% (H)
12L ECG (06/08/24): NSR, tall T-waves V2-V4
COVID rapid antigen test (06/09/2024): Negative
ESRD sec to HTN NSS vs DKD Hba1c (6/9/24): 4.11% ESRD sec to HTN NSS vs DKD Type 2 DM, controlled
(+) anuria FeSO4 325mg/tab 1 tablet once Hepatitis profile (6/8/24) IM Notes (06/11)
(-) nausea daily HbsAg 0.41 - NONREACTIVE Continue diet c/o main service
(-) easy bruising Ferrous + Folate tab 1 tablet Anti-HCV 0.09 - NONREACTIVE IVF: heplock
(-) headache once daily Anti-HBc IgG 1.69 - NONREACTIVE Diagnostics:
(-) fatigue EPO 4,000 3x a week post HD K, Phosphorus, Ionized calcium, Magnesium
Anti-HBs 83.06 - REACTIVE
(-) drowsiness Sevelamer 800mg/tab, 1 tab q8 CBC, PTT, PT
Sodium bicarbonate 650mg/tab Tx:
1 tab 3x/day Imaging Start GICS for 6 cycles
CXR (6/9/24, OSMAK) Low lung volume with bronchovascular crowding. Cannot totally exclude pulmonary congestion or beginning Calcium polystyrene sachet TID
06/11 pneumonia. Start Clonidine 75mcg/tab 1 tab q8
1600H 180/80 -> Due Probable cardiomegaly start Atorvastatain 40mg/tab 1 tab OD
Metoprolol KUB UTZ (05/13/24 Findings: Continue medications as ordered
1730H 180/80 -> Clonidine -> OSMAK) Both kidneys are normal in size with smooth and regular contour. Facilitate HB ultrasound
180/80 -> Clonidine -> 180/80 The cortico-medullary pattern in both sides is intact. Facilitate anemia correction
-> Amlodipine -> 150/90 The right kidney measures 9 x 3.2 x 3.9 cm with cortical thickness of 1 cm.
The left kidney measures 9.1 x 3.7 x 3.7 cm with cortical thickness of 1 cm. Surgery notes (06/12)
There is no evidence of hydronephrosis, lithiasis or mass noted in both kidneys. referred back to Dr Tadeo for possible cut down-awaiting notes
Type 2 DM, controlled The urinary bladder is nondistended. Thank you for this referral
(-) polyphagia Insulin glulisine sliding scale IMPRESSION: Patient seen and examined
(-) polydipsia 180-220 2u Unremarkable ultrasound of both kidneys Medications reviewed
(-) polyuria 221-260 4u Nondistended urinary bladder HOLD HD for now
261-300 6u TVS UTZ (05/10/24, Findings: For referral to service consultant for now
>300 8u OsMak) Uterus is anteverted and enlarged measuring 9.1 x 7.6 x 7.5 cm (volume of 272 mL). refer
Myometrial echopattern is homogeneous.
Hypertension St. II, controlled No focal mass is seen. Type 2 DM, controlled
(-) BOV Endometrial lining is thickened and heterogeneous measuring 2.1 cm. For CBG monitoring and control
(-) headache Amlodipine 10mg/tab 1 tab OD The right ovary is normal in size measuring 3.0 x 1.9 x 2.6 cm (volume of 7.8 mL). For CBG TIDACHS
(-) dizziness Metoprolol 50mg/tab 1 tab BID The left ovary is likewise normal in size measuring 2.6 x 2.1 x 2.0 cm (volume of 6.0 mL).
(-) chest pain Clonidine 75mcg/tab 1 tab q8 No adnexal mass is noted. IM Endo notes (06/10)
(-) DOB/SOB Atorvastatin 40mg/tab 1 tab OD The cervix is open and normal in size measuring 3.1 x 2.9 x 3.0 cm. Fluid is seen within the endocervical canal. Thank you for this referral
(-) vomiting Minimal fluid is seen in the posterior cul-de-sac. Diagnostics: FBS
Last BP elevation at 06/12 Impression: Therapeutics
2000H 160/90 Enlarged anteverted uterus with thickened and heterogeneous endometrium. Tissue correlation is suggested. Insulin glulisine sliding scale
Open cervix with endocervical fluid 180-220 2u
Minimal posterior cul-de-sac fluid 221-260 4u
GICS as follows q2 hours x 6 Unremarkable ultrasound of the ovaries 261-300 6u
Multiple electrolyte cycles (completed 06/10 0200H) Chest Xray (05/09, Cardiomegaly >300 8u
imbalance (Hyponatremia, GICS for 6 cycles (2 cycles given OsMak) HTN St. II, controlled
hyperkalemia, before IV line was out) TVS UTZ (10/12 The anteverted uterus is enlarged and bulky measuring 7.5 x 6.4 x 7.1 cm. Myometrial echopattern is coarsened For BP monitoring and control
hypochloremia) secondary to Glucose D50-50 1 vial TIV + Megason) and heterogeneous. Endometrial stripe is thickened measuring 2.1 cm. Cervix is normal with intact canal
ESRD Insulin HR 10 units TIV measuring 3.2 x 1.9 x 2.1 cm. IM Notes (06/09/24)
(-) chest pain Calcium gluconate 10%, 10 ml as The right ovary measures 3.2 x 2.2 x 4.1 cm (Vol. 14.8 cc). The left ovary measures 2.8 x 2.1 x 2.8 cm (Vol. 8.6 cc). Tx:
(-) palpitations slow IV push-given Multiple subcentimeter peripherally distributed cystic foci are seen in both ovaries. Amlodipine 10mg/tab 1 tab OD
(-) tremors -Salbutamol MDI, 2 puffs now The posterior cul-de-sac is intact. Metoprolol 50mg/tab 1 tab BID
Calcium polysterene sulfonate IMPRESSION:
15g/sachet, dissolve 1 sachet in Enlarged and bulky, anteverted uterus with coarsened and heterogeneous Multiple electrolyte imbalance (Hyponatremia, hyperkalemia,
1/2 glass water now then every myometrium and thickened endometrium. Primary consideration is diffuse uterine adenomyosis; rule out hypochloremia) secondary to ESRD
8 hrs endometrial hyperplasia. Tissue correlation is recommended for further evaluation.
Normal sized ovaries with polycystic features bilaterally. Please correlate with clinical and laboratory findings. IM Nephro (06/09)
t/c Hospital Acquired No meds for now CBG monitoring Tx:
pneumonia 1 - GICS as ordered to complete for 6 cycles then repeat
Date 0500H 1400H 1720H 2100H
(-) DOB/SOB 2 – Calcium polysterene sulfonate 15g/sachet, dissolve 1 sachet in
(-) cough 6/12 138 1/2 glass water now then every 8 hrs
(-) desaturation 6/11 114 179 175 163 3 – Pantoprazole 40mg/tab 1 tab OD
(-) fever
6/10 104 120 151 153
Proliferative diabetic 6/9 124 136 104 150 t/c Hospital Acquired Pneumonia
retinopathy, both eyes referred to IM-Pulmo c/o Dr Ramirez-awaiting notes
Vitreous hemorrhage, left eye No meds for now
s/p Panretinal Proliferative diabetic retinopathy, both eyes Vitreous
photocoagulation, right eye hemorrhage, left eye s/p Panretinal photocoagulation, right eye
(-) sudden vision loss
(-) eye redness Ophtha Notes (06/11)
(-) floaters Thank you for this referral
Patient seen and examined
Visual acuity: 20/20 both eyes Plan to do dilated fundus examination using tropicamile +
Intact EOMs phenylephrine eye drops 1 drop to bothe eyes every 15 mins for 3
doses
Gyne wise Tranexamic Acid 1g TIV every 8 Asking for written clearance form main service to do DFE using the
(-) hypogastric pain hours for 24 hours then 500mg 1 said eye drops , which may increase blood pressure
(-) vaginal bleeding tab every 8 hours as needed for Refer back once cleared for dilated fundus examination
vaginal bleeding Refer
Nulligravid Paracetamol + Tramadol
LMP: May 3-present 325mg/37.5mg/tab 1 tab every 8 Gyne wise
PMP: March last week to April hours as needed for pain For anemia correction
second week
PMP: February 1st week ANES (5/18)
PMP: Nov 6-present Patient seen and examined
(4overnight pads, moderately History and PE done
soaked) Ancillaries noted
PMP: Sept 20, 2023- October Anesthesia plans, risks, and complications explained and fully
3rd week understood by patient and husband
PMP: third week of august Still for anemia and hyperkalemia correction
PMP: 3rd week of July 2023 Respectfully suggesting to do endometrial biopsy as an elective case
to fully optimize the patient
Abdomen flabby, no Patient have signed advanced directives of DO NOT INTUBATE but
 tenderness on light/deep upon assessment, patient is with increased risk of desaturation thus
palpation on all quadrants, no is resolved by intubating patient, with DNI signed, then we cannot
muscle guarding help the patient
Normal looking external Suggesting to undergo HD prior to procedure
genitalia, parous introitus Refer back to APEC as scheduled
SE: cervix pinkish measures
3x3 cm, no lesions, no polyp,
(+) scanty bleeding per os
IE: vagina admits 2 fingers Advanced directives: YES TO ALL
with ease,
cervix closed, no cervical Contact number of relative: 09055692214
motion tenderness, no
adnexal mass/tenderness,
uterus enlarged to 16 weeks
AOG
RVE: intact sphincteric tone,
smooth rectovaginal septum,
rectal vault not collapsed, no
nodulations, with smooth and
pliable bilateral parametria

Pad count: 1 pad moderately

soaked

Bed 1 IW G6P5(5015) BPR 120-140/80-90 DM/LSLF diet with SAP CBC

PILAPIL, MILAGROS Endometrial carcinoma, high grade BP 130/80 Date Hgb Hct WBC S L M E Plt
BALMORI (to consider serous) carcinoma HR 78 06/09
79 FIGO 2 RR 20 s/p 3u 11.7 0.35 19.1 88 7 4 1 234
YC Menopause for 29 years T 37.0 pRBC *advised to secure blood products, green form given to relative of
Blood Transfusion of 3 units PRBC 06/08 5.1 L 0.16 L 22.5 H 83 H 13 4 0 242 patient to secure blood outside
215005 for Anemia very severe secondary I: 1100 *Patient supposedly for transfer to IM isolation ward however as per
O+/NR
06/08/2024 to 1) malignancy 2) acute blood O:1200 IM service patient still to secure official sputum AFB result, patient
Urinalysis
Dr. Santos/ Tungcul/ loss, corrected was appraised for possible THOC if no vacancy at isolation ward
Date Sugar Protein WBC RBC Epithelial Bacteria
Ballesteros, De Paz/ Roque Acute kidney injury secondary to Ht: 5’3
(TL)/ Reyes*/ De Guia, 1) hypoperfusion from acute blood Wt: 80 kg 06/08 3+ Trace 86.3 H 0.5 28.5 5906.6 H
Pesigan/ Jasarino, Vito loss; 2) infection from complicated BMI: 31.2 (obese II) Chemistry:
UTI; 3) Diabetic nephropathy Date BUN Crea BUA HbA1c Na K Cl AST ALT
Complicated UTI Anemia very severe 06/1 4.17 Anemia very severe secondary to 1) malignancy 2) acute blood loss,
Multiple electrolyte imbalance secondary to 1) malignancy 2) s/p BT of 3 units pRBC 1 corrected
(hyponatremia, hyperkalemia) acute blood loss, corrected Diphenhydramine 50mg TIV 30 06/1 130.45 L 3.84 L s/p BT of 3u pRBC
secondary to poor nutrition and (-) pallor mins prior to BT – given 1
DM (-) pale palpebral conjunctivae Calcium gluconate 10% 10cc 06/0 9.18 H 128.32 L 5.68 97.70 19.24 10.77 Acute kidney injury secondary to 1) hypoperfusion from acute
Type II Diabetes Mellitus, poorly (-) generalized weakness SIVP post BT of 3u PRBC-given 5.10 128.19 H 564.20 H blood loss, 2) infection from complicated UTI 3) Diabetic
8 H
controlled (-) dizziness Lipid Profile nephropathy
Hypertension, controlled VLDL Nephro notes (06/10)
Date TC TG HDL LDL
Dyslipidemia Referred to Dr. Vega for AKI complicated UTI
r/o PTB 3.4 1.1 2.03 0.56 Awaiting urine CS
06/10 1.24
Obese II Acute kidney injury 5 9 Awaiting repeat Na, K - 12 mn
secondary to 1) Ideally for ABG
S/P Endometrial biopsy (HIGH hypoperfusion from acute Coagulation studies Noted plans for contrat studies
GRADE CARCINOMA, FAVORS blood loss, 2) infection from No meds for now Date PT % Activity INR APTT RCIN 16 score 4 anemia 3 DM 3 Contrast 2 CR 4
SEROUS CARCINOMA, 2023, complicated UTI 3) Diabetic 05/09 12.3 98.4 1.09 25.2 Risk of 26%
OSMAK) nephropathy 05/30 15.2 H 75.6 1.37 H 39.4 Ris of 1.09%
(-) decreased urine output BUN, Crea 2 days after contrast studies
(-) decreased sensorium ERPR (OsMak, July 14, 2023) Continue ceftriaxone 2 g TIV once a day
ER – focal strong (+) staining PNSS 1 L x 60 cc/hr
PR – focal strong (+) staining Hyponatremia secondary to poor nutrition
Hyponatremia secondary to Hyperkalemia secondary to poor nutrition, corrected
Immunohistochem (Hi-Pre, July 17, 2023)
poor nutrition For electrolyte correction
Hyperkalemia secondary to Calcium polystyrene 1 sachet p16 Positive, strong, diffuse IM Nephro (6/8/24)
poor nutrition, corrected every 8 hours for 3 doses p53 Aberrant/mutational type (>80% nuclear strong staining) Tx: Calcium polystyrene 1 sachet every 8 hours for 3 doses
(+) generalized weakness (completed 6/9 1800H) Tumor Markers (06/27/23)
(-) diarrhea/vomiting CA 125: 7.38 Complicated UTI
(-) seizure CA 19-9: 1.20 For completion of antibiotics
(-) decreased sensorium 12L ECG (6/8): sinus arrythmia TSR urine CS (sent out to GA – 6/8)
Imaging
Complicated UTI Hypertension, controlled; Dyslipidemia
(-) hypogastric pain Ceftriaxone 2g TIV (-) ANST OD CXR Apicolordotic view (06/08/24) Reference was made to the chest radiograph done on the same day (11:37 AM). Cardio Notes (06/10)
(-) dysuria (Day 2)-discontinued Reticular opacities are seen in the right upper lung. Referred to Dr. Cuenca for BP control
(-) hematuria IMPRESSION: Continue the ff:
1. Amlodipine 10 mg/tab 1 tab OD
Consider PTB of undetermined activity, right upper lung. Correlate with pertinent parameters.
Hypertension, controlled; 2. Carvedilol 25 mg/tab 1/2 tab 2 times a day
Dyslipidemia Carvedilol 25mg/tab 1tab BID CXR (06/08/2024) Suspicious opacities in the right upper lung are seen. Type II Diabetes Mellitus, poorly controlled
(-) chest pain Amlodipine 10mg/tab OD Pulmonary vascular markings are within normal limits. For CBG monitoring and control
(-) headache Rosuvastatin 20mg 1 tab once a The heart is magnified. For lipid profile once anemia corrected
(-) dizziness day at bedtime The tortuous aorta is calcified.
(-) nape pain Both hemidiaphragms and costophrenic angles are intact. Endo Notes (06/10)
Referred to Dr. Amba for uncontrolled type 2 DMIdeally for lipid
Osteophytes are seen lining the margins of the visualized spine.
Type II Diabetes Mellitus, profile
poorly controlled Linagliptin 5mg/tab 1 tab OD IMPRESSION: Insulin glargine 26u SC at 8 pm by dinner
(-) polydipsia Insulin Glargine 20u at night Suggest apicolordotic view Insulin glulisine premeals 6-10-6 units
(-) polyuria Insulin Glulisine pre-meals (6u Tortuous and atheromatous aorta Insulun glulisine sliding scale as ordered
(-) polyphagia prebreakfast, 6u prelunch, 6u Degenerative osseous changes of the visualized spine Linagliptin 5 mg 1 tab once a day
See table for CBG monitoring predinner) Rosuvastatin 20 mg 1 tab at bedtime
TVS UTZ (03/07/2023) The uterus is anteverted with smooth contour and heterogeneous echopattern measuring 7.4 x 4.5
Insulin Glulisine sliding scale: CBG TID ACHS
x 3.6 cm. The cervix measures 2.1 x 2.5 x 2.7 cm with homogeneous stroma and distinct
181-220: 2u SC r/o PTB
221-260: 4u SC endocervical canal. Pulmo Notes (06/10)
261-300: 6u SC Within the endometrial cavity is a heterogeneous mass measuring 4.0 x 3.4 x 29 cm (volume: 20.9 Referred to Dr. Orion
>300: 8u SC cc), with >50% myometrial invasion. The caudal tip of the mass is at the level of the internal cervical For sputum AFB x 2
r/o PTB os and is 2.0 cm away from the external cervical os (dist. OCO). The endometrial midline echo is not Noted clearance for transfer to infectious ward
(-) history of previous PTB defined The thinnest myometriumi isat the anterior midcorpus measuring 0.2 cm. The endometrial- N95 at all time
treatment Airborne precaution
myometrial j junction is indistinct.
(-) cough, night sweats NAC 600mg/tab 1 tab BID for 4 Will not treat as PTB if sputum AFB negative x 2
(-) DOB/SOB doses prior to study The right ovary measures 2.4 x 1.6 x 2.0 cm (volume: 3.9 cc). Within the right ovary is a unilocular Please do sputum induction
NAC 600mg/tab 2 tabs PO prior anechoic cyst measuring 1.3 x 1.2 x 1.6 cm (volume: 1.3 cc). There are no solid areas or papillary
to and after the study (if NPO, excrescences seen within. The capsule measures 0.1 cm. Referred to IPC-cleared for transfer to IW
may use IV NAC) The left ovary measures 1.1 x 1.1 x 1.0 cm (volume: 0.7 cc) Endorsed to Dr. Viernes/Almirol
Gyne Wise There are no adnexal masses seen. Please transfer to IW
(+) vaginal bleeding The cul-de-sac is smooth with no free fluid.
(-) severe hypogastric pain Gyne Wise
IMPRESSION:
(-) bladder/bowel movement Ferrous Sulfate 325mg/tab, 1 tab PLAN: Neoadjuvant radiotherapy
changes twice a day ENDOMETRIAL MASS CONSIDER MALIGNANCY, WITH >50% MYOMETRIAL INVASION Since patient cannot comply with neoadjuvant radiotherapy to
Paracetamol + Tramadol RIGHT OVARIAN CYST CONSIDER SIMPLE CYST loosen fixed parametria,
G6P5 (5015) 325/37.5 mg/tab, 1 tab every ATROPHIC LEFT OVARY in light of high grade carcinoma, consider serous, shift to neoadjuvant
Menopause: 1995 8hrs as needed for pain chemotherapy
ENDOMETRIAL BIOPSY (06/12/2023 OSMAK): HIGH GRADE CARCINOMA, FAVORS SEROUS CARCINOMA Since with noted elevated creatinine, patient may not be a good
Previous Gyne PE (c/o Dr. candidate for chemotherapy, may go ahead with neoadjuvant
Santos) radiotherapy if she cannot undergo neoadjuvant chemotherapy .
IE: Cervix dilated as thin CBG monitoring For discharge once cleared by all services on board
smooth rim Date 0500H 1100H 1400H 1720H 2100H 2300J
(+) Fleshy mass protruding, 06/10 125 124 62 -> D5050 184
outgrowth lesion per os
6/9 252  insulin 152 203 Insulin 6u 110
Uterus enlarged to 10 weeks IM Notes (06/11)
size; no adnexal mass nor 12u No objections for discharge
tenderness 6/8 400  300cc  493  referred to 407  insulin 20u IM wise-pulmo, nephro, endo, NST, Cardio
RVE: Shortened bilateral 496 Endo take home medications:
parametria, closed to the 1. Amlodipine 10mg/tab 1 tab OD
pelvic wall 2. Carvedilol 25mg/tab 1/2 tab 2x/day
3. Insulin glargine 20u at night
PE at the ER (6/8) 4. Linagliptin 1 tab OD
IE: (+) Fleshy mass protruding, 5. Rosuvastatin 20mg/tab 1 tab ODHS
outgrowth lesion per os, For sputum AFB at local health center, to treat if AFB (+)
uterus cannot be palpated Refer back IM OPD lever during OB-GYN follow for titration
enlarged abdomen adjustment of Insulin

Pad counting: 1 minimally Pending:

soaked [ ] Urine CS – sent out to GA (06/08)
[ ] For Chest/WAB CT scan with IVC (on June 19, 2024 c/o Dr.
Capuchino)
[ ] ABG- pt amenable for send out
[ ] sputum AFB x 2
[ ] BUN, Crea 2 days post contrast

Advanced directives: YES TO ALL

 REFERRALS
PATIENT INFORMATION DIAGNOSIS SUBJECTIVE/OBJECTIVE THERAPEUTICS LABORATORIES PLAN/NOTES
704 G3P3 (3003) BP 110/70 TCR of 1000kcal DAT CBC
PICONES, JOSEL PASCUAL Cervical Carcinoma HR 210 divided into 3 meals and 2 Date Hgb Hct WBC S L M E Plt
32 (POORLY RR 20 snacks with Ensure 6 06/08 10.2 L 0.31 L 18.5 H 92 3 5 596 H
YC DIFFERENTIATED) St IIB T 36.5 scoops in 200ml water 05/25 13.3 0.39 14.5 91 4 4 1 515 H
S/P Brachytherapy x 4 IVF B fluid 1L x 24 hrs 05/22 10.5 L 0.31 L 16.5 H 93 H 5L 2 581 H
(May, 2024) I: 2649 Fracture, closed, comminuted, displaced,
61564 05/19 8.7 L 0.26 L 16.0 H 94 H 2L 4 603 H
s/p Radiotherapy x 28 O: 2500 subtrochanteric femur, left
Date Admitted: 05/10/2024 05/15 9.2 L 0.28 L 10.4 92 H 6L 2 529 H
fraction Superolateral dislocation, patella, left
Date Referred: 05/24/2024 05/13 8.9 L 0.26 L 11.2 90 H 3 6 1L 447
s/p Chemotherapy x 4 Ht: 47 kg Still for reduction possible open application of
Dr. Santos, Odevilas/Tungcul, cycles (Dec 18 2023, Jan Wt: 150 cm 05/10 11.3 L 0.34 L 10.5 90 H 4L 5 1L 513 H intramedullary nail, left femur.
de Paz, Ballesteros/ Reyes (TL)/ 14 2024) BMI: 20 kg/m2 O+/NR
Tugado, Gallano/ Alzaga, Vito Persistent/Progressive Urinalysis Surgery Notes (06/11/24)
Disease (Bone Metastasis) Date Sugar Protein WBC RBC Epithelial Bacteria DAT, with SAP
Fracture, closed, Paracetamol 500mg tab 1 06/08 NEG 2+ 245.4 13.1 4.1 71.5 Adequate analgesia c/o palliative service
s/p Cervical punch biopsy comminuted, displaced, tab every 6 hours 05/23 NEG NEG 2-4 3-5 FEW FEW For palliative chemo as per gyne onco service
(09/25/2023) subtrochanteric femur, left Tramadol 50mg TIV every 05/19 NEG Trace 8-10 H 2-4 FEW FEW For MDP meeting on 06/14/24 10 am via zoom
Superolateral dislocation, 8 hours 05/13 NEG Trace 1-3 0-2 FEW FEW
Bacterial Vaginosis, patella, left Celecoxib 200mg cap 1 Coagulation studies Ortho Notes (06/07/24)
resolved (-) DOB/ SOB cap BID Dr. Lim updated
Date PT % Act INR APTT
Blood transfusion of 4 (-) fever, last episode: calcium carbonate + Vit Palliative notes highly appreciated please carry
05/25 13.4 90.1 1.2 39.8
units pRBC for anemia 1725H 06/01, 39.0 -> D3 200mg/tab, 2 tabs OD out
05/22 14.0 84/8 1.26 H 40.2
moderate secondary to Paracetamol 1 g TIV -> 37.3 Morphine 10mg/tab,1 tab Referred back to Gyne re future plans and current
(+) foam boot traction in 05/10 12.9 94.0 1.15 41.3
malignancy, corrected every 8 hours round the Chemistry status of patient
Fracture, closed, place, left clock. Rescue dose of Noted pre family conference from Dr Lim updated
Date BUN Crea Mg Albumin Na K AST ALT HbA1c CL iCa Total Ca
comminuted, displaced, Morphine 10mg/tab, 1/2 TCR of 1000kcal DAT divided into 3 meals and 2
06/03 32.42 0.65 L 27.94 L 131.06 L 4.04 95.42 L 1.38 2.34
subtrochanteric femur, tab as needed for patient. snacks with Ensure 6 scoops in 200ml water
05/30 132.83
left Paracetamol 1g TIV every CHON 55g
4 hours round the clock 05/25 4.36 CHO 100g
Superolateral dislocation, Zolendronic acid 4mg by 05/22 31.98 L 0.78 31.52 131.43 L 4.33 24.45 26.60 5.16% Fat 459g
patella, left SIVPx 15mm 3x/week- 05/15 44.98 L 131.21 L 4.20 Continue IVF B fluids 1L x OD
HOLD (06/03/24) 05/14 0.59 L Food recall c/o relative
Previous Emergency Low 05/13 5.11 37.86 L 128.55 L 4.67
Transverse Cesarean 05/10 5.98 44.23 L 33.44 L 129.04 L 5.37 H 55.98 H 44.92 H Anesthesia Notes (05/30/24)
Section I for abruptio Vaginal Discharge GS (05/24/24): SMEAR SHOWS PRESENCE OF GRAM NEGATIVE COCCOBACILLI, MODERATE LEUKOCYTES AND EPITHELIAL CELLS Thank you for this referral
placenta over GETA Vaginal Discharge KOH (05/24/24): NEGATIVE Patient seen and examined
(5/22/23) ECG (05/24): Normal sinus rhythm History and PE done
Imaging Labs noted
Chest xray (06/07, Osmak) No significant chest findings Anesthesia plans, risk and complications explained
Bone Imaging (MMC, 5/7/24) Clinical Data: Patient was diagnosed with poorly differentiated carcinoma of the cervix (2023) and underwent to and fully understood by the patient
chemotherapy and radiotherapy. (+) left femoral fracture. NPO 8 hours prior to wheel-in
Technical Report: Whole body scans in the anterior and posterior views were obtained 3 hours after injection of 466 IVF: PNSS 1L x KVO rate to hook prior to OR
MBq (12.6 mCi) of Tc-99m MDP. Dual intensity images were produced and SPECT was performed from the head to Medications:
mid-thigh. 1. Omeprazole 40mg IV once a day
Scintigraphic Findings: 2. Paracetamol 1g IV 1 hour prior to OR
There is satisfactory skeletal labeling. Both kidneys are visualized. 3. Tramadol 50mg + 9ml PNSS via slow IV push
Increased tracer accumulation in the proximal third of the left femur, corresponds to the known fracture. every 8 hours as needed for moderate and severe
Foci of increased tracer uptake are seen in the following: pain.
- anterior segment of the 8th right rib Secure 2nd IV line (g18 or g 20) on the
- posterior segment of the 7th left rib contralateral arm then shift to helpock
- T6 and T11 vertebra Secure 2 units Prbc properly typed and
- sacrum crossmatched prior to OR
- left ilium For serum Na correction (>= 135mmol/L –
The rest of the visualized skeletal structures show symmetrical and physiologic tracer distribution. 145mmol) prior to OR
Impression: Will refer this case to our service consultant
Increased osteoblastic activity in the areas described above is consistent with bone metastases. Check CBG and VS prior to wheel-in. Inform at
A pathologic fracture in the left femur is a consideration. local1416.
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 Suggest sodium correction prior to OR, but if
the right middle lobe, and superior segment of the right lower lobe, measuring none larger than 3 mm wide. benefits outhweight the risk may proceed with
- Subcentimeter calcified pulmonary nodule in the superior segment of the left lower lobe is identifed measuring 2 mm contemplated rooms
wide
- Small air cyst in the superior segment of the right lower lobe measuring 3 mm wide. IDS Notes (05/24/24)
Pleura: Pleural thickening in the left lower lobe Noted urinalysis results, no symtptoms of dysuria,
Heart and pericardium: Heart size is normal No pericardial effusion. hematuria, flank pain

Anemia moderate
secondary to malignancy,
corrected
(-) pallor
(-) DOB/SOB
Pink palpebral conjunctiva
Bacterial Vaginosis,
resolved
(-) fever
(+) clear vaginal discharge
Gyne wise
(-) vaginal bleeding
(-) hypogastric pain
Soft flabby abdomen, non-
tender, no palpable mass
Gyne onco PE (03/26)
IE: cervix 4-5 cm, smooth
ectocervix with nodularities
on central portion
RVE: shortened, thickened
and fixed right parametria
Pad count: 0
Mediastinum and hila: No enlarged lymph nodes. Fever may be attribute to known malignancy
Chest wall and lower neck: Unremarkable. process
Vessel: Unremarkable. IDS wise will not treat as CUTI
Bones: Lytic lesions with soft tissue component in the vertebral bodies of T11 and T12, posterior aspects of the left 4 th, Respectfully signing out of this case.
7th and 10th ribs, and lateral aspect of the right 8th rib
s/p BT of 4u pRBC - Sclerotic foci in the vertebral bodies of T6 and T7 are seen. Anemia moderate secondary to malignancy,
- Schmorl’s node in the inferior endplate of T11. corrected
Others: The visualized liver parenchyma appears heterogeneous with vaguely-defined hypodensities. s/p BT of 4u pRBC
IMPRESSION:
I. Few non-specific, non-calcified pulmonary and subpleural nodules in the right middle and right lower lobes. Interval Bacterial Vaginosis, resolved
follow-up is suggested to monitor stability or interval change. For completion of antibiotics
2. Subcentimeter calcified granuloma in the left lower lobe.
Metronidazole 500mg tab 3. Small air cyst in the right lower lobe. Gyne wise
1 tab every 12 hours x 7 4. Lytic lesions with soft tissue component in the vertebral bodies of T11 and T12, posterior aspects of the left 4 th, 7th DEFINITIVE PLAN: For palliative chemotherapy
days - Completed and 10th ribs, and lateral aspect of the right 8th rib, worrisome for osseous metastases. For referral back to Gyne Onco
5. Non-specific sclerotic foci in the vertebral bodies of T6 and T7. For multidisciplinary conference 06/14/2024 VIA
6. Heterogeneous liver parenchyma with vaguely-defined hypodensities. Correlation with a dedicated contrast- Zoom - letter forwarded to co-management
None for now enhanced services
CT/MRI is suggested.
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, Previous plans:
probable pathologic fracture secondary to bone metastasis. Ideally For repeat internal examination c/o Gyne
Minimal callous formation is noted. Onco once IM nailing done, then resume
The visualized joint spaces are preserved. remaining 4 brachytherapy sessions
Soft tissue appears unremarkable. WOF: vaginal bleeding, hypogastric pain
Decreased bone mineralization of the left femoral head is noted.
CXR (05/19/24): No significant chest findings Cardio Notes (05/31/24)
CXR (05/13/24): No significant chest findings noted OR plans deferred
CXR (05/10/24): No significant chest findings cardiowise no active management
Pelvis AP / Left hip AP-L / Left knee AP-L Unchanged comminuted fracture, left proximal femur, probably pathologic respectfully signing out
(05/09/24) refer back if warranted
Cervical Punch biopsy (09/25/2023): POORLY DIFFERENTIATED CARCINOMA.
Palliative and hospice care (06/11)
PT seen and examined,
noted plans of management
management of infection c/o current Main service
Therapeutics:
1. Continue morphine and pregabalin as
previously ordered
Psychosoacial and emotional support reassessed
Refer

Pre-family conference form questions of patient:

1: May possible pa po ba na maoperahan ako?
2: Ano na po ang status nang cancer ko? Lumaki,
lumiit, o kumalat?
3: Maguunder go pa po baa ko nang chemo bago
maoperahan?
4: Ano po ang plano saakin? Gagaling po ba ko?
5: Ilang percent po ba ang change ko para
gumaling sa sakit ko nac cancer?
6: Sapat po ba ang treatment na ginagawa po sa
akin para gumaling po ako

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
Date referred: May 21, 2024 (2017-06-21, 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)

ARI 2 Bed 5 G8P8(8008)

LISONDRA, FLAVIANA CUISON Pelvic Organ Prolapse St. IV
77 Menopause for 23 years
NYC CVD Bleed (27.4cc) Frontoparietal Area, Right NIHSS 6 ICH: 0
Hypertension St. II
3873304 Seizure prob sec to CVD Bleed
Date Admitted: 06/10/2024 Hypovolemic Hypoosmolar Hyponatremia prob Suboptimal Intake
Date Referred: 06/10/2024 Asymptomatic Bacteriuria
Dr. Palomares/Tungcul/ Gavino (TL)/ de Guia, Posadas/Tiongson, S/P CVD Infarct, Left Sided Residual (2020)
Kadappurath