A woman with

abdominal pain
Ronald Tejoprayitno
030.09.213

Case Presentation
Name

: Umay
Age : 44 yo
Chief complain : Abdominal pain and
progressive abdominal distention since
10 days ago

History
Rapidly

progressive abdominal
distention and abdominal pain since 10
days ago
Pain sensation on whole abdomen
12 days ago before hospital admission,
patient go to doctor because of Anemia
4X lost conciousness because of severe
abdominal pain

 Chest

pain (-), prutitus (-), cough (-),

fever (-), vomitus (-)
Dyspnea (+), Nausea (+), normal
defecation, minimal urination
USG : fluid intra abdominal

Physical exam
Conciousness
Vital

: Compos Mentis

Sign :

BP : 140/100 mmHg
Pulse : 120
Resp : 40
Temp : 36,6

Head

: CA +/+
SI -/-

 Neck

: Normal
Thorax :

Breathing sound : vesicular, rales (-)

Heart : S1, S2 reg, Gallop (-), murmur (-)

Abdomen

Abdominal distention
Tenderness (+)
Percussion : dullness
Shifting dullness (+)

 Extremity

Oedem : -/-/-

Work up
Hb

: 8,3
Leukocyte : 34.300
Trombocyte : 725.000
Ht : 26
GDS : 125
Ureum : 229
Creatinin : 7

 SGOT

: 230
SGPT : 106
Total Bil : 0,46
Albumin : 2,44
Globulin : 5,11
CA 125 : 1.700

Diagnosis
Anemia,

Ca Ovarii with Acute Kidney

Injury
DD
CKD
Hepatic Ca (Metastasis)

CA Ovarii
Primary

(70% Epithelial Ovarian

Carcinoma)
Secondary/Metastasis (Ca Payudara,
colon, etc)

Sign & Symptom

Abdominal

distention (Ascites)
Bloating, Nausea, vomiting, fullness,
constipation
Anemia/tiredness
Vaginal Discharge
Loss of body weight

 Gynecologic

location, size, surface, mobility,

consistency

Screening

physical exam

USG
CA 125

Treatment
Ovarian

Resection
Chemotherapy

Acute Kidney Injury

Definition

an abrupt (within 48 hours) reduction in

kidney function currently defined as an
absolute increase in serum creatinine of
either 0.3 mg/dl or a percentage
increase of 50% or a reduction in urine
output (documented oligouria of <0.5
ml/kg/hr for >6 hours)(AKIN)

Etiology
Pre

Renal
Renal
Post Renal

Symptom & Sign

Decreased

Urine Production
Weight Gain & Peripheral oedem

Workup
CBC
Serum

Creatinin and Ureum

Electrolyte
Urinalysis

Treatment
Diet

restriction of water, natrium, and

kalium
CaCO3
Folic Acid
Dialysis
Diuretic

Questions
Indication

of dialysis?
How to differentiate between AKI and
CKD?
Pathogenesis of ascites in ovarian
cancer?
What the cause of dyspnea in this case?
How to confirm that ascites in this case
was caused by malignancy?