II.

Pathophysiology
ECTOPIC PREGNANCY

TUBAL OVARIAN ABDOMINAL TUBO-ABDOMINAL

95%-Fallopian s/s are like tubal Primary-Orig. Implantation outside the Zygote that originally implanted in
tube preg. Or bleeding tube the fimbriated end of the fallopian
55%-Ampulla corpus luteum mgt. Secondary- Initial Implantation in tube or tube gradually extends into the
25%-Isthmic is cystectomy or ovary and then subsequent implantation in peritoneal cavity
15%-fimbrial oopherectomy the abdomen after rupture and expulsion

CERVICAL TUBO-OVARIAN HETEROTYPIC TUBO-UTERINE

In vitro-fertilization Zygote that is partly PREGNANCY Results from the gradual extension into
and embryo transfer implanted in the tube Tubal preg. Accompanied the uterine cavity of products of
and partly in the ovary by intrauterine pregnancy conception that originally implanted in
the interstitial portion of the tube

Another Complication:

Corpus Luteum Cyst

Congested Appendix

III. Patient’s Profile

Case no: 379-356-122 Patient’s name: Mrs.Zee Ex

Address: Sta. Rita, Olongapo City Age:38y/o

Admission:Sept.3,2008,6:40 am B-day: July 24,1970

Admission diagnosis:Ectopic Pregnancy Service: Gyne

Final Diagnosis: Corpus Luteum Cyst, Congested Appendix (L)

IV. Past and Present Profile

CC: Missed Period

History of Present illness: TVUS done which revealed L adrenasal

OB History:

LMP: G3P2 OB Score:2002 AOG:93/7 wks

Menstrual History: Menarche: 16 y/o Interval: monthly Duration: 3days

Dysmenorrhea: (-)

Sexual History: Coitarche: 22 y/o STD: NONE

Contraceptive History: CCP

Personal and Social History: HS graduate Smoking History: (-)

Physical Examination:

General Survey: Conscious Coherent

 V/S: BP: 130/80 HR: 84 RR: 19

HEENT: Pink palp.conj.

IE: Cervix closed

Admitting Impression: t/c Ectopic Pregnancy

Plan: Ex-lap

FINDINGS: Corpus Luteum Cyst (L)

V. Intervention and Management

It is the procedure done to the patient.

OPERATIVE RECORD

Pre-Operative Diagnosis: t/c ectopic pregnancy

Post-operative Diagnosis: Corpus Luteum Cyst (L)

OPERATION: Explore lap, Bilateral tubal ligation, appendectomy

FINDINGS: Cross-described Pathologic findings are all-organs explored normal and abnormal

 (1) ovary 4x3x3cm w/ corpus luteum cyst

 R + L Fallopian tubes

Operative Technique:

 Pt. in supine position under spinal anesthesia

  Asepsis + antisepsis

 Drapes applied

 Intrapubic midline Incision control down in the peritoneum.

 (L) ong inspected-corpus luteum cyst

 To do bilateral tubal ligation using the modified powery technique

 Appendix Inspected

 No Abdominal Pregnancy

 To do Appendectomy

PHYSICIAN’S ORDER

9/6/08------------------ please admit to OR

 Severe consent for mgt.

 NPO temporarily

 IVF

 For culdocentesis, WBC Count

 V/S

7 am----------------------Report to Dr. Ortin

  For Ex-lap, salphingectomy + tubal ligation

 Ampicillin gen. IV ANST

POST-OPERATIVE ORDER

9/6/8---------------------S/P EXPLORE LAP, btl, Appendectomy

8:47am------------------back to ward

 v/s, q15 min. until stable

 NPO

 Flat on bed x 6º (2pm)

 Present IVF at 30 gtts/min

 Med:

o D5W 500 ml + 6 amp. Tramadol(tramal), 100 ml to run at 10 uggts/min (10cc/hour) as side drugs

o Occur dose: Tramadol(tramal) 500mg, slow IV, PRN for breakthrough pain

 Monitor I and O hourly and record

7:30pm------------------for 300cc of present IVF

 TSB for fever

 Give Nifedipine 5 mg 8L now

 PHYSICIANS ORDER

9/7/8---------------------May seem indwelling foley catheter

6am----------------------there’s an abdominal binder

 v/s

 Urine ouput adequate(clear yellow)

3:40pm-----------------start methyldopa (aldomet) 125 g, 1 tab; TID

 Mefenamic acid 500g,1 tab, TID

 Vit.B Complex, 1 cap, O.D

 Keep abdominal bider tight

 Take meds

9/8/8---------------------Dulcolax 10 mg/supp., 1 supp. For rectum

91m----------------------May have daily body hygiene

 DAT once

9/9/8

9/10/8--------------------possible discharge today

7am-----------------------final disposition c/o RTC

  Home meds

o Mefenamic Acid 500g

o Vit.B complex

o Methyldopa(Aldomet)125mg, 1 tab; TID

 OPD follow up after 1 week-8 am

 Advised BP monitoring daily

9/10/8---------------------MGH

 Home Meds us previously order

 OPD after 1 week for follow up check-up

VII. LABORATORY

URINALYSIS

MACROSCOPIC EXAMINATION MICROSCOPIC EXAMINATION

COLOR-LIGHT YELLOW WBC(0-2)/HPF—0-2

SPECIFIC GRAVITY-1.010 RBC(0-1)/HPF—0-1

REACTION-ACIDIC RBC(0-1)/HPF-0-1

PROTEIN-NEGATIVE

EPITHELIAL CELLS—FEW
GLUCOSE-NEGATIVE BACTERIA—FEW

MUCUS THREADS—FEW

HEMATOLOGY
EXAMINATION RESULTS(S.I) REF.VALUE
BLOOD TYPE “O” Rh (+)
Hemoglobin 128
Hematocrit .35
Wbc count 5.6
Neutrophils .71
Lymphocytes .29
Eosinophils
Monocytes
Platelet
VIII. DISCHARGE SUMMARY

DATE ADMITTED: 9/6/8

ATTENDING PHYSICIAN: DR. ORTIN/PEPIN/ZOLETA

ADMITTING DIAGNOSIS: t/c ECTOPIC PREGNANCY

FINAL DIAGNOSIS: CORPUS LUTEUM CYST (L), CONGESTED APPENDIX

CHIEF COMPLAINT: MISSED PERIOD

BRIEF CLINICAL HISTORY: Patient consulted to OB-GYNE for missed period, (+)preg.test with corpus luteum cyst

P.E 130/80,84,19, I.E-CERVIX CLOSED

LABORATORY FINDINGS:

Hgb-128, Hct-.35, Wbc-5.6, N-.7, L-.29,bld typ-“o”

COURSE IN THE WARD:

Explore lap, Bilateral Tubal Ligation