Oncoward 5 April 2021

ONCOLOGY WARD REPORT
Monday, April 5th 2021
Supervisors: 1. Prof. dr. M. Fauzie Sahil, SpOG(K)

2. Dr. dr. Deri Edianto, M.Ked(OG),
SpOG(K)
3. dr. Sarah Dina, M.Ked(OG),
SpOG(K)
4. dr. Riza Rivany, SpOG(K)
5. dr. Cut Adeya Adella, SpOG(K)
6. dr. Dwi Faradina, M.Ked(OG),
SpOG(K)
7. dr. M. Rizki Yaznil, M.Ked(OG),
SpOG(K)
Residents: 1. dr. Yuda P. Putra Simbolon

2. dr. Mega Sari Dewi
3. dr. Roni Batara Lubis
DEPARTMENT OF OBSTETRIC AND GYNECOLOGY

FACULTY OF MEDICINE UNIVERSITAS SUMATERA UTARA
7 Patients
No Room Patient ID Supervisor Diagnosis Planning
• Waiting for CT Scan
Result
Ernawati Ovarian tumor susp. Malignancy + • Schedule for
RB 1 48 yo dr. Cut Adeya Leukocytosis (21.040) + operation
1.
3.3.3 P2A0 Adella, Sp.OG(K) Hypoalbuminemia (1.8) + • Check CBC,
82.93.33 Hypokaemia (3.3) Electrolite &
Albumin post
substitution
• Check Albumin
Yusnita
dr. Dwi Faradina, Progressive Cervical Cancer + Bone Post Subtitution 1
RB 1 41 yo
2. M.Ked(OG), Metastasis + Hypoalbuminemia flc
3.4.4 P3A0
Sp.OG(K) (2.2) • RE today
80.88.96
(05/04/2021)
Megawati Dr. dr. Deri Ovarian Cancer Inadequate

RB 1 52 yo Edianto, Staging + Post Sigmoidectomy LSS Today
3.
3.3.6 P3A0 M.Ked(OG), + Post Chemo NAC 4 cycle (05/04/2021)
36.92.04 Sp.OG(K) (18/3/2021)
Wiwid
Dr. Sarah Dina, LSS with fertility
RB 1 45 yo
4. M.Ked(OG), Ovarian Tumor Susp Malignancy sparing (04/04/2021)
2.2.3 Virgo
Sp.OG(K)
82.65.76
No Room Patient ID Supervisor Diagnosis Planning
• Monitoring Vital Sign
Elisaduser and drain volume
Post LSS + Adhesiolisis d/t Ca
RB 1 53 yo Dr. dr. Cut Adeya • Chemotherapy
5. ovarium IIIC + Peritoneal
3.3.3 P2A0 Adela, Sp.OG(K) Cisplatin
Carcinomatocsis + H4
82.56.74 Intraperitoneal
(06/04/2021)
• Tranfusion 3 bag PRC
Nenci (2/3) (HOM)
Cervical Cancer lost follow up +
RB 1 39 th dr. Riza Rivany, • Check CBC post
6. Anemia (5.0) +
3.4.1 P5A0 SpOG(K) transfusion 3 bag prc
Hypoalbuminemia (2.4)
80.77.66 and Albumin post
subtitution
Dhora • Check CBC Post

41 yo dr. Dwi Faradina, Cervical Cancer III B + Post RE Tranfusion 2 bag PRC
7. RA 4
P1A0 M.Ked(OG), SpOG(K) 24x + Anemia (8.3) • Continue for RE if HB ≥
82.54.53 10
PATIENT 1
ERNAWATI
Mrs. E, 48y.o, P2002, Javanese, Moslem, Senior High School, Housewife, married 2
times, first at 22 y.o, second at 29 y.o to Mr. P, 70 yo, (youngest child 15
y.o)Karonese, Moslem, Senior High School, Entrepreneur. The patient was admitted to
Adam Malik General Hospital on Monday, March 29th 2021 with:
Cc : Abdominal enlargement
E : This has been experienced by the patient since 1 year ago and getting worse
since 3 months ago. History of vaginal discharge (+). Decrease of appetite (+). History
of weight loss (+) 20 kg in 3 months. History of vaginal bleeding (-). History of
abdominal massage (-). History of abdominal pain (-). History of irregular menstrual
(-). History of abdominal discomfort (-). Nausea and vomitting (-). History of prolonged
and heavy menstrual bleeding (-). Micturition and defecation within normal limit.
Patient was an oncology outpatient with diagnose : Ovarian Tumor Susp Malignancy
History of Previous Illness : -
History of Medication :-
History of Surgery :-
History of Radiation :-
History of Chemotherapy : -
History of Menstruation : Menarche 12 y.o, regular, 28 days, 80cc, 5-7 days.
Irregular menstrual since 9 months ago
History of Contraception : -
EWS Score: 1
Vital Signs
Sens : CM Anemic : (+)
BP : 110/70 mmHg Icteric : (-)
Pulse : 82 bpm Cyanosis : (-)
RR : 22 rpm Dypsnoe : (-)
Temp : 36°C Edema : (-)
General state : Moderate BW : 90 kg

Nutritional state : Obese BH : 153 cm
llness State : Moderate BMI : 47.2 kg/m2
Generalized Status
• Head : Pale inferior palpebra conjuctiva (+/+), icteric (-/-)
• Neck : Supraclavicula Lymph node enlargement (-)
• Cor : S1 > S2 (+) normal, murmur : (-)
• Thorax : Respiratory sound : Vesicular (+/+).
Additional sound : Rales (-/-), Wheezing (-/-)
• Genitalia : Within normal limit
• Superior Ext : Within normal limit
• Inferior Ext : Pretibial oedem : (-/-)
• Axilla lymph node enlargement (-/-)
• Inguinal lymph node enlargement (-/-)
Localized State
•Abdomen: : Lax, Normoperistaltic, symmetrically enlarged, palpable solid mass, irregular

surface, immobile, tenderness (-), upper pole as 3 finger below xyphoid process on the left
abdominal, lower pole as symphysis level.
•Vaginal Bleeding: (-)
Gynecological State
Inspeculo : Seen smooth portio, mass (-), Blood (-), F/A (-)
VT : smooth portio, vaginal mass (-), Uterus was hard to assess, palpable
solid mass with upper pole as 3 finger below xyphoid process, lower pole as symphysis
level, irregular surface, tenderness (-). Right and left adnexa was hard to assess. Right and
left parametrium were laxed. CD not protruded. Anal Spincter was thight, recral mucosa
was smooth, ampula filled with feces

Laboratory findings
March 24th 2021
Hb : 7.0 N : 12-16 gr/dL
Leucocyte : 23.040 N : 4000-11000/u
Hematocrite : 21.6 N : 36,0-47,0/%
Platelet : 411.000 N : 150.000-450.000/uL
MCV : 84 N : 81-99
MCH : 27.1 N : 27-31
MCHC : 32.4 N : 31-37
RDW : 17.1
Neutrofil : 84.40 N : 50-70
Limfosit : 8.70 N : 20-40
Monosit : 6.20 N : 2-8
Eosinofil : 0.40 N : 1-3
Basofil : 0.30
Neutrofil abs : 19.44 N : 2.7-6.5x103/uL
Limfosit abs : 2.01 N : 1.5-3.7x103/uL
Monosit abs : 1.43 N : 0.2 – 0.4
Eosinofil abs : 0.10
Basofil abs : 0.06
NRBC : 0.0
Laboratory Findings
March 24th 2021
BUN : 14 N: 15-40
Ureum : 30 N: 13
Creatinin : 0.84 N: 0.6-1.2 mg/dl
Natrium : 117 N: 136-155 mmol/dl
Kalium : 3.8 N: 3.5-5.5 mmol/dl
Chlorida : 87 N: 95-103mmol/dl
Bilirubin Total : 0.30 N: 0.2 – 1.2
Bilirubin Direct : 0.20 N: < 0.5
SGOT : 27 N: 5 – 34
SGPT : 23 N: 0 - 55
Albumin : 2.0 N: 3.5 – 5.0
LDH : 836
AFP : 0.61
bHCG : 21.41
CEA : 5.17
CA 125 : 600,7
Diagnosis:
Ovarian tumor susp. Malignancy + Anemia (7.0) + Leukocytosis (23.040) +
Hyponatremia (117)
Therapy :
•IVFD NaCl 0.9% 20gtt/m
•Inj Ceftriaxon 1gr/12h
•Inj Ketorolac 30mg/8h
Planning:
•Blood Transfusion PRC 5 bags @175 cc
•NaCl 3% substitution
•CT Scan Upper Lower Abdomen with IV Contrast
Reported to Supervisor dr. Cut Adeya Adella, Sp.OG(K) Approved

Follow up March 29th 2021
S Weakness
O Presens state
Sens : Compos Mentis
BP : 110/70 mmHg
P : 82 bpm
RR : 20 x/min
T : 36,50C
Localized state
Abdomen : Laxed, Peristaltic (+)
Vaginal Bleeding : (-)
Micturition : (+)
Defecation : (-), Flatus (+)
A Anemia (7,0) + Ovarian tumor susp malignancy + Leukocytosis (23.040) + Hyponatremia (117)
P Transfusion 5 bags PRC

Nacl 3% substitution
Inj Ceftriaxon 1gr/12h
Plan Upper and lower abdominal CT scan with contrast

Urinary catheter
Follow up March 30th 2021
S Weakness
O Presens state
BP : 110/90 mmHg
P : 84 bpm
RR : 20 x/min
T : 36,60C
Localized state
Micturition : (+)
P Transfusion 5 bags PRC

Nacl 3% substitution
Plan Transfusion 5 bags PRC (1/5)
Upper and lower abdominal CT scan with contrast
Follow up March 31st 2021
S Weakness, abdominal enlargement
O Presens state
BP : 110/90 mmHg
P : 84 bpm
RR : 20 x/min
T : 36,60C
Localized state
Micturition : (+)
+ Obesity
P IVFD NaCl 0.9% 20gtt/m
Inj Omeprazole 40mg/12h

Continue therapy
Follow up April 1st 2021
O Presens state
BP : 110/90 mmHg
P : 84 bpm
RR : 20 x/min
T : 36,60C
Localized state
Micturition : (+)
+ Obesity

Check CBC and Electrolyte Post transfusion and Nacl substitution
Continue therapy
Laboratory findings
April 1st 2021
Hb : 11.4 N : 12-16 gr/dL
Leucocyte : 21.040 N : 4000-11000/u
Hematocrite : 33.8 N : 36,0-47,0/%
Platelet : 317.000 N : 150.000-450.000/uL
MCV : 84 N : 81-99
MCH : 28.1 N : 27-31
MCHC : 33.7 N : 31-37
RDW : 16.0
Neutrofil : 83.60 N : 50-70
Limfosit : 8.60 N : 20-40
Monosit : 7.40 N : 2-8
Basofil : 0.30
Monosit abs : 1.56 N : 0.2 – 0.4
Basofil abs : 0.07
NRBC : 0.0
Follow up April 2nd 2021
O Presens state
BP : 110/90 mmHg
P : 84 bpm
RR : 20 x/min
T : 36,60C
Localized state
Micturition : (+)
A Ovarian tumor susp malignancy + Leukocytosis (21.040) + Hypoalbuminemia (1.8) +

Hyponatremia (126) + Hypocalemia (3.3)
Plan Waiting for Upper and lower abdominal CT scan result

Continue therapy
Consult to Internal Medicine
Internal Medicine Department
(02/04/2021)
A:
•Leucocitocis (21.040) d/t Malignancy dd Secondary Infection
•Hypoalbuminemia (1.8)
•Hyponatremia (126)
•Hypocalemia (3.3)
•Ovarian Tumor susp Malignancy
P:
•Albumin Subtitution 2 flc
•KSR 1x600mg
•Salt Capsule 3x1
•High Protein Diet
R/
•Check Albumin and electrolyte (05/04/21)
Laboratory Findings
April 2nd 2021
Albumin : 1.8 N: 3.5 – 5.0
LDH : 771
Fibrinogen : 411.0
D-dimer : > 4000
Follow up April 3rd 2021
O Presens state
BP : 110/90 mmHg
P : 84 bpm
RR : 20 x/min
T : 36,60C
Localized state
Micturition : (+)

Plan Albumin Subtitution 2 flc (1/2)

Waiting for Upper and lower abdominal CT scan result
Continue therapy
Follow up April 4th 2021
O Presens state
BP : 110/90 mmHg
P : 84 bpm
RR : 20 x/min
T : 36,60C
Localized state
Micturition : (+)


Waiting for Upper and lower abdominal CT scan result
Continue therapy
Follow up April 5th 2021
O Presens state
BP : 110/90 mmHg
P : 84 bpm
RR : 20 x/min
T : 36,60C
Localized state
Micturition : (+)

Plan Waiting for CT Scan Result

Schedule for operation
Check CBC, Electrolite & Albumin post substitution
THANK YOU
PATIENT 2
YUSNITA
Mrs. Y, 41 yo, P3A0, Moslem, Acehnese, Senior High School, Housewife, married
once at 18 yo, married to Mr. M, Acehnese, Moslem. This patient came to Adam
Malik General Hospital on March 29th 2021 with:
CC : Abdominal pain
E : This has been experienced by the patient for 2 month ago and
worsening since 1 day ago. History of leucorrhea (+). History of vaginal bleeding
(+) since 1 week ago and worsening since 6 hours ago. History of palpable mass in
abdomen (-). History of lost appetite(+) and weight loss (-). History of nausea and
vomiting(-). History of fever(-) Micturition within normal limit. Blood in
defecation (+). This patient was Oncology outpatient with Ca cervix with bone
metastasis diagnosis.
History of Previous Illness :-
History of Chemotherapy :-
History of Radiotherapy : RE 38 times d/t cervical cancer st IIB (7/2020)
History of contraception :-
History of menstruation : Menarche at 12 yo regular, duration 5-6
days, volume 2-3 pads/ day. Dysmenorrhea (-)
EWS Score: 1
Vital Signs
Sens : CM Anemic : (+)
Temp : 36,1°C Edema : (-)

Illness State : Moderate Height : 145 cm
Nutritional state : Overweight BMI : 26,7 kg/m
Generalized Status :
• Head : Inferior palpebra conj. anemic (+/+), icteric (-)
• Neck : No abnormality
• Thorax : Respiratory sound : Vesiculer
• Additional sound : wheezing (-)/(-), rhales (-)/(-)
• Abdomen : Laxed, normal peristaltic, no palpable mass
• Extremities : Oedem pretibial (-), Cyanosis (-)
• Lymph nodes : Inguinal lymph node enlargement(-/-)
Localized State
Abdomen : Laxed, normoperistaltic, mass(-).
Gynecological State
RVT : Palpable exophitic mass filling until ½ distal vagina, Parametrium was tense,
pelvic wall was Involve, tight spincter ani, smooth anal mucose
Laboratorium findings
March, 29th 2021
Hb : 4.7 N : 12-16 gr/dL

Leucocyte : 17.340 N : 4000-11000/u
Hematocrite : 15.9 N : 36,0-47,0/%
Platelet : 420.000 N : 150.000-450.000/uL
MCV : 100 N : 81-99
MCH : 29.6 N : 27-31
MCHC : 29.6 N : 31-37
Neutrofil : 77.20 N : 50-70
Limfosit : 16.30 N : 20-40
Monosit : 5.10 N : 2-8
Basofil : 0.30 N : 0-1
Monosit abs : 0.88 N : 0.2 – 0.4
March 29th 2021
Glucose adrandom : 104 N: <200 mg/dl

BUN : 21 N: 7-19 mg/dL
Ureum : 45 N: 15-40 mg/dL
Creatinin : 45 N: 0.6-1.1 mg/dl
Chlorida : 103 N: 95-103 mmol/dl
Antigen SARS-Cov-2 : Negative N : negative
Chest X-Ray Result
March, 29th 2021
Conclusion:
Cor and Pulmo was within normal limit.
Histopathology
January, 28th 2021
Conclusion:
•Squamous cell carcinoma (non-keratinizing)
MRI Whole Spine (With
Contrast)
February, 23rd 2021
Conclusion:
•Right retroperitoneal mass sized 10 cm x 5 cm x 8,2 cm
suggestive malignancy
•Mass infiltrating to right kidney and lumbal vertebra L3-4
•Thrombus on right renal vein
•Paraaorta lymph node enlargement
•Left supra-clavicula lymph node metastasis sized 2,7 cm
•Bilateral iliaca bone metastasis
Diagnosis:
Progressive cervical cancer (susp. Bone metastasis)+ anemia (4,7) +
leukositosis (17.340) + Upper GI tract bleeding
Therapy :
-IVFD NaCl 0.9%
-Inj. Ceftriaxone 1 gr/12h
-Inj. Transamin 1000mg  500mg/8h
-Inj. Ketorolac 30mg/8h
Planning:
-Consult to Interna department
-Consult to Orthopaedy department
-Blood transfusion 5 bags of PRC @175 cc
Reported to Supervisor dr. Dwi Faradina,M.Ked(OG), SpOG(K)  Approved

THANK YOU
Follow-up
Monday, March 29th 2021
S -
Sens : CM
BP : 120/60 mmHg
Abdomen: laxed, peristaltic (+) not palpable mass
O Pulse : 90 bpm
Micturition(+)normal,Defecation with blood(+)
RR : 18 rpm
Temp : 36.1°C
A Ca Cervix recurrent + anemia (4,7) + Upper GI tract bleeding + susp. Bone metastase
-IVFD NaCl 0.9%
-Inj. Ceftriaxone 1 gr/12h
P -Inj. Transamin 1000mg  500mg/8h
-Inj. Ketorolac 30mg/8h
Consult to Orthopedy department
Plan Consult to Interna department
Blood transfusion of PRC (1/5)
Orthopedy Department
March,29th 2021
A : Susp. MSD d/t Ca cervix
P : Analgetic (if needed)

Interna department
March, 30th 2021
A:
-Upper GI tract bleeding d/t stress ulcer dd erosive gastritis
-Ca Cervix recurrent dd metastase
P:
-Inserted open NGT
-Fasting 6 hours
-Inj. Omeprazole 80mg  40mg/12h
-Inj. Tranexamide acid 500mg/8h
-Inj.vitamin K 1amp/24h
-Sulcralfat syr 3xC1
-Check HST
-Planning for gastroscopy in stable condition.
-Approved to join assesment on ward.
Follow-up
Tuesday, March 30th 2021
S Weakness
Sens : CM
BP : 110/80 mmHg
Abdomen: laxed, peristaltic (+), not palpable mass
O Pulse : 86 bpm
Micturition(+),Defecation (+)
RR : 20 rpm
Temp : 36.5°C
A Progressive Cervical Cancer + Anemia (4.7) + Hypoalbuminemia (1.5) + Bone Metastasis
P Follow therapy
Tranfusion 5 bag PRC (2/5)

Monitoring Fluid Balance
GEH-Interna department
March, 30th 2021
A:
-Upper GI tract bleeding d/t stress ulcer dd erosive
gastritis
-Ca Cervix recurrent dd metastase
-Hypoalbuminemia
P:
-Inj. Esomeprazole 40mg/12h
-Sulcralfat syr 3xC2
Follow-up
Wednesday, March 31st 2021
S Weakness
Sens : CM
BP : 110/70 mmHg Abdomen: laxed, peristaltic (+)
O Pulse : 88 bpm Micturition(+),Defecation (+), flatus (-)
RR : 18 rpm Fluid balance = +1495 cc
Temp : 36.2°C
P Follow therapy

Albumin Subtitution (1/3)
Plan Monitoring Fluid Balance
Consult to Nephrology Department
Consult to Radiotherapy for Schedule for Simulator
Follow-up
Thursday, April 1st 2021
S Weakness
Sens : CM
RR : 18 rpm Fluid balance
Temp : 36.2°C
P continue therapy
Transfusion 5 bag PRC (4/5)

Simulator Today
April, 2nd 2021
Hb : 10.6 N : 12-16 gr/dL

Leucocyte : 11.870 N : 4000-11000/u
Hematocrite : 25.4 N : 36,0-47,0/%
Platelet : 256.000 N : 150.000-450.000/uL
MCV : 86 N : 81-99
MCH : 35.7 N : 27-31
MCHC : 41.7 N : 31-37
Neutrofil : 84.90 N : 50-70
Limfosit : 6.10 N : 20-40
Monosit : 6.20 N : 2-8
Basofil : 0.20 N : 0-1
Monosit abs : 0.74 N : 0.2 – 0.4
Follow-up
Thursday, April 2nd 2021
S Weakness
Sens : CM
Temp : 36.2°C
P continue therapy

Plan Check CBC Post Tranfusion
April, 3rd 2021
Albumin : 2.2
Follow-up
Thursday, April 3rd 2021
S Weakness
Sens : CM
Temp : 36.2°C
A Progressive Cervical Cancer + Hypoalbuminemia (2.2) + Bone Metastasis
P continue therapy

Plan
Follow-up
Thursday, April 4th 2021
S Weakness
Sens : CM
Temp : 36.2°C
P continue therapy
Albumin Subtitution 1 flc

Follow-up
S Weakness
Sens : CM
Temp : 36.2°C
P continue therapy
Check Albumin Post Subtitution 1 flc

Plan RE today (05/04/2021)
THANK YOU
PATIENT 3
MEGAWATI
Mrs. M, 52 y.o, P3003, Bataknese, Christian, Senior High School, Housewife, married at 23 y.o
to Mr. M, 59 yo, (youngest child 23 y.o), Bataknese, Christian, Junior High School, Farmer. The
patient was admitted to Adam Malik General Hospital on Wednesday April 3rd 2021 with:
Cc : Abdominal Enlargement
E : This has been experienced since 3 moths ago. History of Abdominal pain (+)
intermittently. History of Vaginal bleeding (-). History of Abdominal Massage (+). Hystory of
weight loss (+) 15kg in 3 months. Micturition and Defecation is within normal limit. This
patient was an Oncology-Gynecology outpatient with diagnose Post Laparatomy Exploration +
Debulking Tumor + Sigmoidectomy d/t ileus obstructive + Post Chemotherapy Cisplatin
Intraperitoneal (16/01/2021)
History of Previous Illness :
History of Surgery : LE + Debulking Tumor + Sigmoidestomy (1/21)
History of Chemotherapy : Cisplatin Intraperitoneal 1 cycle (16/01/2021)
Cisplatin – Paclitaxel 3 cycle (26/2/21)
History of Menstruation : Menarche 13 y.o, regular, 28 days, 4-5x changing pads,
duration 6-7 days
Vital Signs
Sens : CM Anemic : (-)
Temp : 36.7°C Edema : (-)

Nutritional state : Normal BH : 145 cm
llness State : Moderate BMI : 23,3 kg/m2
Generalized Status
• Head : Pale inferior palpebra conjuctiva (-), icteric (-/-)
• Neck : Lymph node enlargement (-)
• Inguinal lymph node enlargement (-/+)
Localized State
•Abdomen : Asymetrical enlarge, Shifting dullness (+), undulation (+),
palpable solid mass with upper pole 1 cm below navel, lower pole as symphisis,
immobile, irreguler surface, stoma (+) dry
•Vaginal Bleeding : (-)
Gynecological State
Inspeculo : Seen smooth portio, erotion (-), mass (-), Blood (-), F/A
RVT : Uterine < normal, palpabe mass with upper pole 1 cm below navel,
lower pole at syphisys, immobile, irregular surface, CD was not
protruded, tight Spincter Ani, Smooth rectal mucose

Histopathology
January 13th 2021
Conclusion :
•Mass : Adenocarcinoma (Moderate differentiated)
Cythology
January 13th 2021
Conclusion :
•C2 (benign Smear)
MSCT Abdomen
March 24th 2021
• Right Ovarium sized 3.5-4 cm with malignant adhesive to

uterus
• Massive Ascites
• No Obstruction on both kidney and ureter
• No parailiaca or paraaorta Lymph node enlargement
Rontgen Thorax
March 29th 2021
• Conclusion :
• Cor and Pulmo within normal limit
Laboratory findings
March 29th 2021
Hb : 12.0 N : 12-16 gr/dL
Leucocyte : 4.230 N : 4000-11000/u
Hematocryt : 36.1 N : 36,0-47,0/%
Platelet : 235.000 N : 150.000-450.000/uL
MCV : 91 N : 81-99
MCH : 30.1 N : 27-31
MCHC : 33.2 N : 31-37
RDW : 18.5
Neutrofil : 59.50 N : 50-70
Limfosit : 32.20 N : 20-40
Monosit : 2.40 N : 2-8
Basofil : 0.20
Monosit abs : 0.10 N : 0.2 – 0.4
Basofil abs : 0.01
NRBC : 0.0
HBsAg : Non-reactive
HIV : Non-reactive
Laboratory Findings
March 29th 2021
BUN : 14 N: 15-40
Ureum : 30 N: 13
SGOT: 31 N: 5 – 34
SGPT : 35 N: 0 - 55
Albumin : 4.1 N: 3.5 – 5.0
PT : 11.0 C: 13,6 sec
INR : 0.89 C: 0.8 – 1.30
APTT : 26.5 C: 30.2 sec
TT : 17.2
pH : 7.460 N: 7.35 – 7.45
pCO2 : 30.0 N: 38 – 42
pO2 : 152.0 N: 85 – 100
HCO3: 21.3 N: 22 – 26
Total CO2 : 22.2 N: 19 – 25
BE : -1.8 N: (-2) – (+2)
SO2 : 99.0 N: 95 - 100
Diagnosis:
Ovarian Cancer Inadequate Staging + Post Sigmoidectomy d/t ileus obstructive +
Post Chemo NAC 4 cycle (18/3/21)
Planning:
•LSS (05/04/2021)
Reported to Supervisor Dr. dr. Deri Edianto, M.Ked(OG), Sp.OG(K) Approved

THANK YOU
Follow-up
S Weakness
Sens : CM
Temp : 36.2°C
Ovarian Cancer Inadequate Staging + Post Sigmoidectomy + Post Chemo NAC 4 cycle
A (18/3/21)
P continue therapy
Plan LSS Today (05/04/2021)

THANK YOU
PATIENT 4
WIWID
Ms. W, 45y.o, Virgo, Bataknese, Moeslim, Diploma, Employee, not married. The
patient was admitted to Adam Malik General Hospital on Monday April 4th 2021
with:
Cc : Abdominal Pain
E : This has been experienced since 1 year ago and worsening on
menstrual period. History of Vaginal bleeding (-). No palpable mass. History of
prolonged menstrual period (+), 2 weeks, frequency more than 5 pad change/day
cloth (+). History of Abdominal Massage (-). Micturition and Defecation is within
normal limit. This patient was an Oncology-Gynecology outpatient with diagnose
Ovarian Tumor susp malignancy and planned for USO and TAH consideration on
5/4/21
History of Previous Illness : -
History of Surgery : ESWL (2019)
History of Chemotherapy : -
History of Menstruation : Menarche 13 y.o, regular, 30 days, 100cc, 4-5 days,
dysmenore (+)
Vital Signs

Generalized Status
Localized State
•Abdomen : Laxed, Normoperistaltic, palpable mass cyst with regular surface, mobile
with upper pole 1 cm below navel, lower pole as level of symphisis
Gynecological State
Inspeculo and VT : Not Performed
RT : Tight spincter Ani, smooth rectal mucose, rectall ampula filled with
feces, UT AF normal size, palpable mass cyst with regular surface, mobile with upper pole 1
cm below navel, lower pole as level of symphisis

MSCT Abdomen
February 11th 2021
• Seen Hypoechoic Lession on uterus sized 4.7x4.8x4.9cm
• Seen hypodense lesion with septa on left ovarian cyst sized
7.9x6.1x6.2cm
• Right ovarian cyst sized 3.5x1.9x3.5cm
• No pelvical or paraaortal limph node enlargement
Conclusion :
• Adenomiosis dd uterus cyst + bilateral Ovarian cyst
• Fatty liver
Transrectal Sonography
February 9th 2021
• Conclusion : Adenomyosis + Left Ovarian Cyst

Rontgen Thorax
March 29th 2021
Conclusion :
•Cor and pulmo is within normal limit
•No sign of pulmonal metstase
Laboratory findings
March 22nd 2021
Hb : 13.6 N : 12-16 gr/dL
Leucocyte : 12.180 N : 4000-11000/u
Hematocryt : 39.0 N : 36,0-47,0/%
Platelet : 242.000 N : 150.000-450.000/uL
MCV : 88 N : 81-99
MCH : 30.8 N : 27-31
MCHC : 34.9 N : 31-37
RDW : 12.2
Neutrofil : 60.10 N : 50-70
Limfosit : 21.30 N : 20-40
Monosit : 6.30 N : 2-8
Basofil : 0.70
Monosit abs : 0.77 N : 0.2 – 0.4
Basofil abs : 0.09
NRBC : 0.0
HIV : Non-reactive
Laboratory
Findings
Glucose adrandom : 120 March
N: <200 mg/dl22 2021
th
BUN : 10 N: 15-40
Ureum : 21 N: 13
SGOT : 18 N: 5 – 34
SGPT : 21 N: 0 - 55
Albumin : 3.8 N: 3.5 – 5.0
PT : 0.79 C: 13,6 sec
INR : 1.00 C: 0.8 – 1.30
APTT : 33.0 C: 30.2 sec
TT : 14.7
pH : 7.330 N: 7.35 – 7.45
pCO2 : 21.0 N: 38 – 42
pO2 : 188.0 N: 85 – 100
HCO3 : 11.1 N: 22 – 26
Total CO2 : 11.7 N: 19 – 25
BE : -12.8 N: (-2) – (+2)
SO2 : 100.0 N: 95 - 100
HBsAg: Non Reactive
HIV : Non Reactive
Diagnosis:
Ovarian Tumor Susp Malignancy
Planning:
•LSS with fertility sparing Monday (05/04/2021)
Reported to Supervisor dr. Sarah Dina, M.Ked(OG), Sp.OG(K)

Approved
THANK YOU
Follow-up
S Weakness
Sens : CM
Temp : 36.2°C
A Ovarian Tumor Susp Malignancy + Type II DM
P continue therapy
Plan LSS with fertility sparing Today (05/04/2021)

THANK YOU
PATIENT 5
ELISADUSER
Mrs. E, 53, y.o, P2002, Bataknese, Christian, Senior High School, Housewife, married
at 23 y.o to Mr. A, 60 yo, (youngest child 12y.o), Bataknese, Christian, Junior High
School, Farmer. The patient was admitted to Adam Malik General Hospital on
Wednesday March 31th 2021 with:
Cc : Abdominal Enlargement
E : This has been experienced since 3 moths ago. Hystory of Abdominal pain (+)
intermittently. History of Vaginal bleeding (-). History of Abdominal Massage (+).
Micturition and Defecation is within normal limit. This patient was an Oncology-
Gynecology outpatient with diagnose Ovarian cancer III C + Post Chemotherapy NAC
Carbo-Pacli cycle 3.
History of Previous Illness :
History of Surgery : Cytology ascites (malignant smear)
History of Chemotherapy : Carbo-Pacli cycle 3
History of Menstruation : Menarche 12 y.o, regular, 28 days, 100cc, 4-5 days
menopause 5 years ago
Vital Signs

Generalized Status
Localized State
•Abdomen : Distension, Shifting dullness (+), undulation (+), mass was difficult to
assess
Gynecological State
Inspeculo : Seen smooth portio, mass (-), Blood (-), F/A (-)
VT : Uterine size was normosize, mass was difficult to assess, both of
adnexae difficult to assess, both of parametrial were laxed, CD was protruded

MSCT Abdomen
January 28th 2021
• Mass is visualized from the gynecologic organ in the pelvic cavity which
appeared malignant.
• The size of the mass is difficult to be measured due to its attachment to
uterus and nearby intestines (The mass is seemed to be non-resectable)
• Massive ascites.
• Compression to the vesica urinaria and mass indentation in the
posterior part.
• There are no metastases to the liver or to the other abdominal organ.
• DVT on the left common iliac vein & left and right femoral vein.
MSCT Abdomen
March 24th 2021
• Right Ovarium sized 3.5-4 cm with malignant adhesive to uterus

• Massive Ascites
• No Obstruction on both kidney and ureter
• No parailiaca or paraaorta Lymph node enlargement
Rontgen Thorax
March 29th 2021
• Conclusion :
• Left Hemidiafraghma Effusion ec Phrenicus nerve Parese dd
Diapraghm Hernia
• Left Pleural Effusion
Laboratory findings
March 15th 2021
Hb : 9.2 N : 12-16 gr/dL
Leucocyte : 2.760 N : 4000-11000/u
Hematocryt : 27 N : 36,0-47,0/%
Platelet : 144.000 N : 150.000-450.000/uL
MCV : 93 N : 81-99
MCH : 32.3 N : 27-31
MCHC : 34.7 N : 31-37
RDW : 18.5
Neutrofil : 49.30 N : 50-70
Limfosit : 40.60 N : 20-40
Monosit : 10.10 N : 2-8
Basofil : 0.00
Monosit abs : 0.28 N : 0.2 – 0.4
Basofil abs : 0.00
NRBC : 0.4
HIV : Non-reactive
Laboratory Findings
March 15th 2021
BUN :7 N: 15-40
Ureum : 15 N: 13
SGOT : 24 N: 5 – 34
SGPT : 19 N: 0 - 55
Albumin : 4.1 N: 3.5 – 5.0
PT : 12.6 C: 13,6 sec
INR : 1.00 C: 0.8 – 1.30
APTT : 26.0 C: 30.2 sec
TT : 17.0
pH : 7.410 N: 7.35 – 7.45
pCO2 : 13.0 N: 38 – 42
pO2 : 182.0 N: 85 – 100
HCO3 : 8.2 N: 22 – 26
Total CO2 : 8.6 N: 19 – 25
BE : -13.5 N: (-2) – (+2)
SO2 : 100.0 N: 95 - 100
Laboratory findings
March 17th 2021
Hb : 10.3 N : 12-16 gr/dL
Leucocyte : 7.410 N : 4000-11000/u
Hematocrite : 25 N : 36,0-47,0/%
Platelet : 237.000 N : 150.000-450.000/uL
MCV : 92 N : 81-99
MCH : 34.7 N : 27-31
MCHC : 37.8 N : 31-37
RDW : 17.9
Neutrofil : 83.90 N : 50-70
Limfosit : 8.00 N : 20-40
Monosit : 8.10 N : 2-8
Basofil : 0.00
Monosit abs : 0.60 N : 0.2 – 0.4
Basofil abs : 0.00
NRBC : 0.3
Laboratory Findings
March 29th 2021

BUN : 10 N: 15-40
Ureum : 21 N: 13
SGOT : 23 N: 5 – 34
SGPT : 18 N: 0 - 55
Albumin : 4.2 N: 3.5 – 5.0
HIV : Non-Reactive
HbsAg : Non-Reactive
RT PCR SARS Cov 2 : Negative
Diagnosis:
Ca ovarium Advance Stage + Post Chemo NAC Carbo-Pacli cycle III
Planning:
•LSS (01/04/2021)
Reported to Supervisor dr. Cut Adeya Adella, Sp.OG(K) Approved

THANK YOU
Follow-up
S Operation Wound Pain

Sens : CM
Abdomen: laxed, peristaltic (+)
BP : 110/80 mmHg
Micturition(+),Defecation (+), flatus (-)
O Pulse : 86 bpm
Fluid balance,
RR : 18 rpm
Drain Volume : 800cc
Temp : 36.2°C
A Post LSS + Adhesiolisis d/t Ca ovarium IIIC + Peritoneal Carcinomatocis + H1
P continue therapy
Urine Catheter Removal

Plan Mobilisation
Follow-up
Thursday, April 3rd 2021

Sens : CM
BP : 110/80 mmHg
O Pulse : 86 bpm
Fluid balance,
RR : 18 rpm
Temp : 36.2°C
P continue therapy
IV line Removal
Plan Oral Therapy
Follow-up

Sens : CM
BP : 110/80 mmHg
O Pulse : 86 bpm
Fluid balance,
RR : 18 rpm
Temp : 36.2°C
P continue therapy
Plan Monitoring Vital Sign and Drain Volume

Follow-up

Sens : CM
BP : 110/80 mmHg
O Pulse : 86 bpm
Fluid balance,
RR : 18 rpm
Temp : 36.2°C
P continue therapy
Continue Therapy
Plan Monitoring Vital Sign and drain volume
Chemotherapy Cisplatin Intraperitoneal (06/04/2021) + Paclitaxel 175 mg2
THANK YOU
Patient 6
Nenci
Mrs. N, 39 y.o, P5005, youngest child 3 yo, Karonese, Catholic,
Junior High School, Farmer. Married to Mr. B , 43 yo, Karonese,
Catholic, Junior High School, Entrepreneur. The patient was came to
Adam Malik Hospital on March 31th 2021 at 20.00 pm with:
Cc : Vaginal Bleeding
E : This has been experienced by the patient since 3 days ago,
with volume >5times changes pads/day. History of blood clot(+).
History of post coital bleeding (-). History of abdominal enlargement
(-). History of abdominal massage (-). History Weight loss (+) about
10 kg in past 6 month. History lost of appetite (+). History of fever
(+) since 1 day ago, cough (-). Shortness of breath (+) since 2 weeks
ago. This patient was referred from other hospital with diagnose
Cervical cancer II B + Post RE 20x + Anemia (2.2). Patient was
oncology outpatient clinic with last visit 10/02/2020
History of previous illness : -
History of Histopathology : Keratinizing Squamous cell carcinoma
(10/02/20)
History of Rsdiotherapi : EBRT 20x (10/02/2020)
History of menstruation : Menarche at 13 yo, 28-31 days, frequency 2-3
changing pads/day. Menopause (-).
Chest X-Ray
March 31th 2021
Conclusion: Cor and Pulmo within normal limit

EWS
Score
0
Vital Signs
Sens : Alert Anemic : (+)
Pulse : 112 x/i Cyanosis : (-)
RR : 20 x/i Dypsnoe : (-)
Temp : 38.0°C Oedem : (-)
SpO2 : 99%
Illness State : Severe Height : 152 cm
Nutritional State : Moderate BMI : 21,6
Generalized Status
• Head: Inferior palpebra conjungtiva anemic (+/+), icteric (-/-)
• Neck : Within no abnormality
• Thorax : Cor : S1, S2 reguler, murmur and gallop (-)
Respiratory sound : vesiculer (+/+)
Additional sound : wheezing(-/-), rales (-/-)
• Extremities : Oedem (-/-), Cyanosis (-/-)
Abdominal Examination
Abdomen : Laxed, normoperistaltic, mass (-)
Vagina bleeding : (-)
Vaginal Examination
Inspeculo : Seen Exofitic mass size 4 x 5 x 4 cm, blood (+), not
actively bleeding , vaginal mucosa smooth
RVT : Papable exofitic mass size 4 x 5 x 4 cm, fragile easy to bleed,
both parametrium was tense, adnexa normal, Uterus AF normosize,
spincter anal was thight, ampula was empty,a anal mucosa was
smooth, Pelvic wall was involve
USG TAS
March 31st 2021
USG TAS
March 31st 2021
USG TAS
March 31st 2021
USG TAS
March 31st 2021
USG TAS
March 31st 2021
USG TAS
March 31st 2021
Transabdominal sonography report
March 31st 2021
• Bladder was empty
• Anteflexed uterus with size 70,5 x 5,22 x 60.8 cm
• E-Thickness : 63 mm
• Seen hyperechoic appearance on the cervix with size 63,5 x 40,3 x
74,8mm
• Right Ovarium with size 29.8 x 17,7 mm
• Left Ovarium with size 28.4 x 17,7 mm
• Free fluid (-)
Conclusion: Cervical mass

Laboratory Findings
March 31st 2021
Hb : 1.6 N: 12-14 gr/dL

Leukosit : 16.260 N: 4.000-11.000/uL
Hematokrit : 63 N: 36,0-42,0/%
MCV : 76 N : 81-99
MCH : 20.5 N: 27-31 pg
MCHC : 27.0 N: 32-36 g/dl
Platelet : 382.000 N: 150.000-400.000/u
BUN : 11 N: 15-40
Ureum : 24 N: 13
PT : 14.2 C: 13,6 sec
INR : 1.08 C: 0.8 – 1.30
APTT : 26.7 C: 32.5 sec
Internal Medicine department
A:
-Anemia ec Haemorragic (1,6) + Susp. Ca Cervix
P:
-Transfusion PRC 3 Pack
-Check CBC Post Transfusion, HST, Fibrinogen, D-dimer, Calsium, Albumin,
SI, Ferritin, TIBC
-Acc Join care with Obgyn Department
Diagnosis:
Cervical cancer std II B (Lost Of Follow Up) + Post RE 20x +
Anemia (1.6)
Therapy:
IVFD NaCL 0,9% 20 dpm
Inj. Tranexamic acid 500mg/
Inj. Cetriaxone 1 gr/12h
Plan :
PRC Transfusion 3 Pack/ day
Assessment if Hb > 8 mg/dL
Join Care with Internal Medicine Department
Report to supervisor on duty Dr. dr. Edwin M Asroel, M.Ked(OG)

Sp.OG (K) → Approved
Follow-up
S Weakness
Sens : CM
RR : 18 rpm P/V : Spoting
Temp : 36.5°C
A Cervical cancer std II B (Lost Of Follow Up) + Post RE 20x + Anemia (1.6)
P continue therapy
Plan Tranfusion PRC 3 bag (1/3)

Follow-up
S Weakness
Sens : CM
RR : 18 rpm UOP : 60 cc/hour yellowish
Temp : 36.2°C
P continue therapy
Tranfusion PRC 3 bag (3/3)

Plan Check CBC post tranfusion
Laboratory Findings
April 2nd 2021
Hb : 5.0 N: 12-14 gr/dL

Leukosit : 9.350 N: 4.000-11.000/uL
Hematokrit : 15.9 N: 36,0-42,0/%
MCV : 82 N : 81-99
MCH : 25.6 N: 27-31 pg
MCHC : 31.4 N: 32-36 g/dl
Platelet : 274.000 N: 150.000-400.000/u
Follow-up
S Weakness
Sens : CM
RR : 20 rpm UOP : 70 cc/hour yellowish
Temp : 36.5°C
P continue therapy

Follow-up
S Weakness
Sens : CM
BP : 110/70 mmHg
O Pulse : 86 bpm
RR : 20 rpm
Temp : 36.5°C
P continue therapy

Follow-up
S Weakness
Sens : CM
RR : 18 rpm P/V : spoting
Temp : 36.2°C
P continue therapy

Plan Check CBC post transfusion 3 bag PRC
Thank you
PATIENT 7
Dhora
Mrs. D, 41 yo, P1A0, Mandailing, Moeslim, Senior High School, Housewife,
Married once at 19 yo, to Mr. F, 45 yo, Mandailing, Moeslem, Bachelor,
Employee . This patient came to Adam Malik General Hospital on March 30 th
2021 with:
Cc : Diarrhea
E : This has been experienced since. 5 days ago, >10 times / day, serous.
Weakness (+). Hystory of fever (-). Patient was an oncology outpatient with
Ovarian Cancer IIIB + Post RE 24 times + Post Chemotherapy Cisplatin 5 cycles.
History of Previous Illness :-
History of Surgery : C-Section (2000), Biopsy (02/2021)
History of Chemotherapy : Cisplatin 5 cycles (27/02/2021)
History of Radiotherapy : RE 24 times (26/01/2021)
History of contraception : Hormonal Contraception for 20 years
History of menstruation : Menarche at 12 yo, duration 6-7 days, 2-3
changing pads/day, dysmenorrhea (+).
Vital Signs
Sens : Alert Anemic : (-)

Illness State : Moderate Height : 152 cm
Nutritional state : Normal BMI : 23.8 kg/m
Generalized Status :
• Head : Inferior palpebra conj. anemic (-), icteric (-)
• Neck : no abnormality
• Thorax : Respiratory sound : Vesiculer
Additional sound : wheezing (-)/(-), rhales (-)/(-)
• Abdomen : laxed, normoperistaltic.
• Extremities : Oedem pretibial (-), Cyanosis (-)
• Lymph nodes : no enlargement
Localized State
Abdomen : Laxed, Normoperistaltic, No Palpable Mass
Gynecological State
Inspeculo : Not Performed
RVT : Not Performed

Laboratory findings
March 28th 2021
Hb : 9.0 N : 12-16 gr/dL
Leucocyte : 4.460 N : 4000-11000/u
Hematocrite : 25.0 N : 36,0-47,0/%
Platelet : 230.000 N : 150.000-450.000/uL
MCV : 84 N : 81-99
MCH : 30.2 N : 27-31
MCHC : 36.0 N : 31-37
Internal Medicine Department
(30/03/2021)
A:
- Acute Diarrhea
- Hyponatremy (117)
- Hypocalemy (3.2)
P:
- NaCl 3% 10 dpm
- Loperamide (extra 1 tab/diarrhea)
- KSR 600 mg/24h
Diagnosis :
Cervical Cancer III B + Post RE 24x + Post Chemotherapy Cisplatin
cycle V + Anemia (9.0) + Acute Diarrhea
Plan :
Transfusion 1 bag of PRC @175 cc
Other Theraphy based on Internal Medicine Dept
Reported to Supervisor dr. Dwi Faradina, M.Ked(OG), SpOG(K) 

Approved
THANK YOU
Follow-up
Tuesday, April 1st 2021
S Weakness
Sens : CM
BP : 130/80 mmHg
O Pulse : 88 bpm
RR : 20 rpm
Temp : 36.5°C
Cervical Cancer III B + Post RE 24x + Post Chemotherapy Cisplatin cycle V + Anemia (9.0) +
A Acute Diarrhea
Check CBC Post Transfusion 1 bag PRC

Plan Continue for RE if HB >10
Laboratory findings
April 1st 2021
Hb : 8.3 N : 12-16 gr/dL
Leucocyte : 1.680 N : 4000-11000/u
Hematocrite : 22.6 N : 36,0-47,0/%
Platelet : 167.000 N : 150.000-450.000/uL
MCV : 81 N : 81-99
MCH : 29.7 N : 27-31
MCHC : 36.7 N : 31-37
Follow-up
Tuesday, April 2nd 2021
S Weakness
Sens : CM
BP : 110/70 mmHg
O Pulse : 88 bpm
RR : 18 rpm
Temp : 36.6°C
A Acute Diarrhea

Follow-up
Tuesday, April 3rd 2021
S Weakness
Sens : CM
BP : 110/80 mmHg
O Pulse : 86 bpm
RR : 20 rpm
Temp : 36.7°C
A Acute Diarrhea

Follow-up
Tuesday, April 4th 2021
S Weakness
Sens : CM
BP : 120/60 mmHg
O Pulse : 86 bpm
RR : 18 rpm
Temp : 36.2°C
A Acute Diarrhea

Follow-up
Tuesday, April 5th 2021
S Weakness
Sens : CM
BP : 110/70 mmHg
O Pulse : 80 bpm
RR : 18 rpm
Temp : 36.2°C
A Acute Diarrhea
Check CBC Post Tranfusion 2 bag PRC

Plan Continue for RE if HB ≥ 10
Other Theraphy According to Internal Medicine Dept
THANK YOU

Oncoward 5 April 2021

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Oncoward 5 April 2021

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ONCOLOGY WARD REPORT

Monday, April 5th 2021

Supervisors: 1. Prof. dr. M. Fauzie Sahil, SpOG(K)

Residents: 1. dr. Yuda P. Putra Simbolon

DEPARTMENT OF OBSTETRIC AND GYNECOLOGY

Megawati Dr. dr. Deri Ovarian Cancer Inadequate

Dhora • Check CBC Post

General state : Moderate BW : 90 kg

•Abdomen: : Lax, Normoperistaltic, symmetrically enlarged, palpable solid mass, irregular

abdominal, lower pole as symphysis level.

•Vaginal Bleeding: (-)

was smooth, ampula filled with feces

Reported to Supervisor dr. Cut Adeya Adella, Sp.OG(K) Approved

P Transfusion 5 bags PRC

Plan Upper and lower abdominal CT scan with contrast

P Transfusion 5 bags PRC

Plan Transfusion 5 bags PRC (4/5)

Plan Transfusion 5 bags PRC (5/5)

A Ovarian tumor susp malignancy + Leukocytosis (21.040) + Hypoalbuminemia (1.8) +

Plan Waiting for Upper and lower abdominal CT scan result

Albumin : 1.8 N: 3.5 – 5.0

A Ovarian tumor susp malignancy + Leukocytosis (21.040) + Hypoalbuminemia (1.8) +

Plan Albumin Subtitution 2 flc (1/2)

A Ovarian tumor susp malignancy + Leukocytosis (21.040) + Hypoalbuminemia (1.8) +

Plan Albumin Subtitution 2 flc (2/2)

A Ovarian tumor susp malignancy + Leukocytosis (21.040) + Hypoalbuminemia (1.8) +

Plan Waiting for CT Scan Result

General state : Moderate BW : 56 kg

Hb : 4.7 N : 12-16 gr/dL

Glucose adrandom : 104 N: <200 mg/dl

Reported to Supervisor dr. Dwi Faradina,M.Ked(OG), SpOG(K)  Approved

P : Analgetic (if needed)

Tranfusion 5 bag PRC (2/5)

Tranfusion 5 bag PRC (3/5)

Transfusion 5 bag PRC (4/5)

Hb : 10.6 N : 12-16 gr/dL

Transfusion 5 bag PRC (5/5)

Monitoring Fluid Balance

Albumin Subtitution 1 flc

Check Albumin Post Subtitution 1 flc

General state : Moderate BW : 49 kg

•Abdomen : Asymetrical enlarge, Shifting dullness (+), undulation (+),

immobile, irreguler surface, stoma (+) dry

•Vaginal Bleeding : (-)

lower pole at syphisys, immobile, irregular surface, CD was not

protruded, tight Spincter Ani, Smooth rectal mucose

• Right Ovarium sized 3.5-4 cm with malignant adhesive to

Reported to Supervisor Dr. dr. Deri Edianto, M.Ked(OG), Sp.OG(K) Approved

Plan LSS Today (05/04/2021)

General state : Moderate BW : 49 kg

with upper pole 1 cm below navel, lower pole as level of symphisis

•Vaginal Bleeding : (-)

Inspeculo and VT : Not Performed

cm below navel, lower pole as level of symphisis

• Conclusion : Adenomyosis + Left Ovarian Cyst

Reported to Supervisor dr. Sarah Dina, M.Ked(OG), Sp.OG(K)

Plan LSS with fertility sparing Today (05/04/2021)

General state : Moderate BW : 49 kg

•Vaginal Bleeding : (-)

VT : Uterine size was normosize, mass was difficult to assess, both of

adnexae difficult to assess, both of parametrial were laxed, CD was protruded

• Right Ovarium sized 3.5-4 cm with malignant adhesive to uterus

Glucose adrandom : 92 N: <200 mg/dl

Reported to Supervisor dr. Cut Adeya Adella, Sp.OG(K) Approved