Summary of Database

Mr. AH/ 43 y.o/ Ward 17

Autoanamnesa/Heteroanamnesa
Chief Complaint: Pro Chemotherapy
History of Present Illness:
There was no complaint during this period of admission.
Patient was diagnosed with Gastric cancer since November 2020. The first
symptom was nausea and loss of appetite. There was weight loss during initial
symptom, but patient didn’t remember. There was no pain accompanying the
symptom. Patient has underwent chemotherapy 1st series 3rd cycle.
 Summary of Database
Past Medical History:
No remarkable history

Family History:
There was no family with history of malignancy or other disease

Social History:
He is a merchant, and he was a high school graduate

Review of System:
Fever (-), Urination and defecation was normal.
 Physical Examination
General appearance looked slightly ill Sat O2 96% on room air
GCS 456 BW: 70 kg, Height: 165 cm
BMI: 25.771 kg/m2

BP 130/92 mmHg PR 92 bpm regular strong RR 20 tpm Tax 36.5oC

Head Conjunctiva Anemic (+)
Neck JVP R+2 cmH20

Chest Symmetrical, retraction (-)

Lung Sonor | Sonor Vesicular | Vesicular Rhonkhi : - | - Wheezing : -|-
Sonor | Sonor Vesicular | Vesicular -
|- -|-
Sonor | Sonor Vesicular | Vesicular -
|- - |-
Cardio Ictus invisible, palpable at MCL (S) ICS V
LHM ~ ictus, RHM ~ SL (D) S1 S2 single, regular,
murmur (-) gallop (-)

Abdomen Flat, soefl, Bowel Sound (+) normal, shifting dullness (-)
Liver/ unpalpable, liver span 14 cm,
Lien/ Traube space tympani
Scar post gastrectomy

Extremities Edema (-), pale (-).

Laboratory Findings (18/3/21)
LAB VALUE NORMAL

Leucocyte 5960 4.700 – 11.300 /µL

Hemoglobine 9.3 11,4 - 15,1 g/dl

PCV 28.6% 38 - 42%

Thrombocyte 192.000 142.000 – 424.000 /µL

MCV 84.4 80-93 fl

MCH 27.4 27-31 pg

Eo/Bas/Neu/ 4.7/0.2/61.3/ 0-4/0-1/51-67/

Limf/Mon 24.7/9.1 25-33/2-5

Eclia NR NR

ANC 3540

Natrium 143.3 136-145 mmol/L

Kalium 3.57 3,5-5,0 mmol/L

Chloride 104 98-106 mmol/L

Electrocardiography (18/3/2021)
 Electrocardiography (18/3/2021)
 Sinus rhythm HR 100 bpm
 Frontal Axis : Normal
 Horizontal Axis : Normal
 P Wave : 0.08s
 PR interval : 0.12s
 QRS complex : 0.08s
 Q wave : Normal
 QT interval : 0.36s
 ST Segmen : Normal, isoelectric
 T Wave : Normal

Conclusion : Sinus rhythm, HR 100 bpm

Abdominal CT (1/10/2020)
Abdominal CT (1/10/2020)
 Abdominal CT (1/10/2020)
Hepar : Normal size, sharp edges, regular, normal echoparenchyme, normal
portal and hepatic vein, normal biliary system, no nodule or cyst
Gallbladder : normal size, normal wall, no stone or sludge
Lien : Normal size, normal echoparenchyme, no nodule or cyst
Pancreas : Normal size, normal echoparenchyme, no nodule or cyst
Ren D : normal size, normal echocortex, sinus and cortex border visible, no
stone, ectasis or cyst
VU: Wall normal, no stone or mass
Distended gaster appearance with food fluid and contrast media, retention
with air fluid level
Circular thickening appearance of whole pylorus wall with regular outer wall
and irregular inner wall, leaving very narrow lumen
Only little amount of contrast media fill intestine
No intraperitoneal free fluid
CONCLUSION
- Suggestive Pyloric Carcinoma obstructing almost whole gastric outlet
- Hepar/Lien/Pancreas/Ren D & S/Gall Bladder normal
- No Lymphadenopathy Loco Regional
 PA Gastrectomy (19/10/2020)

1. From Pylorus and duodenum

• Signet ring cell adenocarcinoma
• Suggested to do IHC

2. From Gastrectomy
• Signet ring cell adenocarcinoma
• Tumor growth to serosa around 1 mm apart
• Tumor cell still found at the proximal border from gaster
and pylorus cut
• T3NxMx
 IHC (04/11/2020)

• Immunophenotype in 2 from 3 specimen showed

signet ring cell carcinoma
 POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed
Mr. AH/ 43 y.o/ Ward 17 1. Signet Ring Cell - - Non-Pharmacological PMo
Carcinoma Gaster - Diet TKTP 2000 - S, VS, UOP,
Subjective stadium IIA T3N0M0 kkal/day chemotherapy
- History of Gastric Cancer since 3 KS 90% reaction,
months ago
- Initial symptom was nausea, loss Pharmacological - CXR, abdominal
of appetite and body weight - IVFD NS : Futrolit = USG
2:1 ~ 1500 cc/24h
Objective - Chemoterapi Ped
- Anemic conjunctiva Regimen Brexel – - Education
- Gastrectomy scar
Carboplatin -5 FU 1st about
Lab 18/3/2021 series 4/4 cycle treatment and
Hb: 9.3 g/dL prognosis
-PA Gastrectomy (19/10/2020)
- Physical social
Signet ring cell carcinoma, Tumor cell support
still found at the proximal border
from gaster and pylorus cut

IHC 4/11/2020
Immunophenotype in 2 from 3
specimen showed signet ring cell
carcinoma

CT Scan 1/10/2020
-Suggestive Pyloric Carcinoma
obstructing almost whole gastric
outlet
-Hepar/Lien/Pancreas/Ren D &
S/Gall Bladder normal
-No Lymphadenopathy Loco Regional
 POMR (Problem Oriented Medical Record)
CUE AND CLUE PL IDx PDx PTx PMo&Ed

Mr. AH/ 43 y.o/ Ward 17 2. Anemia in Pharmacological PMo

Subjective Malignancy PRC Transfusion - S, VS, CBC
1 pack/day until post
- History of Gastric Cancer since 3 Hb>10 g/dL transfusion
months ago
- Initial symptom was nausea, loss of
appetite and body weight Ped
- Education
Objective about
- Anemic conjunctiva disease
progression
Lab 18/3/2021 and
Hb: 9.3 g/dL treatment
MCV/MCH: 84.4/27.4
 Problem Analysis

Age Infection H. Phylori Family history

Signet Ring Cell Adenocarcinoma

Gaster

Cancer Pain
Pathophysiology Carcinoma Gaster
Pathophysiology Carcinoma Gaster
Pathophysiology
Carcinoma Gaster
Key Message Diagnosis

ESMO Guideline, 2016

 Key Message Diagnosis

WHO Classification of Gastric Cancer

Key Message Diagnosis

ESMO Guideline, 2016

Key Message Diagnosis

ESMO Guideline, 2016

Management Analysis

ESMO Guideline, 2016

ESMO Guideline, 2016
ESMO Guideline, 2016
 Key Message Social

• Patient also needs support from his family through

multiple chemotherapy session
• Patient needs family to help him should there be
declining in condition post chemotherapy
 Condition This Morning

• GCS 456
• BP : 118/72 mmHg
• HR : 84 bpm
• RR : 18 tpm
• Saturation O2 : 99% RA
• Tax : 36.3 C