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8/11/2019 Tri Widatik
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Onchology Case Report
Onchology Surgery dr. Sardjito MedicalCenter of Yogyakarta
2014
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IDENTITY
Name : Trd
Birth Date : 10th of September 1985
Sex : Female
MR Number : 1670246
Hospitalized Date : 4th of April 2014
Ward : 2
nd
of Cendana
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Admission
Primary Survey
A : Clear speaking, no snorring , no gurgling
B : no dyspneu, RR 26 x/mntC : Warm feet and hands, Blood Pressure 100/60
Pulse 98 x/mnt RCT < 1 second
D : GCS E4V5M6, isokor of pupil 3mm/3mm, Light
Reflex +/+
Initial Asesment : No life threatening
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Secondary Survey :
Chief complain : Fatigue History : about 1,5 year ago the patient
undergo operation in Boyolali State Hospitalfor tumour removal of the left
femur.Pathological anatomy result wasFibrosarcoma . Three months after, thetumour is regrow. Again she was operated inSalatiga Stated Hospital with the
histopathologic result for the same reslult.Then the patient was referred to MoewardiMedical Center for further teratment.
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Operation has been done with thehistopathological result for fibrosarcoma.FTSG procedure has been done for closingthe operation defect. Chemotherapy wasplanned for the patient. She refused theprocedure. A month before hospitalization
she came to Sardjito Hospital EmergencyRoom for dizzines,lethargic complain. TheHemoglobin is 4 gr%
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During hospitalization she was tranfused with 6bag of PRC. She was sent home.Radiotherapy was planned in 15th of April2014. In the day, she come to RadiotherapyCenter, but suggested for hospitalizationbecause of the general weakness. The
Hemoglobin was 6,9 gram%, white bloodcount is 31.400. The radiotherapy wasreplanned after optimalization condition.
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PHYSICAL EXAMINATION
General Appearance : Weak , Compos Mentis
Vital Sign :
BP = 90/60 mmHg P = 92 x/mnt,RR = 24 x/mnt t = 36º
VAS = 8
Head : Anemia of the Conjuntivae (+/+),Scleral Icteric (-/-)
Neck : No JVP uprise, No lnn palpable
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Thorax :I : Simetric, no motion lag of the chestP : The same vokal fremitus for both side
P : The sonoric sound for both sideA : The same vesicular sound for both side
Abdomen:
I : FlatA : normal bowel soundP : SupelP: Timpani
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Local status of the left femur
region I : mass on the medial
side of the left femur,15x 2o cm in size,with ulkus
P : Pain
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Medial Side of the left
femur
Lateral side of the left
femur
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Result for Thorax Exam
(12/3/2014) Normal
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Result for Femur Radiologic
Exam (12/3/2014) Soft tissue mass of
the left poteromedialaspect without bonedestruction
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Blood examination
resut(15/4/2014)WBC 31,4 RBC 2,46
Hb 6,9 Ht 20
AT 286 Alb 0,88
SGOT 16 SGPT 16
BUN 4,5 Creat 0,26
GDS 109 Natrium 109
Kalium 3,79 Cl 74,7
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ASSESSMENT
Fibrosarcoma of the left Femur regionAnemiaLeucocitosis
HipoalbuminHipoNatremiaHipoChloremia
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Plan
Complete Blood Count examination,BUN/Creatitin, ALT/AST,Albumin, Eletrolite
General Condition Correction Blood Tranfusion untill Hemoglobin
Concentration above 10 gram%
IVFD Natrium Chloride 0,9% 30 dpm
Ceftriaxone injection 1 gram/12 hours
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Plan
Metronidazole injection 500 mg/8 hours
Ketorolac injection 30 mg/hours
Ranitidin injection 50 mg/12 hours Paracetamol tablet 500 g/8 hours
Albumin 20 % tranfusion/day
Elektrolite Corection
Consult to Internal Medicine Departement :Sugested for NaCl 3% 8 dpm
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Natrium Chloride 0,9% 30 dpm
Ceftriaxone injection 1 gram/12 hoursMetronidazole injection 500 mg/8 hours
Ketorolac injection 30 mg/hours
Ranitidin injection 50 mg/12 hoursParacetamol tablet 500 g/8 hours
Albumin 20 % tranfusion/day
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Follow up 18/4/2014
S: fatigue, pain,
O: General apperance, week, VAS: 3
Local status of the left femur
I:tumour mass covered by gauze, oozeout.
P: pain
A: Fibrosarcoma of the left Femur regionAnemiaHipoalbumin
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Natrium Chloride 0,9% 30 dpm
Ceftriaxone injection 1 gram/12 hours
Metronidazole injection 500 mg/8 hours
Ketorolac injection 30 mg/hours
Ranitidin injection 50 mg/12 hours
Paracetamol tablet 500 g/8 hours
Albumin 20 % tranfusion/day
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Blood exams Result
(18/4/2014)
WBC 15,46 Total
protein
2,69
RBC 2,37 Albumin 0,79
HGB 6,6 Natrium 118
PLT 327 Kalium 2,6WBC 15,46 Chloride 97
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Follow up 19/4/2014
S: fatigue, pain,diarhea O: General apperance, week, VAS: 3
Local status of the left femur
I:tumour mass covered by gauze, oozeout.
P: pain
A: Fibrosarcoma of the left Femur regionAnemiaHipoalbuminDiarhea
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P: General Condition Correction
Blood Tranfusion untill Hemoglobin
Concentration above 10 gram%IVFD Natrium Chloride 0,9% 30 dpm
Ceftriaxone injection 1 gram/12 hours
Metronidazole injection 500 mg/8 hoursKetorolac injection 30 mg/hours
Ranitidin injection 50 mg/12 hours
Paracetamol tablet 500 g/8 hours
Albumin 20 % tranfusion/day
New Diatab 2 tablet/ diarhea
Consul Internist for diarhea
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19/4/2014
WBC 14,9 RBC 2,40
HGB 6,8 PLT 305
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Follow up 20/4/2014
internist S: diarhea >10x/day
O: General apperance, week, VAS: 3
Local status of the left femur I:tumour mass covered by gauze, ooze
out.
P: painA: Fibrosarcoma of the left Femur regionAnemiaHipoalbumin
Diarhea
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P: IVFD kaen 3B : Novamil : RL = 30 dpm
New diatab 3x1
Imodium 1 tab (extra)
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Follow up 23/4/2014
S: fatigue, pain,
O: General apperance, week, VAS: 3
Local status of the left femur I:tumour mass covered by gauze, ooze
out.
P: painA: Fibrosarcoma of the left Femur regionAnemiaHipoalbumin
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Natrium Chloride 0,9% 30 dpm
Ceftriaxone injection 1 gram/12 hoursMetronidazole injection 500 mg/8 hours
Ketorolac injection 30 mg/hours
Ranitidin injection 50 mg/12 hoursParacetamol tablet 500 g/8 hours
Albumin 20 % tranfusion/day
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23/4/2014
WBC 17,85 AST 11
RBC 3,02 ALT 10
HGB 8,7 BUN 2,9HCT 23 CREAT 0,23
PLT 332 NATRIUM 123
ALB 1,15 KALIUM 2,4RANDOMBLOOD
GLUCOSE
107 CHLORIDE 102
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Follow up 24/4/2014
S: fatigue, pain,
O: General apperance, week, VAS: 3
Local status of the left femur I:tumour mass covered by gauze, ooze
out.
P: painA: Fibrosarcoma of the left Femur regionAnemiaHipoalbumin
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Natrium Chloride 0,9% 30 dpm
Ceftriaxone injection 1 gram/12 hours
Metronidazole injection 500 mg/8 hours
Ketorolac injection 30 mg/hours
Ranitidin injection 50 mg/12 hours
Albumin 20 % tranfusion/day
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Blood Culture/sensitivity
Result (24/4/2014) Negatif
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Follow up 25/4/2014
S: fatigue, pain, Diarhea
O: General apperance, week, VAS: 3
Local status of the left femur
I:tumour mass covered by gauze, oozeout.
P: pain
A: Fibrosarcoma of the left Femur regionAnemiaHipoalbumindiarhea
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Natrium Chloride 0,9% 30 dpm
Ceftriaxone injection 1 gram/12 hours
Metronidazole injection 500 mg/8 hours
Ketorolac injection 30 mg/hours
Ranitidin injection 50 mg/12 hours
Albumin 20 % tranfusion/day
Imodium 1 tablet (extra)
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Follow up 28/4/2014
S: fatigue, pain,
O: General apperance, week, VAS: 3
Local status of the left femur I:tumour mass covered by gauze, ooze
out.
P: painA: Fibrosarcoma of the left Femur regionAnemiaHipoalbumin
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Natrium Chloride 0,9% 30 dpm
Clindamycin 300mg/6hour
Aspar K2x1
Ondancentron injection 4mg/12hour
Ketorolac injection 30 mg/8hours
Ranitidin injection 50 mg/12 hours
Albumin 20 % tranfusion/day
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Urine Culture/Sensitivity
(28/4/2014) Source of infection : Candida albicans
Sensitive to Fluconazole and Nystatin
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Follow up 29/4/2014
Internist S: fatigue, diarhea
O: General apperance, week, VAS: 3
Local status of the left femur
I:tumour mass covered by gauze, oozeout.
P: painA: Fibrosarcoma of the left Femur region
Anemia
Hipoalbumin
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P: Clindamicin => STOP
Fluconazole infus 200mg/12hour
Ciprofloxacin infus 400mg/12hour
Metronidazole infus 500g/8jam
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29/4/2014
WBC 24,7 RBC 2,61
HGB 7,9 PLT 297
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Follow up 2/5/2014
S: fatigue, pain, dyspneu O: General apperance, week, VAS: 3
Local status of the left femur
I:tumour mass covered by gauze, oozeout.
P: pain
A: Fibrosarcoma of the left Femur regionAnemiaHipoalbuminUTI
Pleural efusion
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Kaen mg3 : kalbamin = 22dpm
Ciprofloxacin 400mg/12hourFluconazole 200g/24hour
Metronidazole 500mg/8hour
Ondancentron injection 4mg/12hourKetorolac injection 30 mg/8hours
Ranitidin injection 50 mg/12 hours
Albumin 20 % tranfusion/day
U i E i ti R lt
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Urine Examination Result
2/5/2014
pH 6,0 Colour Yellow
Glucose - Blood -
Urobilinoge
n
- Keton -
Bilirubin - Leucocyte 500 /U
Nitrit +1 Protein +-
Eritrocyte 14/µL Leukocyte 59/µLEpithel 68/µL Cylinder 4/µL
Bacteria 22.37,5/µL Yeast Like
Cell
228/µL
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Result for USG (2/5/2014)
Right Pleural Effusion
No metastasis toInternal abdominalorgan
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Follow up 5/5/2014
S: fatigue, pain, dyspneu O: General apperance, week, VAS: 3
Local status of the left femur
I:tumour mass covered by gauze, oozeout.
P: pain
A: Fibrosarcoma of the left Femur regionAnemiaHipoalbuminUTI
Pleural efusion
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Kaen mg3 : kalbamin = 22dpm
Ciprofloxacin 400mg/12hourFluconazole 200g/24hour
Metronidazole 500mg/8hour
Ondancentron injection 4mg/12hourKetorolac injection 30 mg/8hours
Ranitidin injection 50 mg/12 hours
Albumin 20 % tranfusion/day
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5/5/2014
WBC 18,3 GDS 89
RBC 2,69 Na 120
HGB 7,9 K 2,14HCT 21,9 Cl 98
PLT 22 GDS 89
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Follow up 6/5/2014
S: fatigue, pain, dyspneu O: General apperance, week, VAS: 3
Local status of the left femur
I:tumour mass covered by gauze, oozeout.
P: pain
A: Fibrosarcoma of the left Femur regionAnemiaHipoalbuminUTI
Pleural efusion
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P: General Condition Correction
Blood Tranfusion untill HemoglobinConcentration above 10 gram%
IVFD Kaen mg3 : kalbamin = 22dpm
Ciprofloxacin 400mg/12hourFluconazole 200g/24hour
Metronidazole 500mg/8hour
Ondancentron injection 4mg/12hourKetorolac injection 30 mg/8hours
Ranitidin injection 50 mg/12 hours
Albumin 20 % tranfusion/day
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