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MEIGS SYNDROME

Nur Ayu Virginia I, S. Ked 1118011089Vidianka Rembulan, S. Ked 1118011139 Perceptor:dr. Dedy Zairus, Sp.PCLINICAL WORK OF INTERNAL MEDICINESMF PULMONOLOGYPERIOD MAY 2015 TO JULY 2015ABDUL MOELOEK HOSPITALBANDAR LAMPUNG

PATIENT STATUSPATIENT IDENTITY Initial Name: Mrs. ISex: FemaleAge: 28 years oldNationally: Indonesia (javanese)Marital Status: marriedReligion: MoeslemOccupation: FarmerEducational Background: Junior High SchoolAddress: Gedung Meneng, Tulang Bawang

ANAMNESISTaken from: AutoanamnesisDate: July 8th 2015 Time: 15.00 WIB Chief Complain : Shortness of breath since 1 weeks agoAdditional Complain :Abdominal pain, abdominal swelling, cough, nausea

History of Present Illness Patient was admitted with shortness of breath that worsened in the last 1 week. Shortness of breath can be felt even when resting, especially when patient is lying down, happens intermittently, not affected by weather, and not only appear at night. Patient felt better and much more relieved in sitting position rather than lying down. Patient also felt chest pain and coughing that happen together with shortness of breath. Chest pain does not radiates to back, shoulder or jaw and felt like sharp sensation. Pain worsens if patient cough or breathe. Patient has cough with greenish sputum since one week ago, and no presence of blood. Cough happens at any time, not specifically at night. Patients stomach got bigger and swollen since seven months ago. Pain can be felt in all regio, stomach felt like twisting and happens intermittent. Patient also felt nausea, but not vomiting. Patient said she has decreased appetite because her stomach feels uncomfortable each time she eats or inserts food, so the patient feels her body gets thinner but her stomach continued to swells. Patient had been treated in Abdul Moeloek Hospital and diagnosed with Ovarian Cancer. Patient have also been treated in pulmonology for the same symptoms three weeks ago, and has been treated with pleural puncture with liquid volume approximately 1500 cc. Patient deny have previous high blood preassure, diabetes mellitus, lung tuberculosis and asthma.

(+)Small pox (-)Malaria (-)Kidney stone(-)Chicken pox(-)Disentri (-)Hernia(-)Difthery(-)Hepatitis (-)Prostat(-)Pertusis(-)TifusAbdominalis (-)Melena(-)Measles(-)Skirofula (-)Diabetic(+)Influenza(-)Siphilis (-)Alergy(-)Tonsilitis(-)Gonore (-)T u m o r (-)Kholera (-)Hipertension. (-)Vaskular Disease (-)Pneumonia (-)Duodeni Ulcer (-)Tuberculosis (-)Pleuritic (-)GastritisThe History of Illness :Familys diseases History :Father has died, the cause is not knownMother still alive, healthy.Three siblings still alive, healthy.Children are still alive, healthy.Is there any family who suffer :No family members that have the same symptoms with the patient

+(-)Anestesi(-)Hard to bite(-)Parestesi(-)Ataksia(-)Weak muscle(-)Hipo/hiper-estesi(-)Afasia(-)Tick(-)Amnesis(-)Vertigo(-)Others(-)Disartri(-) Convultion(-) Syncope

Body Check UpGeneral Check Up

Height: 165 cmWeight: 50 kgBlood Pressure: 120/80mmHgPulse: 104 x/minute, regularTemperature: 36.7 0CBreath (Frequence&type) :36x/minuteNutrition Condition: lowConsciousness: Compos MentisCyanotic: (-)General Edema: normalThe way of walk: weakMobility: ActiveThe age predicyion based on check up : 26 years old

Mentality AspectsBehavior: NormalNature of Feeling: NormalThe thinking of process: NormalSkinColor: BrownKeloid: (-)Pigmentasi: (-)Hair Growth: Normal, Black, SimetrisArteries: TouchableTouch temperature: AfrebrisHumid/dry: DrySweat: NormalTurgor: NormalIcterus: An icterusFat Layers: ThinEfloresensi: (-)Edema: (-)Others: (-)

Lymphatic GlandSubmandibula: no enlargementNeck: no enlargementSupraclavicula: no enlargementArmpit: no enlargementHeadFace Expression: normalFace Symmetric: SymmetricHair: BlackTemporal artery: NormalEyeExopthalmus: (-)Enopthalmus: (-)Palpebra: edema (-)/(-)Lens: Clear/ClearConjunctiva: Anemis +/+Visus: NormalSklera: Icteric -/-

EarDeafnes: (-)Foramen: (-)Membrane tymphani: intactObstruction: (-)Serumen: (-)Bleeding: (-)Liquid: (-)

MouthLip: normalTonsil: (-)Palatal: NormalTeeth: (-)Trismus: (-)Farings: UnhiperemisLiquid Layers: (-)Tongue: Normal

NeckJVP: Normal , not increasedTiroid Gland: no enlargementLimfe Gland: no enlargementChestShape: simetricArtery: NormalBreast: small

Lung Inspection: Left: asymmetric, retraction (-) Right: asymmetric, retraction (-)Palpation: Left: decreased fremitus, pain (-) Right: normal fremitus, pain (-)Percussion: Left: dullness Right: resonanceAuscultation: Left: decreased vesicular breath sound, wheezing (-), rhonchi (-) Right: vesikuler breath sound, wheezing (-), rhonchi (-) Cor Inspection: Ictus cordis not visible Palpation: Ictus Cordis not palpablePercussion: Right: ICS IV parasternum dextra Left: ICS V midclavicula sinistraAuscultation: Heart Sound 1 &2 normal, murmur (-), gallop (-).ArteryTemporalic artery: No abnormalitiesCaritic artery: No abnormalitiesBrachial artery: No abnormalitiesRadial artery: No abnormalitiesFemoral artery: No abnormalitiesPoplitea artery: No abnormalitiesPosterior tibialis artery: No abnormalitiesStomach Inspection: distended, swollenPalpation: Stomach Wall: pain (+) Heart: Hepatomegali (-) Limfe: Splenomegali (-) Kidney: Ballotement (-)Percussion: Shifting Dullness (+)Auscultation: Intestine Sounds (+)Genital (based on indication)Male: no indicationPenis : no indicationTestis : no indicationMovement Joint ArmRightLeftMuscleNormalNormalTones(+)(+)Mass(-)(-)JointNormalNormalMovementActiveActiveStrength55Heel and LegWound/injury: not foundVarices: (-)Joint: NormalMovement: ActiveStrength/Power: 5Edema: (-) Others: (-)

ReflexsRightLeftTendon ReflexNormalNormalBisepNormalNormalTrisepNormalNormalPattelaNormalNormalAchilesNormalNormalCremasterNormalNormalSkin ReflexNormalNormalPatologic ReflexNot FoundNot Found

LaboratoryHematology (29-7-2015)Normal Haemoglobin : 10,5 gr/dl12-16 gr/dlLeucocyte : 10.500 /ul4500-10700 / ulErythocyte: 2,6 mil/ul4,7-6,1 mil/ulHematocrit: 23%42-52%Trombocyte:443.000/ul150.000-450.000/ulMCV:89 fl79-99 flMCH: 32 pg27-31 pgMCHC:32 g/dl33-37 g/dlVariety countBasophils: 0 %0-1%Eusinophils: 0%1-3%Bands: 0 %2-6%Segmens: 81 %50-70%Lymphocytes: 13 %20-40%Monocytes: 5 %2-8%LED: 54