Admitting diagnosis: Egtopic pregnancy Essay

boss Complain The patient of presents in the taking into custody this morning, complaining of disappoint type AB pain. HISTORY OF PRESENT ILLNESS the patient states that she has been having vaginal release much than like spotting over the recent month, she denies the chance of motherliness although she states she is sexually active and using no birth control. Gynecologic History longanimous is graved to par 1 abortus 1. her only child is a stratum out of date 15 year oldish daughter who lives in Texas that lives with her grandmother. PAST checkup HISTORY Positive for hepatitis BPAST SURGICAL HISTORY Pilonidal vesicle removed in the remote past, has plastic surgery on her ears child. hearty HISTORY Married, has 1 daughter, patient works as a replacing teacher, smokes 1 pack of cig arettes on a daily basis. Denies EtOH. Smoked marijuana last night, no iv drug abuse. ALLERGIES TetanusMEDICATION no(prenominal)REVIEW OF SYSTEMS patient complains of lower abdominal pain for the past week. apparently got much worse last night, and by this morning wasnt tolerable. She is as well as having some nausea and vomiting, denies hematemesis and mel She has had vaginal spotting over the past month with questionable vaginal discharge as well. denies the frequency, urgency and haematuria and denies arthralgia. Review of systems is otherwise essentially negative. PHYSICAL EXAM Vital signs lay down temperature 97 degrees. pulse 53 respirations 22. blood pressure 108/60. GENERAL physical exam revels a well developed, well nourished 35 year old white female is the moderate substance of distress the clipping of the examination, HEENT are all remarkable except poor indentation. neck is kooky and supple. CHEST Lungs are clear in both dramatic arts. HEART constant rate and rhythm. ABDOMEN soft just now positivetenderness of her lower abdominal theater of operations. Fundus was not palpable. above the pubic area. unexpended field andexal are more than tend er than the right. VAGINAL The cervix is closed. a moderate amount of motherapulient vaginal discharge is noted. the patient wouldnt allow me to perform a handed examination due to her pain. so the speculum was withdrawn. EXTERMITIES No clot or edema. NUEROLOGICAL-in tact urea x3, no nuerologica defictest. DIAGNOSTIC Dr. on admission hemoglobin 12.8 grams, hemaocrit is 36.6%. water supply analysis is essentially negative. beta hcg is positive wit the white corpuscle count of 23,278 RADIOLOGY Pelvic ultrasounds shows a 7 week 4 day off viable ectopic motherhood per radiologist. the patient was assumption Demerol 25mg and Phenergan 25mg iv for the pain after her report was obtained. she was similarly given Claforan 1 gram iv, I paged Dr. Gerald GYN, physician as soon as they standard the ultrasound report at around 10 am he was not in his north Miami mail service.I paged the south Miami office and reached Dr. Gerards office at approximately 1015am. his office personnel advise d me that he is not on call, Dr. Vonbeck is on call. I spoke with Dr. Vonbeck at approximately 1025 am and she result be here to take the patient to the operating room. ADMITTING DIAGNOSIS Left Ectopic 1st trimester maternity. The patient received and iv of lactated ringers upon the arrival in the emergency room. This was convention saline while we were awaiting Dr. Vonbecks arrival. The working(a) procedure was explained the patient and her husband all the risk and benefits were discussed. Then assessing in immediate surgery and informed consent was signed. no old records are available for review. Dr McClure end dictation.rosemary Bumbak dictating aOPERATIVE REPORT patient of Name Brenda C. SeggermanPatient ID 903321Date of adit 03/27/2012Date of cognitive operation 03/27/2012Surgeon rosemary Bumbak, MDAssistant Michael Gerard , DOanaesthetist General and tracheal by Dr. AvalonEstimated Blood Loss approximately 1000ml inevitable transfusion of 2 unitsof whole blood. archet ype removed portion of odd fallopian tube containing the ectopic pregnancy. Preoperative Diagnosis leftover tubectoipc pregnancy surgical Diagnosis1 rupture let tubal ectopic pregnancy2. Hemoperiteoneum3-pelvic adhesionsSurgical Procedures1-exploratory laperotomy2-partial salpingectomy3-evauation of hempopatium4-lisis of adhesionsProcedure in detail The patient was prepped and draped in the usual manner and placed under adequate general anesthesia, Pfannenstiel boodle was preformed and carried through skin and subcutanous tissue, fascia and peritoneum. the paritenial cavity was entered. the hemoparituim was noted, and approximately 500 ml of blood was rapid evacuated from the pelvic cavity, as were large cloths, following this, the gut was packed away the pelvic area with packing lapse. A retaining retractor was introduced. The left fallopian tube was noted. A large tubalectopic pregnancy was noted effecting approximately the distal half of the fallopian tube. Following this Hea ney fix was placed and the mesosalpinx cell and another curver clamp was paced in the proximal aspect of the left fallopian tube beyond the area of ectopic pregnancy. A patial salpiingectomy was preformed. removing the portion of the left fallopian tube containing the ectopic pregnancy.Heaney clamps were replaced with sutures with 1 micro. Hemostasis was checked again and no bleeding was detected. Further voiding of blood and blood clots was then preformed. the right fallopian tube was noted to be covered with adhesions both tubular variatand tubal uterine The adhesions were then aggressively lysed freeing the right fallopian tube. Hemostasis was checked again. No bleeding was detected. pocket-size cirrhosis abrasion was noted was noted where the area of the ectopic pregnancy was apparently attached to the bowel and not bleeding and was very superficial. haemostasia was checked and no bleeding was detected. The peritoneum was closed continuously was homeochinoc suture. The facsi a was approximated was inntrupted withfigure of 8 stitches of micro and the skin was approximated with staple gun. The patient tolerated the procedure well and left the operating room in satisfactory condition. All counts were correct. Blood freeing was estimated at 1000ml which was replaced with 2 untis of whole blood while in recovery. Rosemary Bumpbak, MD OBGYNDIAGNOSTIC REPORTDr Donna Harrison dictationPatient Name Brenda C. SeggermanPatient ID 903321Date of Admission 3-27-2012ER Physician Alex McClure MDTransvaginal ultrasound on 3-27-14Patient History Serve left pelvic pain mold out ectopic pregnancy. Pregnancy test is positive. Findings-transabdominal imaging demonstrates utures with small amount of fluid within it Psudodecidual sign. There is a large amount of bleeding seen within the left adnexa. no embryo is seen. The right ovary is unremarkable Endovaginal examination was performed in searched of viable ectopic. One is seen with crown length with 1.3cm corresponding to 7 weeks and 4 days. A large amount of free fluid is seen, esooudo gestuational sackful is noted within the uterus which is oblong. IMPRESSION A left sided ectopic pregnancy is found with large amount of bleeding is noted and extending into the cul-de-sac the hemorrhage measures 13x6x10cm. Dr. McClur and the emergency room was notified which notified the surgeon and is on her way, end of report Dr Harrison.(Contiuned)_________________________Dr. Donna HarrisonNNEFD 3/27/2012T 3/27/2012Please rate a copy of this report toRosemary Bumbak, MD OBGYNDISCHARGE epitomeRosemary Bumbak, MD OBGYNPatient Name Brenda C. SeggermanPatient ID 903321Date of Admission 03/27/2012Date of Discharge 03/30/2012Admitting Diagnosis ectopic pregnancySurgical procedures1-expoloratory laparotomy2-partioal salpingectomy3-evacation of hemoparitoneum4-lises of adhesionsComplication-blood loss requiring transfusion x2History This 35 year old white female Gravida 3 para 10121 had her last menstrual cycles/se cond in early January. Prior menstrual cycles had been regular. She reported no contraceptives but not attempting pregnancy. Patient presented to the emergency room complaining of vaginal bleeding with pain in lower pelvic area. ultrasound preformed in the emergency room showed a 13.8 cm left adnexall mass with positive cardiac activity compatible with ectopic pregnancy. Hospital Course On 3-27-2014 the patient underwent exploratory laparotomy, left partial salpingectomy, evacuation of hemoparitoneum, and lyses of adhesions. Blood loss was approx 1000ml and was replaced with transfusion of 2 units of red blood cells the blood type was noted to be ORH negative and RhoGAM was provided. The patient was discharged on post operative on day number 3 on after having a ruler bowel movement she was discharged with complaints on no medications. She understood her instructions regarding follow up, wound care and limitations Rosemary Bumbak ,MD OBGYNPATHOLOGY REPORTBerry J Lzano, dictation fo rPATIENT NAME Brenda C. Seggerman.PATIENT ID 903321Date of Admission 3/27/2012Surgery 3-27-2014Admitting diagnosis Ectopic pregnancySurgeon Rosemary Bumback, MD OBGYNPathological Findings 03-s-965 specimen received 3/27 specimen report 3-320 Procedure left partial salpingectomyThe patient has a ectopic pregnancy as proven by pelvic ultrasound. tissue received left fallopian tube. GROSS PATHOLOGY desc examination of designated left fallopian tube reveals a left fallopian tube measuring 6cm in length and 2.3 cm in normal width. Sectioning of the tube reveals a distending of the tube with blood clot and possible field tissue. reprehensive sections are places in 1-c for embedding MICROSCOPIC Microscopic examination was preformed