Pre-operative conference

1. P R E - O P E R AT I V E C O N F E R E N C E
JUNE 14, 2022
R E P U B L I C O F T H E P H I L I P P I N E S
D E P A R T M E N T O F H E A L T H
SOUTHERN ISABELA MEDICAL CENTER
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
JOMA CRIZELLE ZARA-YASOL, MD/ JENNIFER AGLUGUB, MD/ DEANNE PINTUCAN, MD
Residents-in-Charge
_______________________
Consultant-in-Charge

2. G E N E R A L D ATA
o A.V
o 22 years old
o Gravida 1 Para 1 (1001)
o Married
o Cordon, Isabela

3. CHIEF COMPLAINT
Abdominal
Enlargement

4. PAST MEDICAL HISTORY
(-) Hypertension
(-) Diabetes
(-) Bronchial Asthma
(-) Heart Disease
(-) Allergies
(-) Malignancy
(-) Previous Operation:

5. FAMILY HISTORY
(+) Hypertension - mother
(-) Diabetes Mellitus
(-) Bronchial Asthma
(-) Heart Disease
(-) Allergies
(-) Malignancy
oHigh School Graduate
oUnemployed
oNon-smoker
oNon-alcoholic beverage
drinker
oNo illicit drug use
PERSONAL & SOCIAL
HISTORY
FAMILY & PERSONAL / SOCIAL
HISTORY

6. MENSTRUAL / OBSTETRICAL HISTORY &
GYNECOLOGICAL HISTORY
o Menarche: 13 years old
o Interval: Regular
o Duration: 5 days
o Amount: 2 pads per day/ moderately soaked
o Pain: (-) dysmenorrhea
o LMP: June 8, 2022
o PMP: May 2, 2022
o Coitarche: 19 years old
o Sexual partner/s: 1
o FP Method: Implant
o STI: None
o Pap-smear: No

7. OBSTETRICAL HISTORY
Gravida 1 Para 1 (1-0-0-1)
G1 2020 FT NSD Hospital Living No complications

8. HISTORY OF PRESENT ILLNESS
1 year
prior to
consult
• Patient had severe hypogastric pain, non radiating, relieved by pain
medication
• No abdominal enlargement
• No palpable mass
• No consultation done

9. HISTORY OF PRESENT ILLNESS
6 days
prior to
consult
• Enlargement of abdomen
• Not associated with hypogastric pain
• No changes in bowel and bladder movement
• Consulted at private MD were whole abdominal ultrasound was
requested and done
• Advised to consult to an OB-GYNE specialist, were she was advised for
operation but due to financial constraint opted to consult at our
institution for further evaluation and management

10. REVIEW OF SYSTEMS
CONSTITUTIONAL No fever, no chills, no malaise, no weight loss
HEMATOLOGY No easy fatigability, no easy bruisability
CNS No headache, no dizziness, no seizure, no loss of consciousness
HEENT No blurring of vision, no hearing loss, no tinnitus
RESPIRATORY (-) cough, (-) colds, no apnea
GIT (-) constipation, No vomiting, no diarrhea
GUT No dyspareunia, no abnormal vaginal discharge, no dysuria, no
urinary frequency, no urgency
NMS No arthralgia, no myalgia, no numbness

11. PHYSICAL EXAMINATION
General survey: Conscious, coherent, not in cardiorespiratory distress
Vital signs: BP: 100/80 mmHg HR: 92 bpm RR: 20 cpm Temp: 36.4◦C
Weight: 65.2 kg Ht: 152 cm BMI: 28.2 (pre-obese)
SKIN (-) pallor, no jaundice, no cyanosis
HEENT: Pink palpebral conjunctiva, anicteric sclera
Neck: Supple, no neck vein engorgement
Breast: Symmetrical contour, no dimpling, no palpable mass, no abnormal nipple
discharge
Chest: Symmetrical chest expansion, no retractions, no crackles on both lung field
Heart: Adynamic precordium, normal rate and regular rhythm, no murmur

12. PHYSICAL EXAMINATION
Abdomen:
Globular
Normoactive bowel sounds
No fluid wave
With palpable, movable, cystic pelvoabdominal mass,
measuring 28 x 20 cm in diameter, non-tender

13. PHYSICAL EXAMINATION
Pelvic exam:
Speculum exam:
Normal looking external genitalia
Cervix is pinkish, smooth, no lesion, no abnormal discharge
Bimanual Internal Exam: Vagina admits 2 fingers with ease
Cervix closed, firm, midline
Uterus cannot be assessed
With palpable, movable, cystic pelvoabdominal mass, measuring 28
cm in diameter, non-tender
Recto-Vaginal Exam: Cervix closed, firm, midline
Good sphinteric tone, rectal vault empty, no mass/lesion
Extremities: No gross deformities, with full and equal pulses, no edema

14. SALIENT FEATURES
22 years old
Gravida 1 Para 1 (1001)
CC: Abdominal enlargement
Abdominal PE:
Globular, with palpable, movable, cystic pelvoabdominal mass,
measuring 28 cm in diameter, non-tender
Bimanual Exam:
Cervix closed, firm, midline
Uterus cannot be assess
With palpable, movable, cystic pelvoabdominal mass, measuring 28 cm in diameter,
non-tender

15. IMPRESSION
Gravida 1 Para 1 (1001)
Ovarian New Growth, probably Benign

16. PLAN
Exploratory Laparotomy
Oophorocystectomy
Possible Unilateral Salpingo-oophorectomy

17. WHOLE ABDOMINAL ULTRASOUND
J U N E 3 , 2 0 2 2
ABDOMINAL
AORTA
The abdominal aorta is normal in size. No aneurysmal dilatation noted. No evident para-aortic
lymphadenopathy
URINARY
BLADDER
The urinary bladder is physiologically distended showing smooth contour and outline. The wall
is not thickened. No evident lithiasis seen
UTERUS Normal sized retroverted uterus measuring about 6.3 x 4.2 x 3.9 (LxWxAP). Parenchymal
echopattern is homogeneous. No focal mass noted. Endometrial stripe is intact with bilaminar
thickness of 0.9 cm
OVARIES The normally appearing ovaries are not visualized. Instead, there is however a large wall
defined pelvo-abdominal cystic mass superior to the uterus and urinary bladder with low to
medium level internal echoes, some thin septations, no internal vascularity on Color Doppler
study and measuring approximately 23.4 x 27.3 x 14.9 cm (LxWxAP). There is also a thick-
walled complex cystic structure in the left adnexa measuring about 4.1 x 5.4 x 4.1 cm

18. WHOLE ABDOMINAL ULTRASOUND
J U N E 3 , 2 0 2 2
IMPRESSION Pelvoabdominal cystic mass and complex left adnexal cyst, likely ovarian in origin. Consider
ovarian new growth.
Unremarkable ultrasound of the liver, biliary tree, gallbladder, pancreas, spleen, kidneys, and
urinary bladder
Negative for para-aortic lymphadenopathies
Normal sized retroverted uterus