- Mrs. R, a 64-year-old woman, was admitted to the hospital with abdominal pain and jaundice. Imaging found a mass in her pancreas along with liver and gallbladder abnormalities. Laboratory tests showed increased bilirubin and tumor markers suggestive of pancreatic cancer. - The morning report discussed two patients, one being Mrs. R with suspected pancreatic cancer and another being a 4-day old infant admitted with an enlarged head since birth. Imaging of the infant found severe hydrocephalus, and examination determined her head circumference was enlarged. - Both patients had detailed workups, including history, exams, labs, and imaging, to determine diagnoses and guide further treatment.

1. Morning Report
Case 2
dr. Dwi Maheza
dr. Rifal
dr. Delicia
dr. Meivi
dr. Syarfika
Night Shift,Friday, 16th September 2022 (September sixteen, two thousand twenty two)

2. Patient History
Name : Mrs. R
Age : 64 (sixty four) years
RM : 993330 (nine nine tree tree tree zero)
Clinical diagnosis : Ca Caput pancreas
Chief complaint : Abdominal pain at hipocondrium dextra
Patient admitted to the hospital with chief complaint abdominal pain at
hipocondrium dextra, spread to the back since 1 month a go. Abdominal pain
appears after eating some food. Nause (+) since 2 weeks a go. No history of
vomiting. Headache (+). chest pain (not often),
Patient also complaint icteric in her eyes since 3 weeks a go.
fever (-), decrease 15 (fifteen) kg in last one month, decrease appetite.
Urinate : colored like a strong tea
defecate : pale stool, greasy stool since 1 month a go

3. ANAMNESIS
- History of being treated at bulukumba with diagnosis :
Hepatitis A and take some drugs
- No history of DM,HT, heart disease,kidney disease,
- No history of smoking
- work as housewife

4. GENERAL STATUS
GCS : E4M6V5 (fifteen)
Vital sign :
Blood Pressure : 140/90 (one hundred forty/ ninety mmHg
(everything else is within normal limits)
Pulse rate : 72 x/min
Respiratory rate : 16 x/min
Temperature : 36.3 °C
Spo2 : 99% without modality
VAS : 3/10

5. LOCAL EXAMINATION
Head : Conjunctiva anemic, sclera icteric
Thorax : Within normal limits
Abdomen
Palpation : immobile hard mass, as big as a
baseball
Measuring approximately long 5 (five) wide 4 (four) cm at
hipocondrium dextra, Hepar and lien difficult to evaluate
Extremitas : within normal limit

6. LAB 16/9
WBC 7.1
HB 10
Platelet 240
Neutrophil 59.6
Lympochyte 29.1
GDS
Ur/Cr 15/0.56
PT/INR/APTT 11.3/1.05/27.3
SGOT/SGPT 106/117
Bilirubin total/direk 30.30/ 24.9
Na/K/Cl 137/3.2/104
HbSAg/Anti HCV Nonreactive/non reactive
Laboratory Examination
16 September 2022
URINALISA
Warna Kuning muda
Ph 6.5
Protein -
Bilirubin 3 (increase)
Nitrit -
Blood -
• Bilirubin increase
• SGOT SGPT increase
• Tumor marker Ca 19-9 >500 (more than
five hundred)
• everything else is within normal limits

7. An abdominal MSCT scan without contrast has been performed on the sagittal and coronal reformat axial slices with the following results:
- Heterogeneous mass (twelve until fourty two HU) (12-42 HU) relatively well-defined, irregular edges, non-calcified measuring +/- (long tree
point twenty four, wide four point twenty one, tall tree point fourty eight cm) 3.24 x 4.21 x 3.48 cm in the head of the pancreas, which results in
dilatation of the pancreatic duct in the proximal part and fat stranding around it
- Liver: Not enlarged, regular surface, sharp tip, parenchyma density is lower than the spleen. Dilated intra and extra-hepatic bile ducts are seen.
No apparent SOL density/metastatic nodule
- Gallbladder: Distended, regular mucosa, no stone density . sludge density (thirty-eight HU) (38 HU)
- Spleen: Not enlarged and parenchymal density within normal limits. No apparent SOL density/metastatic nodule
- Left Kidney: Decreased size, parenchymal density within normal limits. No PCS dilatation. It appears as a hypodense lesion fifteen HU(15 HU)
with well-defined margins, regular edges, non-calcified measuring diameter two cm on the lower pole.
- Right Kidney: The shape, size and density of the parenchyma are within normal limits. No PCS dilatation . No stone density, cyst, mass and other
pathological lesions
- Urinary Vesica: Mucosa is regular, the walls are not thickened, there is no visible stone/mass density
- There is no enlargement of the abdominal paraaortic lymph nodes
- Calcification of the abdominal aorta (aortic atherosclerosis)
- No free fluid density in the peritoneal cavity
- Osteophytes on the anterolateral aspect of CV T9-L5 (thoracolumbar spondylosis) with air density mines four hundred thirteen HU (-413 HU) on
intervertebral discs CV Ttwelve, Lumbal one. Lumbal five, sacrum one T12-LI, L5-SI (Vacuum disc phenomenon)
- There are multiple blastic lesions on CV L3, bilateral femur and right iliac wing. The other bones that were scanned were intact
●Impression :
- Mass of the head of the pancreas with dilatation of the pancreatic duct proximal to it, distended GB and intra and extra hepatic
cholestatic
- Left renal atrophy DD/hypolplasia
- Sludge GB
- Fatty liver
- Simple left renal cyst
- Observation of multiple CV L3 blastic lesions, bilateral femoral bones and right iliac wing with suspected bone metastases
- Degenerative disc disease

8. MSCT WHOLE ABDOMEN
WITHOUT CONTRAST

9. TERIMA KASIH

12. MORNING REPORT
CASE 3
dr. Dwi Maheza
dr. Rifal
dr. Delicia
dr. Meivi
dr. Syarfika
Night Shift,Friday, 16th September 2022 (September sixteen, two thousand twenty two)

13. Patient History
Name : Mrs. S
Age : 4 days
RM : 993349 (nine nine tree tree four nine)
Clinical diagnosis : Hydrocephalus non communicans
Chief complaint : enlarged head since deliver
Patient admitted to the hospital with chief complaints enlarged
head since baby delivered
fever (-), seizure (-), dyspnea (-)
.

14. baby girl was born by cesarean section with an indication
of the long 2nd stage, aterm, baby doesn’t cry after
delivered
Weight : 3700 (three thousand seven hundred)
gram
Body length : 52 (fifty two)cm
Patient History
PREGNANCY HISTORY :
Her mother aged 26 (twenty six) years, this baby girl is 5th child,
mother does not routinely control and take vitamins and blood-
boosting drugs. Fever (-) DM (-), no history of vaginal discharge,
no history of herbs drink and others drug

15. GENERAL STATUS
Weight : 3700 (three thousand seven hundred) gram
Body length : 52 (fifty two) cm
Head circumference : 44 (forty four) cm (macrocephaly)
Gestasi : 38 (thirty eight) weeks
Spo2 : 98 (ninety eight) % without modality
VAS : 0 neonatal infant pain score
SSP : within normal limit
Thoraks : within normal limit
Cor : within normal limit
Abdomen : within normal limit
Metabolic : within normal limit
Hematologi : within normal limit

16. LAB 16/9
WBC 10.5 (slightly increased)
HB 14
Platelet 305
Neutrophil -
Lympochyte -
GDS -
Ur/Cr 17/0.35
PT/INR/APTT -
SGOT/SGPT 32/14
Bilirubin total/direk -
Na/K/Cl 138/4.4/107
HbSAg/Anti HCV -
Laboratory Examination
17th September 2022
Everything else is within normal
limits

17. MSCT Brain without contrast 16th September 2022
MSCT Scan examination of the head without contrast axial slices with sagittal
and coronal reformat has been carried out with the following results:
- Severe dilatation of the bilateral lateral and third ventricular systems
with corpus callosum and brain tissue thinning and cranial vault
deformity. ventricle IV within normal limits
- Midline doesn't shift
- Subarachnoid space within normal limits
- CPA, pons and cerebellum within normal limits
- Paranasal sinuses and mastoid air cells were scanned within normal limits
- Both bulbus oculi and retrobulbar structures were scanned within normal
limits
- The anterior, sphenoid, mastoid and posterior fontanelles are still wide open
- Cephalic index = 91(ninety one)
Impression :
- Severe obstructive hydrocephalus suspect e.c aquaductal
stenosis
- Cephalic index = 91 (ninety one) (ultrahydrocephalus)

18. TERIMA KASIH