The document reports on the morbidity and mortality cases from the Department of Family and Community Medicine at Perpetual Succour Hospital for August 2011, including statistics on hospital admissions, census in family medicine, leading causes of morbidity, and mortality cases. Internal medicine had the highest percentage of total admissions at 46%, while the top three leading causes of morbidity in family medicine were acute gastroenteritis, pneumonia, and urinary tract infections. The single mortality case was a 50-year-old female with invasive ductal carcinoma of the left breast.
6. LEADING CAUSES OF MORBIDITIES IN FAMILY
MEDICINE (ADULTS)
1. Acute Gastroenteritis with Some Dehydration 08
2. Community Acquired Pneumonia, Moderate Risk 08
3. Urinary Tract Infection 08
7. HEENT 5
Acute Exudative Tonsillitis 3
With Urinary Tract Infection 1
With Systemic Viral Infection 1
Recurrent Tonsillitis
With Drug-induced Gastritis and
Esophagitis sp UGIE 1
Maxillary Sinusitis; Dyslipidemia 1
8. RESPIRATORY 14
Bronchial Asthma In Acute Exacerbation 2
9. RESPIRATORY 14
Community Acquired Pneumonia Moderate Risk
8
With Atrial Septal Defect 1
With DM2; Dyslipidemia 1
Pulmonary tuberculosis
4
With Dyslipidemia; Hypertension 1
With Cholelithiasis 1
With sp CVD Infarct Left MCA 1
19. NEPHROLOGY 11
Complicated Urinary tract infection 8
with DM type 2 1
with DM type 2; Hypertension Stage 2 1
with Cholelithiasis; Gastritis; DM2;
Hypertension Stage 1
1
with Nephrolithiasis, Right
1
with Nephrolithiasis, Left 1
20. INFECTIOUS DISEASE 10
Classical Dengue Fever 5
With Acute Exudative Tonsillitis 2
With Benign Prostatic Hyperplasia; GERD 1
Dengue Hemorrhagic Fever 1
Enteric Fever; Ethmoidal Sinusitis Left
1
Measles; Acute Tonsillopharyngitis 1
Viral Exanthem 2
With Renal Cyst,Left 1
21. NEUROLOGY 4
Acute Cerebrovascular Disease Infarct 3
Right Lentiform Nucleus with HCVD; DM2 1
Right Frontal, Right Caudate, Right Lentiform,
Both Thalami, Right Internal Capsule
And Pons With BPH; HCVD
1
Left Lenticulocapsular Area And Left Corona
Radiata 1
22. NEUROLOGY 4
Acute CVD Hemorrhage Left Thalamo-
Capsular Area Right; HCVD 1
23. ONCOLOGY 3
Invasive Ductal Carcinoma left Breast Stage
IV
(Lung and Bone Metastasis) sp MRM(2002)
&
sp Chemotherapy (March2011)
1
Adenocarcinoma Right Lung St IV
(Bone Metastasis)
1
Squamous Cell Carcinoma Tongue Stage IV
24. MUSCULOSKELETAL 6
Diabetic Foot Left with DM2; HCVD 1
Diabetic Foot Right; DM2 1
28. MORTALITY 1
M.G. 50/F, Lilo-an
Chief Complaint: dyspnea.
Final Diagnosis: Invasive Ductal Carcinoma
Left Breast Stage IV
(with lung and bone metastases)
Date admitted: July 29, 2011
Date expired: August 5, 2011
No. of hospital days: 7
29. TAKE OFF CASE
Patient Profile
M. F. 60/M, Filipino, Roman
Catholic, Paknaan, Mandaue City
Social/Past Medical History
Smoker for >50 pack years, occasional alcoholic
beverage drinker
(-) Food and Drug Allergies
Previous Hospitalization: July 2011, PSH-
Pneumonia
30. Chief Complaint: Dyspnea
History of Present Illness
9 days PTA – discharged with a diagnosis of
CAP moderate risk.
4 hours PTA – noted onset of dyspnea on
exertion and backpain.
2 hrs PTA – fever and dyspnea
37. ON ADMISSION
ECG CXR Xray Lateral decubitus
Sinus Rhythm, Non- Pleural Effusion, Right Pleural Effusion, Right
specific ST-T wave ----- -------
changes
38. Medications:
Salbutamol + Ipratropium nebulization,
Paracetamol PO, Ranitidine IV, Meropenem IV,
Clindamycin IV, Metformin, Gliclazide, NaCl tab,
Erdosteine.
Co-managed with a Pulmonologist
39. Other Labs:
K 4.47
Na 121
Sputum Negative
AFB (3x)
40. 1ST HOSPITAL DAY
S: (+) Dyspnea, (+) fever
O: BP110/80-120/80, PR108-112, RR24-27,
T37.5-38.9, O2 Sat 89-91%
C/L: Equal Chest Expansion, decreased
breath sounds at the R lung field, (+)
rales
CVS: distinct heart sounds, tachycardic,
regular rhythm
41. UTZ of Hemithorax (Marked and estimated):
Axillary:
767 cc (5cm depth)
Posterior: 697 cc (5cm depth)
No existence of fibrous bands nor loculations
Impression: Pleural effusion Right
42. Clotting time 10 mins
Protime C13/ p 15.1/ % activity 75%/ INR 1.21
Bleeding time 1 min
Blood type A+
CBS 159-201mg/dL
43. Thoracentesis was done (450cc of foul-
smelling, purulent pleural fluid)
Biopsy of pleural fluid: adequate cellularity,
abundant erythrocytes and moderate
lymphocytes. No tumor cells demonstrated.
Sputum Gram stain showed Candida
albicans
44. Blood Culture (2 diff sites): no growth after 5
days of incubation.
Rpt CXR: Pleural effusion, Right
46. P: Medications:
Meropenem IV, Ranitidine IV,
Salbutamol+Ipratropium nebulization q6h,
Metformin 500mg BID, Diamicron30mg OD
Clindamycin 300mg IV
Erdosteine 300mgPO BID
Paracetamol PO RTC.
O2 inhalation @4LPM
Referred to Cardiothoracic Surgeon for CTT.
47. 2ND HOSPITAL DAYS
S: (+) Dyspnea, (+) febrile episodes
O: V/S BP 110/70 – 120/80, PR 98-110,
RR 21-26, T 37.4 – 37.8, O2 sat 88- 92%
C/L: equal chest expansion, (+) rales
CVS: distinct heart sounds, Tachycardic
48. CBS: 257-265mg/dl
CTT was done: drained 800cc of purulent,
foul-smelling fluid.
Rpt CXR: Resolving Right Pleural Effusion;
Pulmonary Congestion; Concomittant
Pneumonia is considered.; Right CTT in
place: Subcutaneous Emphysema Right;
50. A: Empyema thoracis secondary to Lung Abscess
sp Thoracentesis, sp CTT
P: Medications:
Salbutamol + Ipratropium nebulization q8hrs
Paracetamol PO PRN, Ranitidine IV, Meropenem
IV,
Clindamycin IV, Metformin, Gliclazide,
NaCl tab, Erdosteine.
Tramadol +Paracetamol tablet 1 tab q 6hrs RTC
Incentive spirometry
51. 3RD – 6TH DAY OF HOSPITALIZATION
S: (-) dyspnea, (+) febrile episodes
O: BP 120/80- 140/70, PR 102-112, RR21-24,
T 36.8- 37.9, O2 sat 90-94%; noted yellowish
to bloody CTT drain.
FBS 125.77mg/dL
Na 132
K 3.99
CBS 102 – 168mg/dL
52. RPT CXR: Resolving Right Pleural effusion;
Resolving Pulmonary congestion;
concomittant pneumonia still considered;
Right CTT in place; Resolved subcutaneous
emphysema Right.
2DED: 63% Concentric LV Remodelling W/
Adequate Contractility And Systolic Function
But W/ Doppler Evidence Of Diastolic
Dysfunction Grade 2.
53. A: Sepsis 2nd Lung Abscess w/ Empyema
Thoracis
and Pulmonary Congestion sp Thoracentesis;
sp CTT
P: Furosemide 40mg IVTT 2 doses were given.
Clindamycin IV was shifted to Clindamycin
300mg 1 cap q6hrs po.
54. Other meds continued:
Salbutamol + Ipratropium nebulization q12h
PRN, Paracetamol PO, Meropenem IV,
Metformin, Gliclazide, NaCl tab, Erdosteine.
Tramadol +Paracetamol tablet 1 tab q 6hrs
RTC
Conzace 1 capsule OD PO
Continue incentive spirometry
55. 7TH – 10TH HOSPITAL DAY
S: (-) dyspnea, (-) febrile episodes
O: BP 130/80, PR 82-88, RR 21-23, T 36 36.2, O2 sat
94-95%;
<100cc of pleural fluid/day.
PPD test: negative after 48-72hrs
Pleural fluid anaerobic culture: Anaerobic Streptococcus
CBS: 90 – 168mg/dL
A: Resolving Pleural Effusion Right;
Resolving Pulmonary Congestion
56. P: IVF terminated and changed to heplock;
Decreased O2 inhalation at 2LPM then
discontinued.
Clindamycin PO was increased to 300mg 2
caps q6hrs;
Paracetamol+tramadol tablets was dec to q8 PRN
Last dose of NaCL tablet was given.
Other meds were continued.
Chest tube was removed.
57. 10TH HOSPITAL DAY
S: (-) dyspnea, (-) fever
O: BP 120/70- 140/80, PR 78-96, RR 20-23, T
36.0-36.2.
CBS: 136mg/dL
A: Stable
P: patient was discharged w/ home meds:
Metformin 850mg BID PO pc meals
Gliclazide 30mg OD PO ac Breakfast
Conzace 1 capsule OD PO
58. Home meds:
Meropenem 1g heplock for 5 days to complete 2
weeks then shift to Co-amox 625mg tab TID PO
for 6 weeks
Clindamycin 300mg 2 capsules TID x 5 weeks to
complete 6 weeks
59. FINAL DIAGNOSIS
1. Sepsis secondary to Lung Abscess w/
Empyema Thoracis Right; S/P
Thoracentesis, Right, S/P CTT, Lysis of
loculations, Pleural lavage, Right under
fluoroscopic Guidance
2. Diabetes Mellitus type 2
The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen.