Patient Profile:
12 year old student admitted for abdominal pain.

Pertinent data:
She was born full term though her mother had pre-eclampsia during pregnancy but ante-natal course was unremarkable. She was at par with age with regards to speech, motor, and mental development. She had no menarche yet. History of DM, HTN, and Liver CA on grandparents, and mother had breast cyst.

History of Present Illness:
9 months Prior To Admission (PTA) - patient had epigastric pain, resolved by intake of antacids. Good appetite, but irregular bowel movements reported (every 2-4 days interval)
3 months PTA - the patient noted that her abdomen was bigger than usual. Frequent gas pains, and reported it took her longer to defecate than before.
2 days PTA - complained of tightness of her abdomen. Gnawing pain on the lower back area and seem to radiate to the lower abdomen.
Few hours PTA - The patient complained of a persistent, diffuse pain on the abdomen and thus was brought to the ERD of the hospital.

Physical Examination:
BP - 100/60
HR - 90/min
RR - 18/min
Temp - 37.2 Celsius

Conscious, coherent & not in respiratory distress
No palpable head or neck mass
Pink palpebral conjunctiva, anincteric sclera
No axillary hair noted
Breast: Tanner stage 1
Equal chest expansion, clear breath sounds
Tense and Globular abdomen, fluid wave noted
Irregular solid-cystic masses palpated on the hypogastric area
Direct tenderness in deep palpation of the abdomen. No rebound tenderness
Absent bowel sounds
No inguinal nodes palpated

Gyne Exam: No pubic hair noted, external genitalia grossly normal. Internal exam not done

Rectal exam: Good sphincter tone, rectal vault empty. Cystic masses palpated on cul de sac. Uterus and adnexa hard to delineate, No blood on examining finger.

Laboratory exam:
CBC:
Hemoglobin 10g/L
WBC: 13,500 (Neutrophil 59%, Lymph 39%, Monocytes 2%)
Platelet count: 356,000

Blood Chem:
K - 4.2 mmol/L
Na - 139 mmol/L
Creatinine - 1.0 mg/dL
SGPT - 41 U/L
LDH - 430 U/L
AFP - 5476 ng/mL
B-HCG - 3.0 mIU/mL
Serum CA 125 - 78 U/L
Blood type - A+

Stool Exam:
Formed brown stools, 2-4 WBCs and positive for Trichuris trichura ova.

Urinalysis: Unremarkable

IMAGING
Chest PA - Poor inspiratory film. Upper lung field clear

Whole Abdoment Ultrasound:
Abdomino-pelvic mass extending up to the inferior lobe of the liver. Multiple solid to cystic masses noted @ hypogastric area. No liver masses noted. Bowel loops are deflected posteriorly. The uterus and the ovaries cannot be visualized.


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