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LABORATORY WORK SHEET

CBC 1/16 1/25 1/26 1/27 1/2 1/29 1/30 1/31 2/1 2/3 2/4 2/7 2/8 2/9 2/11 2/12 2/13
8
Hgb 147 145 137 158 128 129 108 113 127 86 104
Hct 0.45 0.43 0.41 0.48 0.39 0.38 0.33 0.34 0.39 0.26 0.32
WBC 14.4 43.0 55.4 43.7 44.0 36.3 40.2 42.3 86.3 92.1 88.0
6 7 7 7 5 5 2 7 7 0 9
Basophil 0 0 0 0 0 0 0 0 0 0 0
Eosinophil 1 1 0 0 2 3 0 1 0 0 0
Stab 0 5 3 1 0 1 1 0 12 8 5
Neutrpphil 85 74 83 81 70 71 79 71 62 74 73
Lympocyte 8 3 2 2 4 4 3 2 4 1 1
s
Monocyte 6 12 12 16 22 17 15 23 21 15 20
Platelet 643 838 680 728 635 701 606 567 639 467 435
MCV 86.8 86.8 84.0 83.4 84.8 86.1 89.2 85.2 85.3 85.2 88.0
MCH 28.2 28.3 28.1 27.7 27.8 29.0 28.1 28.2 27.9 28.3 29.1
MCHC 32.5 33.7 33.7 32.8 32.7 33.7 32.9 33.2 32.7 33.2 33.0
ABO B +
Creatinine, 145 178 160 252 210 139 146 223 140
mmol/L
(N 46-92)
BUN, 11. 9.3 9.2 10.8 9.2 12.4
mmol/L
0
(N 2.5-6.10)
Na+, mmol/L; 140 140 144 142 139 140 145 140
(N 137-145)
K+, mmol/L; 5.3 4.1 3.1 3.9 3.1 4.0 3.4 4.4 3.7 4.7
(N 3.5-5.1)
Mg2+,mmol/L 0.60 0.79 0.6 0.70 0.83 1.12
(N 0.7-1.0)
3
Ca2+,mmol/L 1.9 1.8 1.9 2.0
(N 2.1-2.55)
P+,mmol/L 0.9 0.7
(N 0.81-
2
1.45)
Albumin, g/L 17.4 18.4 16.1 13.1
(N 35-50)
Uric acid, 0.25 0.19
/L
AST, /L; (N 28
14-36)
ALT, /L; (N 18
9-52)
HbAic, 5.70
mmol/L (N
3.9-5.55)
Lipase, /L 272
LDH, 477
mmol/L
Troponon I, 0.01
ng/ml (N 0-
51 N
0.03)
TSH, uIU/ml 0.31
(N 0.27-
3.75)

1/28 1/29 1/29 1/29 1/30 1/31 1/31 2/1 2/1 2/1 2/2 2/8 2/11 2/12
11pm 7am 12am 11pm 6am 3am 9am 6am 3:45am 9pm 4am 5am
PT 49 48 51 37.9 39.7
INR 147 1.68 1.43 1.83 1.77
PTT 40.2 35.8 48.8 56.5 46.2 99.5 70.9 90.1 47.0 56.1 79.7 49.2
Control 23.8 32.7 32.7 32.7 23.5 32.8 32.8 24.3 24.3 24.1 24.1 24.0
Urinalysi 1/16 1/2 2/9 Histopatholog 1/3 Acute necrotizing jejunitis/ ileitis. Acute serosis and peritonitis.
s 6 y 0 Congestionand viable surgical margins labeled A1, B and E.
pH 5.5 6.0 5.5 Surgical margin labled A2 and A shwing acute necrotizing
Sp grav >1.03 1/2 1.0 jejunitis/ileitis,
5 1
CHON Negativ 28 28
e
CHO 1.0 >3. 0.3 Blood culture 1/2 Negative after 5 days on both right and left arms.
0 6
WBC 6.4 11.2 8.4 2/9 Negative after 5 days on left arm and IJ catheter site.
RBC 20.1 76. 16 Fecalysis 2/6 (+) Enthamoeba histolytica cyst
6
Epth 6.2 4.8
cells
Bacteria 7.2 48

Chest Xray 1/1


6
1/1
6
1/2
6
2/1 (Compared with 1/16/17) ET in place, tip at 2.4cmabove carina. IJ catheter tip auggestively atatrio-caval junction. No
active infiltrates on the lung parenchyma. Heat unenlarged.
2/1 (Compared with 2/1/17) Poor inspiratory effeort ciasing browding in Bronchovascular markings and broadening of the
0 cardiac shadow. ET not seen. No active infiltrates on the lung parenchyma. Heat unenlarged.
2/11
2/11
1/2 (Compared with 1/16/17) Progression of the ileus with dilated bowels in the upper abdomen with some air fluid levels.
6 Mottled fecal ensities in the rectodigmoid. Rectal gas appreciated. No pneumoperitonium, air-fluid level, organomegally, or
abdominal calcifications. Renal and Psoas shadows intact. Staple wires noted.
Plain 2/11 (Compared with 1/26/17) Rectal gas appreciated. No pneumoperitonium, air-fluid level, organomegally, or abdominal
abdomenal calcifications. Renal and Psoas shadows intact. Staple wires noted.
Xray
Ct scan 1/3 (Correlated with the January 30 2017 contrast-enhanced whole abdomen examination)
angiography 0 Two semi-round filling defects are again appreciated in the distal thoracic and upper abdominal aorta (levels of T10 and T11)
of the respectively measuring 1.1 x 0.7 x 0.9 cm (CCXTXAP) and 1.3 x 1.1 x 1.3 cm (CCxTxAP). Both essentially unchanged in size
since the previous examination. Additionally, thrombus is seen completely fillan the distal superior mesenteric artery (level of
abdominal L2-L3), with no further note of contrast passage into the right colic and middle colic arteries. However, the inferior
aorta and its pancreaticoduodenal artery as well as the jejunal and iieai artery branches are contrast opacified and intact.
branches A tiny filling defect is noted in the common hepatic artery.
The celiac artery and its three terminal branches (left gastric, splenic and hepatic artery) are visualized and noted to be intact.
The bilateral renal arteries arise at the same level and are intact.
The distal abdominal aorta common iliac external iliac, internal iliac, and femoral arteries ( lateral Circumflex branches) are
normal in caliber. There is no evidence of aneurysmal dilatation or stenosis.
Impression:
Thrombus formations in the aorta (t10 and t11 levels) and distal superior mesenteric artery which exhibits
complete occlusion.
Tiny thrombus in the common hepatic artery.
Whole 1/2 Liver: Multiple cystic focus scattered in the right liver lobe, the two largest are closely adjacent to
each other located in segment V measuring 0.9 and 1.3 cm while the rest range in size from 0.2 to 0.6
abdomen CT 7 cm. Another cyst is present in segment IVA measuring 0.9 cm. The rest of the liver is normal in size and
scan with IV attenuation with no other focal mass seen in them.
contrast Gallbladder: Normal in size and the wall is not thickened. No calculi are noted. Intrahepatic
biliary ducts: Prominent in size. Common bile duct: Normal. Pancreas and pancreatic duct: Normal.
Spleen: Note of geographic underfilling of contrast material. No other focal mass lesion seen.
Adrenals: Normal
No enlarged nodes are seen.
Kidneys: Normal in size and show normal excretory function with no evidence of hydronephrosis.
Multiple cortical and exophytic cysts. There are patchy areas of reduced enhancement seen in both kidneys with note of "rim
sign" seen best at the posterior aspect of the left kidney.
Ureters and urinary bladder: Normal
There is focal mucosal thickening at the region of the gastric anttum. There is also few mucosal wall outpouchings in the
ascending and descending colon. The small intestine are distended with fluid and air. The rest of the stomach and other
opacified intestinal segments are unremarkable.
Prostate gland and seminal vesicles: Normal.
No abnormal fluid collection are demonstrated.
Intimal calcification is appreciated in the aorto iliac vessels. At least two small rounded thrombi formation are evident in the
descending aorta, at the level of T10 and T11 vertebral body measuring 1.2 amd 1.7 cm, respectively. There is also a small
felling defect at the distal segment of the superior mesenteric artery. Minimany develo aetsjngastei Iagtdefect at the distal
segment of lumbar and lower thoracic vertebral bodies
Impression:
Changes in the spleen and kidneys are suggestive of infarction.
Thrombus formation in the thoracic aorta and suggestively within the distal segment of the of the superior
mesenteric artery.
Small bowel ileus. Bowel ischemia is not ruled out.
Multiple hepatic lobe cysts and prominent intrahepatic and common bile ducts.
Focal gastric antral mucosal thickening.
Colonic diverticuli.
Bilateral renal cysts (Bosniak I).
2/7 (Compared with the January 27, 2017)
There is no change in the number of the non-enhancing fluid-attenuated foci scattered in the right
liver lobe, of which the two largest are closely adjacent to each other again located in segment V
with current unchanged sizes of 0.9 and 1.3 cm.
Liver and intrahepatic biliary ducts: Normal Gallbladder: Normal in size and the wall is not thickened. No calculi are noted.
Common bile duct is again dilated and measures about 0.8 cm with no intraluminal densities. Pancreas and pancreatic duct:
Normal
As before, there are multiple, non-enhancing low attenuation areas in the spleen, some of which
exhibiting wedge-shaped appearance, extending to the splenic capsule. No new focal mass lesion
seen.
Adrenals: Normal . No enlarged nodes are seen.
Kidney: Normal in size and show normal excretory function with no evidence of .
hydronephrosis. Multiple cortical and exophytic cysts are again diffusely scattered in both kidney. Sizes- 0.2 to 0.9 in the right
and 0.2 to 0.8 in the left. There are again .
patchy areas of reduced enhancement appearing as wedge-shaped parenchymal defects Involving both renal cortices and
medulla which extends into the capsule with note of "cortical rim sign seen best at the posterior aspect of the left kidney.
Ureters: Normal. Urinary bladder: Normal Prostate gland and seminal vesicles: Normal
Free fluid collections are now evident in both paracolic gutters as well as in the supra- and infra-mesocolic regions.
The focal mucosal wall thickening at the region of the gastric antrum has resolved. Segments of
the jejunum and ileum have been surgically resected (s/p jejuno-ileal resection with end-to-end
anastomosis). The remaining portions of the small bowel are minimally gas- and fluid-dilated,
exhibiting thickened walls with mural hyperenhancement. The previously reperted few mucosal wall outpouchings in the
ascending and descending colonic segments are not visualized in this
examination.
Intimal calcifications are again appreciated in the aorto-iliac vessels. At least two small rounded
thrombi formations are again evident in the descending aorta, at the level of the T10 and T11
vertebral body again measuring 0.7 cm and 0.9 cm cm (in greatest axial diameter),
respectively. There is again note of a small filling defect at the distal segment of the superior
mesenteric artery.
Lungs: Linear densities in both lower lung lobes and the lingula. Development of bilateral pleural effusions.
Impression: (noted since january 27, 2017)
Post jejuno-ilieal resection with end-to-end anastomosis changes.
Generalized mild ileus and evidences of peritoneal irritation of the remaining small bowel segments.
Development of abdominal ascites.
Essentially unchaged thrombus formations in the thoracic aorta and within the distal segment of the of the
superior mesenteric artery.
Unchanged findings of possible splenic and renal infarctions as well as multiple hepatic and renal cysts
(Bosniak I).
Resolution of the intrahepatic duct dilatation and focal gastric antral mucosal thickening.
Non-visualization of the colonic diverticuli.
Development of bilateral pleural effusion with associated passive atelectasis of the adjacent lung
segments.
Unchanged dilated common bile duct, lower thoracolumbar spondylosis and bilateral lower lung fibrosis.

ECG 1/19 Normal sinus rhythm with isolated PAC, left ventricular hypertrophy by voltage, non specific ST-T wave
changes
1/26 Sinus bradycardia, non specific ST-T wave changes.
1/31 Normal sinus rhythm, interventricular conduction delay, left ventricular hypertrophy by voltage
2/2 2pm Normal sinus rhythm, non specific ST-T wave changes
2/2 3pm Normal sinus rhythm with isolated PAC, interventricular conduction delay non specific ST-T wave
changes
2/11 Sinus tachycardia with occasional PVC, normal axis
2/14 Sinus tachycardia with occasional PVC, normal axis
2/14 Sinus tachycardia, normal axis, infero-lateral wall ischemia
2decho with 1/30 Concentril Left ventricular remodeling with segmental wall motion abnormality and with preserved
doppler systolic function. Diastolic profile suggestive of ipared left ventricular relaxation. Thickend mitral and
studies aortic valves. Normal pulmonary artery pressure with mild regurgitation.
24- Hour 1/30 Basic rhythm was sinus Low frewuwncy premature ventricular contractions seen almost in singles.
Holter study Intermittent episodes of multifocal atrial tachycardia seen during period of waking cycle. No evidence of
myocardial ischemia.

ABG 1/26/17 1/28/17 2/11/17 2/11/17 2/12/17


pH 7.409 7.49 7.381 7.3 7.347
pCO2 31.0 30.6 24.8 24.7 28.5
pO2 8.71 81.4 182 83.2 59.0
HCO3- 19.2 29.3 14.3 16.5 15.2
BE -3.4 6 -3.0 -9.9 -9.1
O2 sat 98.5% 95.1% 98.6 95% 88.3%
@ 2lpm @ 2lpm @ FiO2 @ FiO2 FiO2
40% 40% 100%

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