M&M

06/05/16

Mrs CP
49 yo female
T2DM
-Hba1c 7.5%
-peripheral neuropathy
Obesity
-laparoscopic band surgery
NASH
Neuropathic pain
CKD
-secondary to diabetes
-on monthly aranesp prior to admission
Iron deficency anaemia
HTN
Asthma

Mrs CP
MRSA neck abscess
-surgical resection 15/3/16 & IVABx
-Cx by septic shock
AKI on CKD
-In the setting of sepsis
-CVVHDF HDx
-Cx by fluid overload and hypoxia
Lung metastasis
-Ongoing hypoxia despite euvolaemia
-CT: Innumerable pulmonary nodules identified evenly
distributed
throughout both lungs. Extensive mediastinal
lymphadenopathy.

Mrs CP
Cervical cancer
-Vulval pain post TOV
-Hx menorrhagia and intermenstural bleeding
-last PAP smear 6 years ago
-TVUS capital radiology 8/3/16 - mildy enlarged heterogenous
myometrium
-gynae review - irregular mass under the clitorus, irregular mass
abutting intraoitus - right vaginal wall.
-MRI pelvis - likely metastatic cervical ca. local spread vagina and
the endometrium
-Bx: poorly differentiated adenocarcinoma of the cervix
-CT CAP - lung & liver +/- brain mets
-O&G oncology - given advanced stage of disease and other comorbidites no chemotherapy or radiotherapy likely to be of
mortality or symptomatic benefit. For symptom management only.
-Severe perineal pain Mx by APS and then palliative care

Mrs CP
End of life care
-Increasing symptom burden
particularly on dialysis
-Discussions with family and patient
decision to withdraw from dialysis
-Discharged home with MWPC
-Died the following day Wed 4/5/16