Re: Alcoholic with DUB
From: Gail Waldby (gwaldby@willinet.net)
Wed Jun 21 12:26:33 2000
Portal hypertension causes severe bleeding if you operate on
hemorrhoids--the vagina and hemorrhoids are close enough that it may be
something similar. You can also get duodenal, gastric and ileostomy
varices from portal hypertension.
Gail Waldby, MD
Huron Clinic SD
ainsron@msn.com wrote:
>
> I saw an interesting patient in the ER yesterday with a problem I've
> never seen before. She is a known alcoholic, C/O heavy vaginal bleeding
> with clots for six weeks. 2wks before she was seen in the ER, examined
> by a PA and placed on Provera 10mg BID for the working Dx of
> annovulatory DUB; I'd seen her for a similar problem several years ago.
> She was scheduled to see me in two weeks but because the bleeding wasn't
> controlled, she returned to the ER. On exam this time, the ER doc
> didn't see any bleeding from the cervix, it was coming from the
> posterior vaginal wall and ultrasound showed no endometrial thickening,
> polyp, etc. She denies any intercourse since the bleeding started or
> instrumentation of the vagina, but had been using tampons. When I
> examined her she had two large desquamated areas on the anterior and
> posterior walls with active bleeding from the posterior wall. It was
> not indurated or otherwise abnormal in appearance. I took her to the
> OR, biopsied the areas (bled like hell when I biopsed them, several
> small pumpers) and oversewed them and packed the vagina overnite, which
> controlled the bleeding. Her preop labs showed abnormal LFTs, mild
> hyperbilirubinemia, neutropenia, thrombocytopenia (49,000), normal PT,
> PTT and INR. She had several large bruises and bleeding time was over
> 30 minutes. My working diagnosis is bleeding disorder secondary to
> hyperspleenism. Anyone ever seen anything similar? Does portal
> hypertension cause problems with vaginal varices, like it does at the
> esophagus? No bleeding when I took the pack out, but she also ended up
> in the ICU in DTs this AM.
>
> --
> Ronald E. Ainsworth, MD
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