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Re: Alcoholic with DUB From: DoctorJoe@aol.com Wed Jun 21 13:38:06 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "Re: f/u: Need your help(long)" Previous message: DoctorJoe@aol.com: "Re: Now we get sued over undiagnosed nuchal cords...." Maybe in reply to: ainsron@msn.com: "Alcoholic with DUB" Next in thread: art fougner, md: "Re: Now we get sued over undiagnosed nuchal cords...." In a message dated 6/21/00 12:22:05 PM, ainsron@msn.com writes: >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. Perhaps she needs a more thorough coagulation work up. Supposed she's a "hidden" vonWildebrand's who is only now showing up because of abnormal liver functions and relatively decreased clotting factors (maybe not enough to throw a regular PT/PTT way off)? Also, what effect would Provera have on someone whose liver is already out of whack? Joe P. Next message: Richard Chudacoff, MD: "Re: f/u: Need your help(long)" Previous message: DoctorJoe@aol.com: "Re: Now we get sued over undiagnosed nuchal cords...." Maybe in reply to: ainsron@msn.com: "Alcoholic with DUB" Next in thread: art fougner, md: "Re: Now we get sued over undiagnosed nuchal cords...."

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