Re: Alcoholic with DUB
From: ainsron@msn.com
Thu Jun 22 10:36:32 2000
That's an interesting thought, these were also kissing lesions. Haven't
got the path back yet, I'll let you know.
> I had a similar case without the confounding issue of the alcoholism. 21
>y/o sudden onset heavy vaginal bleeding. On exam she had pumpers on the left
>sidewall from the middle of a necrotic appearing lesion. There was a kissing
>lesion on the right but no pumpers. I stopped the bleeding and biopsied both
>sides. Pathology came back "Electrical or thermal injury". When I told her
>this, her response was: "I didn't put a hot curling iron in there." I said
>OK.
>
>Dan
>
>-----Original Message-----
>From: ainsron@msn.com
>To: Multiple recipients of list OB-GYN-L
>Sent: 6/21/00 12:21 PM
>Subject: Alcoholic with DUB
>
>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
>
--
Ronald E. Ainsworth, MD
|
|
