Re: Alcoholic with DUB
From: ainsron@msn.com
Thu Jun 22 10:46:58 2000
I didn't order one, probably wouldn't have been a bad idea. I'll order
that with FSPs unless the GP who is handling her alcohol related problem
has already.
>Fibrinogen?
>
>--
>Rupak Ranjan Roy
>MRCOG
>
>>----- Original Message -----
>From: Geffrey Klein, MD <gklein@icsi.net>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net>
>Sent: 22 June 2000 12:23
>Subject: Re: Alcoholic with DUB
>
>> At 12:21 PM -0500 on 6/21/00, 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
>>
>> What was her PT/PTT? Alcoholics with liver disease can have an
>> aquired coagulopathy..
>>
>> --
>> _______________________
>> Geffrey H. Klein, MD
>> _______________________
>> geffrey.klein@obgyn.net
>> 200 Medical Center Blvd Suite 103
>> Webster, TX 77598
>> (281) 332 6723
>>
>> http://www.geffreyklein.com
>>
--
Ronald E. Ainsworth, MD
