Re: Alcoholic with DUB
From: ainsron@msn.com
Thu Jun 22 10:54:06 2000
Thanks for the suggestion, I had thought that tampons could be the
culprit causing the desquamation, compounding the bleeding disorder.
I'll certainly advise her to discontinue them. Whether or not she will
is questionable, at this point she is so sedated from all the librium
she is getting, she doesn't know what day of the week it is.
>I had similar patients . This patient has some kind of bleeding tendency
>and this should be evaluated . (most probably alcohol related liver problem
>that effects coagulation ) . Our point is the usage of tampons . Tampons
>sometimes stick to the vagina or cervix , when the user removes it , it
>removes the overlying epithelium with it , it really bleeds to much . I have
>seen similar 3 cases in the ER . They used tampons after abortions and
>tampons desquamated the cervix , adrenalin soaked tamponage stoped the
>bleeding's in all cases .
>
>Fatih Demirtola ,MD.
>Obstetrician & Gynecologist
>Ankara , Turkey .
>E-mail :fmtola@metu.edu.tr
>-----Original Message-----
>From: ainsron@msn.com <ainsron@msn.com>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net>
>Date: 21 Haziran 2000 Çarşamba 20:23
>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
>
>begin 666 Fatih Demirtola MD.vcf
>M0D5'24XZ5D-!4D0-"DXZ1&5M:7)T;VQA($U$.T9A=&EH#0I&3CI&871I:" @
>M1&5M:7)T;VQA($U$#0I/4D<Z4')I=F%T92!0<F%C=&EC92 L06YK87)A("Q4
>M=7)K97D-"E1)5$Q%.D]B<W1E=')I8VEA;B9'>6YE8V]L;V=I<W0-"D5-04E,
>M.U!2148[24Y415).150Z9FUT;VQA0&UE='4N961U+G1R#0I%3D0Z5D-!4D0-
>!"@``
>`
>end
--
Ronald E. Ainsworth, MD
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