Re: Interesting case
From: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au)
Fri Sep 30 18:08:48 2005
What about porphyria?
Steve
________________________________
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R.
--
________________________________
Daniel Braun
Sent: Friday, 30 September 2005 9:33 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Interesting case
I'm going to give the answer either this PM or Sun. Everybody is going
to respond with a slap to the forehead and go "Duh" just like I did.
Dan
On 9/30/05, arunangsu de <arunangsude@yahoo.com> wrote:
hi
could it be acute pancreatitis with later resolution
and pseudopancreatic cys formation?
--- "R. Daniel Braun" <rd.braun@gmail.com> wrote:
> I want to present this as an unknown and see if
> anybody can get the real
> diagnosis.
> 26 Y/O G5 P 4004 LMP 2-9-05 EDC 11-16-05 confirmed
> by 23 week US.
> All of her prior pregnancies were NSVD's of FT
> appropriate weight babies at
> term and without complications.
> On 9-19-05 at 31 wks 4 days BP was 124/90 and urine
> protein was 1+, it had
> been trace 3 weeks earlier. In the triage area, her
> BP varied from 120-150/
> 84-102. She was admitted to hospital for observation
> and multiple labs which
> were all normal except for uric acid of 8.6 and LDH
> of 648. She was kept on
> Bed Rest with Bathroom privileges and closely
> monitored.24 hr Urine protein
> was 450 mg/24 hours. EFW by US was 1330 gms.
> Betamethazone was given over 24
> hours startin on 9-25-05.
> She did well without incident or change until 16:40
> hrs on 9-28-05,(33 weeks
> gestation) when the resident was called to see her
> for severe RUQ pain. BP
> was 168/97 T 96.0 and she was exquisitely tender in
> RUQ and epigastrium,
> there was no rebound noted. She was transferred to
> L&D, Liver function tests
> and CBC were obtained. LFT's were normal, except for
> LDH of 636. Hgb was 14,
> up from 13.8, 3 days before; platelets wer 247K up
> from 186K, 3 days before.
> Magnesium Sulfate was started and she was observed.
> At 20:25 hrs, she was feeling fine with no pain at
> all. BP was 120/84. Urine
> output was 250cc/hr since 17:00 hrs.
> On 9-29-05 at 00:10 hrs, she de3veloped a recurrence
> of her pain. BP 140/
> 80. Again exquisitely tender with no rebound. Pain
> is such that patient is
> writhing in the bed. She had had 3 episodes of
> emesis over the last 6 hours.
> Fetal monitor was reassuring. Normal reflexes. LDH
> now 1107. Diferential
> includes Cholecystitis, severe pre-eclampsia, and
> Gastric upset. She was
> given Morphine Sulfate for the pain and it went away
> again, only to return
> at 03:00 hours. Exam remains the same. At this time
> it was felt that she
> should be delivered by C/S through a vertical
> incision because of the
> possibility of Liver Capsule rupture. She was
> crossmatched for several units
> of blood (8). The provisional diagnosis at this time
> was atypical severe
> pre-eclampsia.
> Is there anyone there who wouldn't have delivered
> her at this point ?
> She was delivered of 3# 6 oz. 1532 gm apgar 9/9
> male. It was noted that
> there was no hemoperitoneum and the uterine incision
> was closed.
> This is where I am going to stop and see what you
> all think we found with
> our abdominal exploration.
> Dan
>
> --
> R. Daniel Braun
> Kinky for Governor
>
--
R. Daniel Braun
Kinky for Governor
Tasmania Together 5 Year Review: Have your say http://www.tasmaniatogether.tas.gov.au/
