Re: Interesting puzzling case
From: Myer Bornstein (mborn@massmed.org)
Thu Aug 31 14:46:14 2006
Of course the radiologists suggest another test to help with diagnosis or to
confirm etc. How are they going to make money?
:-)
Myer
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D.
> Ashley Hill
> Sent: Thursday, August 31, 2006 2:52 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Interesting puzzling case
>
> I'm sure it's the same at your hospitals, but at mine you always get
> "chest x-ray normal, suggest CT or MRI (or whatever additional test) to
> confirm." Darn radiologists!
>
> Ashley
>
> At Thu, 31 Aug 2006, R. Daniel Braun wrote:
> >
> >But cheap and effective.
> >
> >On 8/31/06, art fougner, md <evsono@pipeline.com> wrote:
> >>
> >> Erect Chest Film? Dan, that's SO 20th Century LOL.
> >>
> >> Art
> >>
> >> At Thu, 31 Aug 2006, R. Daniel Braun wrote:
> >> >
> >> >Ashley,
> >> >What is wrong with an upright PA Chest film to look for air under the
> >> >diaphragm? By two weeks any CO2 that was left from the laparoscopy
> will
> >> be
> >> >LOOOOOOOOOOOOOOOONG gone. Lot cheaper than repeating the CT Scan
> >> >
> >> >Dan
> >> >
> >> >On 8/30/06, D. Ashley Hill <dahmd@cfl.rr.com> wrote:
> >> >>
> >> >> This type of case will drive you nuts. Two weeks out is a little
> long
> >> >> for a GI injury to manifest, but there are case series that show up
> to
> >> >> 1/7 small bowel injuries will take up to 2 weeks to show up,
> >> >> particularly if the injury was from thermal damage. It might be
> >> >> worthwhile repeating the CT scan, always unpopular with patients.
> Is
> >> >> there a significant bandemia? According to a colorectal surgeon I
> know
> >> >> GI injuries often show elevated bands (note my lack of supporting
> >> >> evidence). If you have ruled out other sources of infection
> >> (pneumonia,
> >> >> cholecystitis, appendicitis, clostridium difficile) then you may
> have
> >> to
> >> >> re-scope her to look around, with the understanding that she may end
> up
> >> >> with a laparotomy. Don't leave us hanging, and good luck.
> >> >>
> >> >> Ashley
> >> >>
> >> >> At Wed, 30 Aug 2006, Joe Cutchin wrote:
> >> >> >
> >> >> >Watch her like a hawk. Don't want to miss bowel injury. I would
> >> imagine
> >> >> >by now though if she has bowel injury it would be manifesting
> itself
> >> >> >with more severe symptoms. Bottom line: I would feel more
> comfortable
> >> >> >examining her myself if I did the surgery. Joe C
> >> >> >
> >> >> >ENDODOK@aol.com wrote:
> >> >> >
> >> >> >> Interesting puzzling case:
> >> >> >>
> >> >> >> 39 yr old G2P2 (C/Sx2) underwent simple LSH for adenomyosis,
> >> discharged
> >> >> >> 4 hrs.post-op. Recuperation rapid. Awoke 2AM p.o. day 14, with
> >> >> >> epigastric and RUQ pain, and 2 diarrheal stools. No chills/
> fever/
> >> >> >> anorexia/, nausea or vomiting. Pt has very long Hx. of "stomach
> >> >> >> problems", work-up by GI "delayed gastric emptying", Rx with
> Reglan
> >> >> and
> >> >> >> Zantac. Sx. occur a couple of times per year, slow response to
> above
> >> >> meds.
> >> >> >>
> >> >> >> Pt. lives 35 miles away, went to her local
> community
> >> >> >> hospital that evening as pain increasing. P/E totally negative-
> >> Vitals
> >> >> >> normal, abdomen soft, non-tender, no distention, no guarding, no
> >> >> >> rebound, BS wnl. Pelvic unremarkable- no mass/ induration /
> >> tenderness/
> >> >> >> local heat ( as one can find with a hot TOA). Hct 40%, WBC
> 19,000.
> >> >> >>
> >> >> >> Your thoughts??
> >> >> >>
> >> >> >> Glenn Bradley MD
> >> >> >>
> >> >>
> >> >> --
> >> >> D. Ashley Hill, MD
> >> >> Associate Director
> >> >> Department of Obstetrics and Gynecology
> >> >> Florida Hospital Family Practice Residency
> >> >> Medical Director, Loch Haven Ob/Gyn Group
> >> >> Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
> >> >> Orlando, Florida
> >> >>
> >> >--
> >> >R. Daniel Braun
> >> >
> >> > "The way to health is an aromatic bath and scented massage
> >> everyday".
> >> > Hippocrates
> >> >
> >>
> >> --
> >> art fougner, md
> >> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
> >>
> >--
> >R. Daniel Braun
> >
> > "The way to health is an aromatic bath and scented massage
> everyday".
> > Hippocrates
> >
>
> --
> D. Ashley Hill, MD
> Associate Director
> Department of Obstetrics and Gynecology
> Florida Hospital Family Practice Residency
> Medical Director, Loch Haven Ob/Gyn Group
> Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
> Orlando, Florida
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