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LEFT upper quadrant painFrom: Glen Elrod (dr99645@yahoo.com)Mon Feb 4 17:24:06 2008
18 yo G1P1 delivered by another provider (lay midwife) early January. I met her when she came to the ER with a delayed postpartum hemorrhage that I ended up transfusing her 2 units after her D&C. At one of her postop/post hospital checks she mentions that she has had left upper quadrant pain. Initially I thought it was new, but now know that it has been there for 2 years or more. She notices it all the time to some degree. She notes it to be worse with being up and about, better with sitting or particularly lying down. She denies any systemic symptoms otherwise (thinking splenomegaly and mono symptoms) On exam I can't palpate the spleen (would I really know it if I felt it? probably since she is thin) and there is not much abdominal wall tenderness. CBC shows thrombocytosis with plt count of 575 but nearly normal h/h and normal indices and normal WBC. Comprehensive metabolic panel is normal. Today, now two weeks later and still having pain. Better exam and I do feel the tip of the spleen and it is tender to palpation. She does have an increase in pain over the rectus muscles when she goes from lying flat to a sitting position. Specifically, she is tender just where the rectus and the transversus/oblique intersect. Since it was there before the pregnancy, I think I can discount the transfusion and reactive thromobcytosis as a cause. Does anyone else have any better suggestions other than muscle strain of 2 year duration??? Thanks, Glen
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