Re: Alcoholic with DUB
From: james connerth (babydoc@apex.net)
Wed Jun 21 12:34:46 2000
Prob some type of coagulopathy due to ETOH liver disease--Age?-Endometrial
bx and pap?Have used depo provera in this similar situation.
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
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