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Re: Alcoholic with DUB From: Geffrey Klein, MD (gklein@icsi.net) Wed Jun 21 20:21:40 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey Klein, MD: "Re: Managed care--ultrasound (long)" Previous message: Garry E. Siegel: "Re: Managed care--ultrasound (long)" In reply to: ainsron@msn.com: "Alcoholic with DUB" Next in thread: ainsron@msn.com: "Re: Alcoholic with DUB" Reply: ainsron@msn.com: "Re: Alcoholic with DUB" At 12:21 PM -0500 on 6/21/00, 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 What was her PT/PTT? Alcoholics with liver disease can have an aquired coagulopathy.. -- _______________________ Geffrey H. Klein, MD _______________________ geffrey.klein@obgyn.net 200 Medical Center Blvd Suite 103 Webster, TX 77598 (281) 332 6723 http://www.geffreyklein.com Next message: Geffrey Klein, MD: "Re: Managed care--ultrasound (long)" Previous message: Garry E. Siegel: "Re: Managed care--ultrasound (long)" In reply to: ainsron@msn.com: "Alcoholic with DUB" Next in thread: ainsron@msn.com: "Re: Alcoholic with DUB" Reply: ainsron@msn.com: "Re: Alcoholic with DUB"

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