Re: Alcoholic with DUB

From: Dr. Fatih Demirtola (fmtola@metu.edu.tr)
Thu Jun 22 02:09:32 2000

I had similar patients . This patient has some kind of bleeding tendency and this should be evaluated . (most probably alcohol related liver problem that effects coagulation ) . Our point is the usage of tampons . Tampons sometimes stick to the vagina or cervix , when the user removes it , it removes the overlying epithelium with it , it really bleeds to much . I have seen similar 3 cases in the ER . They used tampons after abortions and tampons desquamated the cervix , adrenalin soaked tamponage stoped the bleeding's in all cases .

Fatih Demirtola ,MD. Obstetrician & Gynecologist Ankara , Turkey . E-mail :fmtola@metu.edu.tr -----Original Message----- From: ainsron@msn.com <ainsron@msn.com> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net> Date: 21 Haziran 2000 Çarşamba 20:23 Subject: Alcoholic with DUB

>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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