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Re: Splenomegaly and pregnancy From: ainsron@msn.com Wed Aug 23 11:27:56 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: babydoc: "Re: OB: Fundal pressure" Previous message: Richar B Kates MD: "Re: amnioscopy" Maybe in reply to: ainsron@msn.com: "Splenomegaly and pregnancy" Next in thread: Garry E. Siegel: "Re: Cytotec" Reply: Garry E. Siegel: "Re: Cytotec" Good suggestions, those are what I came up with on my medline search also. >Ron, s'pose infxn has been excluded (HIV, EBV/Mono, & zebras [Plasmodium - oooouch, I can hear Eberhard screaming already]/Schisto). Sounds like the Hematologist has excluded peripheral smear evidence of myelodysplasia). Would think storage diseases would have had other manifestations by age 14. Maybe try Gastroenterology. With nml LFT's sounds like extrahepatic portal HTN aggravated by vascular changes in pregnancy. This could be secondary to AVM/cavernoma or other congenital vessel abnormality; or postthrombotic, with cavernous tranformation (Behcet's/Protein C def). Extrahepatic, noncirrhotic portal HTN usually presents in childhood, or early adulthood. Color/Pulsed duplex doppler may be helpful to evaluate portal, splenic, and superior mesenteric circulation (particularly with respect to changes during respiration), and evaluate the retroperitoneum and esophagus for varices. If non-cirrhotic portal HTN, there is a 13% incidence of variceal bleeding during pregnancy (Kochh! >ar, 7/99, Dig Dis Sci 44:1356-61), which can be managed with endoscopic scleroRx (Pauzner 1/91, AJOG 164:152). Keep us posted. tj. > >ainsron@msn.com on 08/21/2000 10:07:00 AM >To: ob-gyn-l@forum.obgyn.net@Internet >cc: (bcc: Terrence Jones/CA/KAIPERM) >Subject: Splenomegaly and pregnancy > >I have a 15yo, G1 (who ironically I also delivered) who initially saw a >CNM for care and subsequently transferred care to me for high risk >pregnancy care because of splenomegaly. She noted a sudden increase in >abdominal girth at about 14 weeks and a sonogram showed "massive >splenomegaly." F/U ultrasound demostrates the same and on exam her >abdomen is asymmetrically enlarged, largest and fullest in LUQ. She has >normal hematologic parameters - normal platelets, normal peripheral >smear, normal H&H and normal liver function tests. She is quite thin, >and I think it would have been noted before if it was present prior to >pregnancy. She has had a hematologic consultation with no specific >findings or recommendations and I discussed it with a perinatologist who >basically said, "Hmm, never seen that before, but I'll look for >information." He called me back today after reviewing some information >and said it could be a sign of glycogen storage diseases and suggested >genetic consultation. Anyone have any other thoughts or suggestions? >Thanks > >-- >Ronald E. Ainsworth, MD > -- Ronald E. Ainsworth, MD Next message: babydoc: "Re: OB: Fundal pressure" Previous message: Richar B Kates MD: "Re: amnioscopy" Maybe in reply to: ainsron@msn.com: "Splenomegaly and pregnancy" Next in thread: Garry E. Siegel: "Re: Cytotec" Reply: Garry E. Siegel: "Re: Cytotec"

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