Re: Interesting case
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Sep 30 06:30:25 2005
I'm going to give the answer either this PM or Sun. Everybody is going to
respond with a slap to the forehead and go "Duh" just like I did.
Dan
On 9/30/05, arunangsu de <arunangsude@yahoo.com> wrote:
>
> hi
> could it be acute pancreatitis with later resolution
> and pseudopancreatic cys formation?
>
> --- "R. Daniel Braun" <rd.braun@gmail.com> wrote:
>
> > I want to present this as an unknown and see if
> > anybody can get the real
> > diagnosis.
> > 26 Y/O G5 P 4004 LMP 2-9-05 EDC 11-16-05 confirmed
> > by 23 week US.
> > All of her prior pregnancies were NSVD's of FT
> > appropriate weight babies at
> > term and without complications.
> > On 9-19-05 at 31 wks 4 days BP was 124/90 and urine
> > protein was 1+, it had
> > been trace 3 weeks earlier. In the triage area, her
> > BP varied from 120-150/
> > 84-102. She was admitted to hospital for observation
> > and multiple labs which
> > were all normal except for uric acid of 8.6 and LDH
> > of 648. She was kept on
> > Bed Rest with Bathroom privileges and closely
> > monitored.24 hr Urine protein
> > was 450 mg/24 hours. EFW by US was 1330 gms.
> > Betamethazone was given over 24
> > hours startin on 9-25-05.
> > She did well without incident or change until 16:40
> > hrs on 9-28-05,(33 weeks
> > gestation) when the resident was called to see her
> > for severe RUQ pain. BP
> > was 168/97 T 96.0 and she was exquisitely tender in
> > RUQ and epigastrium,
> > there was no rebound noted. She was transferred to
> > L&D, Liver function tests
> > and CBC were obtained. LFT's were normal, except for
> > LDH of 636. Hgb was 14,
> > up from 13.8, 3 days before; platelets wer 247K up
> > from 186K, 3 days before.
> > Magnesium Sulfate was started and she was observed.
> > At 20:25 hrs, she was feeling fine with no pain at
> > all. BP was 120/84. Urine
> > output was 250cc/hr since 17:00 hrs.
> > On 9-29-05 at 00:10 hrs, she de3veloped a recurrence
> > of her pain. BP 140/
> > 80. Again exquisitely tender with no rebound. Pain
> > is such that patient is
> > writhing in the bed. She had had 3 episodes of
> > emesis over the last 6 hours.
> > Fetal monitor was reassuring. Normal reflexes. LDH
> > now 1107. Diferential
> > includes Cholecystitis, severe pre-eclampsia, and
> > Gastric upset. She was
> > given Morphine Sulfate for the pain and it went away
> > again, only to return
> > at 03:00 hours. Exam remains the same. At this time
> > it was felt that she
> > should be delivered by C/S through a vertical
> > incision because of the
> > possibility of Liver Capsule rupture. She was
> > crossmatched for several units
> > of blood (8). The provisional diagnosis at this time
> > was atypical severe
> > pre-eclampsia.
> > Is there anyone there who wouldn't have delivered
> > her at this point ?
> > She was delivered of 3# 6 oz. 1532 gm apgar 9/9
> > male. It was noted that
> > there was no hemoperitoneum and the uterine incision
> > was closed.
> > This is where I am going to stop and see what you
> > all think we found with
> > our abdominal exploration.
> > Dan
> >
> > --
> > R. Daniel Braun
> > Kinky for Governor
> >
>
--
R. Daniel Braun
Kinky for Governor
