Re: Interesting case
From: art fougner, md (evsono@pipeline.com)
Fri Sep 30 07:35:26 2005
What did her ovaries look like?
art
At Fri, 30 Sep 2005, R. Daniel Braun wrote:
>
>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
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
