Re: Interesting puzzling case- part 2 (LONG)
From: Andrew Folley (agfolley@hotmail.com)
Thu Aug 31 23:03:46 2006
Admit. Cat Scan abdomen. Look for abcess behind liver. IV anerobic
coverage and po vancomycin for possible clostridia (check stool cultures and
what is diff on WBC?)
>From: ENDODOK@aol.com
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Interesting puzzling case- part 2 (LONG)
>Date: Wed, 30 Aug 2006 19:35:01 -0500
>
>Thank you all who responded re the initial communication on this case.
>Now
>part 2:
>
> Following the initial ER evaluation on day one of sx., pt. and her RN
>mother inclined to believe " a flare-up" of her long standing "stomach
>problem". The following late afternoon, pt. called and declared nothing
>had
>changed... pain the same, no anorexia, nausea, vomiting, distention,
>chills, fever,
>bleeding. 2 loose stools that day, moderate headache. Pt agreed to drive
>to my
>office for evaluation the following AM.
> Saturday AM pt seen. No change in history. P/E negative... afebrile,
>BP
>and pulse normal, no nausea or vomiting, no further diarrhea, no chills
>or
>fever. Abdominal exam = soft, no distention, Incisions healed, no
>tenderness/
>guarding/ rebound. BS normal. Pelvic = no tenderness/ induration/ masses
>or
>warmth. Hospital UTZ = Small amount cul-de sac fluid.
>Hct 35%; WBC 24,000. Emperically started on Cipro ( something is infected
>but where??). Pt developed fever 101-103 during that night, I am called in
>early
> AM, immediately direct pt to our hospital facility.
> On admission, Hx. slightly changed -- Abdominal pain now at level of
>umbilicus. Temp 102. RN mom had administered a Harris flush for
>alleviation of
>"gas" ( no effect) and pt had on her own taken some MOM because of no BM
>for 2
>days, resulting in 3 diarrheal stools while in transit from home.
>Abdominal
>and pelvic exam exactly as before... totally negative!!
>Hct on admission 35%, WBC 24,000.
>
>Your management thoughts??
>
>JGB
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