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Abdominal pain and 14 weeksFrom: RICARDO FRANCALACCI SAVARIS (savaris@orion.ufrgs.br)Wed Oct 23 05:49:33 1996
I face a strange case on my last duty, The answer for this case is going to appear afterwards. A 14 y.o. with 14 weeks arrives at L&D ward brought by her young fellow. She is in poor conditions and drunk, complaining with difuse paroxistical, ciclic abdominal pain for the last few hours, followed by vomiting, no vaginal losses. The pain is difficult to be characterized by the patient, but was very,very intense. She had no prenatal care. She was a prostitute. Other systms: She refers addiction to coccaine, canabis, no EV use. She stopped to use drugs for 2 months Constipation for 3 weeks Refers elimination of Ascaris few weeks ago No hystory of previous surgeries Routine exams: Urine: bacteria (moderate) blood (+) leukocytes: 10 Hemogr.: Hemoglobine: 9 g/dl, eosinophyls: 500 cells/ml (5%), the rest was normal, no signs of onfections. Physycal Examination: No fever Cervix: not effacec, conserved Uterus enlarged compatible with 14 weeks, no pain on motion No signs of Pielonephritis Lungs:clear Abdomen:no tenderness Rectal inspection: normal Bowel Movements: present USound: Topic pregnancy, 14 weeks, no alterations. Abdomen X-ray: normal The surgeon was called for evaluation. He said that there was no acute abdomen, it was not a surgical case Gastro evaluation: He asked for Lipase, hepatic enzymes. The result: All normal Prescription: NPO IV fluids Ampicilin 1g EV qid Hioscin for pain Methoclopramide EV if necessary Evolution: The patient kept complaining about intense pain. What would you do? Ricardo Savaris,MD,MSc Porto Alegre, RS Brazil e.mail: savaris@orion.ufrgs.br Tel.: 55 51 981 2272
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