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Abdominal pain and umbilical secretionFrom: Ricardo Savaris (savaris@orion.ufrgs.br)Wed Oct 1 17:33:35 1997
Dear neters, I just had a consult with a patient who came to me complaining of abdominal pain, I believe that this is not my field, but here is the case Female, 23 years old complaining of abdominal pain starting from the flanks to the umbilical region last Monday (29/9/97). She went to ER, presenting bloating, no fever, normal blood pressure, tenderness on Left Hipogastric region and para umbilical region, no rebound tenderness. They asked Blood count e urine analisys, the hemogram was normal, urine with 5 leukocytes, 7 epithelial cels, 4 blood cells (per field). She stayed in observation for 5 hours on a drip with Hioscine, two hours later she was discharge with the diagnostic of urinary infection, receiving OFLOXACIN (a quinolone) and non steroid anti inflamatory drugs and paracetamol 750. She came to me today saying that the pain is not so intense as Monday. The pain is relief with Paracetal 750 mg. On my office I could complement the story. Ths pain has been with her for many years, it is very intense, last time started at the same time when she started a new diet and acupunture for weight loss (coincidence?) She had a volvus when she was 4 month old, the scar is on the right hypogastrc region. the umbilicus drains a yellowish secretion, staining her clothes, she has this also for many years (she cannot precise how long). Last gyn exam showed HPV and vaginal discharge with gardnerella vaginalis. No further important things on medical history On my physical exam: Enlarged mass 1 cm below the left costal edge, painfull on compression, without rebound tenderness, there is another painfull point also near the navel, on the left side of the umbilical region, abdominal distension, bowel movements are normal, Vaginal exam normal, without pain, no delayed period (LMP on 18/9/97). Presence of clue cells. I decided to ask for an abdominal US, suspend the non steroidal anti inflamatory drugs, just keep the paracetamol. Any ideas? Thanks
-- Ricardo Savaris, M.D., MSc, TEGO Porto Alegre, Brazil savaris@orion.ufrgs.br
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