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Abdominal painFrom: Ricardo Savaris (savaris@orion.ufrgs.br)Thu Dec 11 01:05:17 1997
Hi listers, Yesterday afternoon, a patient came into my office fro an emergency consultation (I really dont like this emergencies, I am at my office and I cannot provide much help there, and most of the times she ends up at the E.R.), but here is the case: 32 y-old, gesta 3 para 2 , 1 abortion, started yesterday morning with intense colic pain starting on her back and goes to the front. The pain moved, afterwords to the supra pubic region. The pain is like labour pain, no relief position, last for few minutes and disapear. At the same time she started with an abnormal uterine bleeding, not intense. No use of drugs or fever. Her menses are regular 28 days cicles, 7 days of menses. LMP: November, 20th no contraceptive method since quimioterapy Medical past history: Breast cancer 6 years ago, sectorectomy + radioterapy + quimioterapy. No history of urinary stones On the physical exam: No tenderness on her back. Abdominal defense, and rebound tenderness. Vaginal examination: pain in uterine mobilization, no adnexial pain, uterus in normal size. After the exam she started with the pain. Ordered FBC, Urine analisis and Sedimentaion Rate (I sent her to E.R.) FBC: Hb 13 Leucocytes: 4.800 Urine analisys: all in normal range, 1-2 leuc/field, no bacteria, 1 blood cell/field At the E.R. they asked for a pregnancy test and discharge to home. No chance for nephrolithiasis. She is still with this ciclic pain. Any suggestion?
-- Ricardo Savaris, MD, TEGO, MSc Porto Alegre, Brazil 55 51 3301354
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