Re: Abdominal pain
From: rbraun@iupui.edu
Sun Dec 14 07:22:47 1997
Wait, watch, and only do something if there is a need. i.e. symptoms
recur.
R. Daniel Braun, MD FACOG
On Sat, 13 Dec 1997, Ricardo Savaris wrote:
>
> > Date: Fri, 12 Dec 1997 11:13:45 -0600 (CST)
> > From: cgharsha@stvincent.org (Cathy Harsha MD)
> > To: OB-GYN-L@OBGYN.net
> > Subject: Re: Abdominal pain
> > Message-ID: <199712121713.LAA28801@talk.obgyn.net>
> >
> > At Thu, 11 Dec 1997, Ricardo Savaris wrote:
> > >
> > >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.
>
> I saw this patient yesterday, her pregnancy test was negative. She says
> that her pain almost disapear after the stop of the bleeding. I examined
> her again. She still has pain on the vaginal examination, but it is all
> over, mainly over the rectum. She said that she has dispareunia. I started
> to think about endometriosis, but before scope her I asked the US
> transvaginal. If it is normal, I have intention to scope her. What do you
> think?
>
> Ricardo Savaris, MD, MSc, TEGO
> Porto Alegre, Brazil
> savaris@orion.ufrgs.br
> 55 51 3301354
>
