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RE: Case of the week August 27th
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RE: Case of the week August 27th - August 30, 2007 11:10:27 PM
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SJBird55
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From: Michigan
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Ah... my interpretation of "persistent" pain is obviously different than yours or a patient's... I hear "persistent" and I think more than 6 weeks. So technically the pain did come on recently.
I think of DVTs being associated with birth control pill use. What was she prescribed? So... does she smoke cigarettes? If she does, how often and how many? Her symptoms aren't quite the typical for this problem though. Any shortness of breath? Any visual changes/problems? Has she recently been on a flight somewhere?
Wags, did you have a typo? RBC of 0-3 is in a normal range, which means 15 would be considered high.
I'm not sure why BUN is slightly high. Creatinine and the BUN/creatinine ratio is within normal limits. Since you can be a sneaky devil... is she significantly burned?
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RE: Case of the week August 27th - August 31, 2007 12:58:24 AM
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bonez
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Well I'll stick my neck out and suggest a embolytic problem. Renal arterial issue leading to pain from organ ischemia? Or more likely an embolism within the renal body itself since like the lung we have end stage circulation.
< Message edited by bonez -- August 31, 2007 1:02:50 AM >
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RE: Case of the week August 27th - August 31, 2007 7:56:26 AM
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Tom Reeves DPT ATC
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aneurysm? ovarian ca?
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RE: Case of the week August 27th - August 31, 2007 1:22:01 PM
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Dr.Wagner
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From: Indianapolis
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quote:
Ah... my interpretation of "persistent" pain is obviously different than yours or a patient's... I hear "persistent" and I think more than 6 weeks. So technically the pain did come on recently.
A:There is no time frame for "persistent", we may substitute "unrelenting", "continuous", "continuing to exist despite interference or treatment" ...remember, these are words patient use and must be clarified
Q: I think of DVTs being associated with birth control pill use. What was she prescribed? So... does she smoke cigarettes
A: Yes...she was very oddly prescribed DOUBLE dose OCP's by a Nurse Practioner...for the treatment of "irregular periods"...this is not recommended nor well established in any literature. Does she smoke cigarettes: yes and marijuana
Q: Wags, did you have a typo? RBC of 0-3 is in a normal range, which means 15 would be considered high.
A: a count of 15 is "above normal" depending on the wbc and epithelial cell count...200 is high, 100 is high, 500 is high...15 is slightly above normal. Happens in no less than 25% of random urine samples...but in her case may be helpful to note and use as a benchmark for worsening or clearing urine hematuria
Q:I'm not sure why BUN is slightly high. Creatinine and the BUN/creatinine ratio is within normal limits. Since you can be a sneaky devil... is she significantly burned?
A: Actually her BUN IS high, not terrible, but showing "pre renal azotemia" and something far more concerning than 15 rbc in the urine...It raised an eyebrow and clearly shows she needs some fluids. But since her Cr. is elevated also (just a tad), it makes you wonder if there is an intrinsic quality to the value.
Q:Well I'll stick my neck out and suggest a embolytic problem. Renal arterial issue leading to pain from organ ischemia? Or more likely an embolism within the renal body itself since like the lung we have end stage circulation.
hmmm what do you see on this IV contrasted CT of the abdomen?
 Attachment (1)
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Dr. Wagner DO
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RE: Case of the week August 27th - August 31, 2007 4:57:14 PM
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Tom Reeves DPT ATC
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is that a kidney fracture?
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RE: Case of the week August 27th - August 31, 2007 8:02:05 PM
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Dr.Wagner
Posts: 1242
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From: Indianapolis
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This is a renal artery thrombosis leading to renal infarction...this is due to the OCP given to this patient.
It was a hard case...but it challenges people to think on many levels, testing, imaging, pharm etc.
I appreciate everyone taking part!
< Message edited by Dr.Wagner -- September 1, 2007 10:27:57 AM >
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