sarika
Forum Guru
Topics: 195
Posts: 1,200
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. A 27-year-old woman is brought to the emergency
department by
her mother who found her comatose 30 minutes ago. Her
mother says that
her daughter had been having lower abdominal pain and
vaginal bleeding
over the past week. The patient had an ectopic
pregnancy 2 years ago
and was also treated with doxycycline for pelvic
inflammatory disease at
that time. Her blood pressure is 40/20 mm Hg, pulse
is 160/min, and
respirations are 24/min. The abdomen is distended and
rigid with
decreased bowel sounds. Hemoglobin level is 4.2 g/dL,
and leukocyte count is
12,500/mm3. Culdocentesis is positive. Which of the
following is the
most appropriate next step in management?
A
) Bromocriptine therapy
B
) Clomiphene therapy
C
) Conjugated estrogen therapy
D
) Ergot derivative therapy
E
) Hysteroscopy
F
) Laparoscopy
G
) Dilatation and curettage
H
) Endometrial ablation
I
) Exploratory laparotomy
J
) Total abdominal hysterectomy
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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exploratory laporatomy,i went for that choice and i think thats right.
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| drashishmahajan
Forum Senior
Topics: 6
Posts: 92
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THIS IS RUPTURE UBO-OVARIAN ABSCESS... TT--- LAPROTOMY
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| CocaCola
Forum Guru
Topics: 35
Posts: 907
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Fluid resusitation and
I - Laparotomy
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| ram3
Forum Guru
Topics: 51
Posts: 586
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this is from emedicine
During the last 30 years, gynecologic laparoscopy has evolved from a limited surgical procedure used only for diagnosis and tubal ligation to a major surgical tool used to treat a multitude of gynecologic indications. Today, laparoscopy is one of the most common surgical procedures performed by gynecologists.
For many procedures, such as removal of an ectopic pregnancy, treatment of endometriosis, or ovarian cystectomy, laparoscopy has become the treatment of choice. Compared with laparotomy, multiple studies have shown laparoscopy to be safer, to be less expensive, and to have a shorter recovery time. The advantages of laparoscopy for other procedures, including laparoscopically assisted hysterectomy and the staging and treatment of gynecologic cancers, continue to be elucidated
Edited by Aashi on 06/19/07 - 08:00 AM. Reason: Ram3, for the 100th time,give your opinion on what might be the answer, dont come to a conclusion that all others are wrong!
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| young_doc
Forum Guru
Topics: 58
Posts: 737
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Ram3, Please refrain from constantly telling others they are wrong. It doesn't come out very nicely....especially when the other's are right!
The answer is in fact Laparatomy.
You would NOT do Laparascopy on such a hemodynamically unstable patient as this one.. ESPECIALLY since she's bleeding into her peritoneum.
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| Justice
Just signed contract
Topics: 118
Posts: 2,372
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Laparoscopy would serve as a slow bullet...
I would open her up open-wide being open-eyed...
(I) Exploratory laparotomy
But before that I would hook her up to some fliuds (she does need this but this option is not on the list) plus give her conjugated estrogen to stop bleeding...
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| dr_arc
Forum Senior
Topics: 5
Posts: 156
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definitley exp lap.
but justice, no conjugated estrogens here, that is only and only for an anovulatory DUB pt who is hemodynamically unstable due to the DUB bleed.it acts on the endometrium.
dear ram3 yes we all agree that medicine has wonderfully evolved these days but for such an unstable pt it is still always good old expl lap.
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| coolmavs
Forum Guru
Topics: 46
Posts: 757
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yes...exploratory lap!
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