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DVT

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fox
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05/30/07 - 03:57 PM

48.A 65 year old female who had a stroke a year back and is bed-ridden for almost 15 hours a day due to severe paresis presents to the ER with abdominal distension and pain in the left leg (calf). She could not get up to pick up the phone and 911 was called when the home nurse came to her in the morning. SHe has been having the distension for almost 2-3 weeks but now she finds it intolerable and hurts when she breathes.
PE:
Abd: Ascites +++, Liver enlarged +++, Spleen enlarged ++, no spider angiomata present.
Leg: Left foot has no edema, left leg - calf is extremely tender and DOppler confirms DVT. Right leg has no edema, No vulvar edema
CVS: Right lung bas has minimal rales , no pain, (no chest pain in the HPI), NO JVD, NO neck vein distension

Temp - normal, Pulse - 94, RR - 30
THE CAUSE OF ASCITES IS:
a).Congestive cardiac failure
b).Pulmonary Embolism and Right HF
c).DVT moving into the systemic circulation
d).Protein C deficiency
e).Atherosclerosis
f).Nephrotic syndrome
g).Cirrhosis secondary to HCV infection

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doc_clotaire
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05/30/07 - 04:20 PM

b).Pulmonary Embolism and Right HF

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doyoudig
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05/30/07 - 04:36 PM

woud you not see JVD in RHF?
I am btw E and C --will go for E??

ARJ
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05/30/07 - 04:55 PM

should be e).Atherosclerosis

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fox
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05/30/07 - 05:00 PM

Good reasoning doyoudig. I dont know the source of this q nor do I have the answer, but lets try reasoning it out

THE CAUSE OF ASCITES IS:
a).Congestive cardiac failure:-------- No JVD/ rales. So r/o
b).Pulmonary Embolism and Right HF .-------- Again No JVD So r/o
c).DVT moving into the systemic circulation--------Should ideally cause pedal edema/ vulvar edma So r/o
d).Protein C deficiency . - keep it aside for the time being
e).Atherosclerosis : How will atherosclerosis cause isolated liver& splenic edema? doesnt make sense. r/o
f).Nephrotic syndrome . No gen edema/ anasarca. So r/o
g).Cirrhosis secondary to HCV infection. No spider angiomata/ no pedal edema/ so r/o.

This leaves us with Protein C by exclusion. Also looks like that there is obstruction in the portal circulation only. So I guess its Protein C deficiency, which can cause isolated thrombosis like splenic vein/ renal vein thrombosis etc.

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doyoudig
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05/30/07 - 05:15 PM

u know what ur right, I was thinking of protein C but culd not make the assciation, did prot C def have any relation to Budd Chiari Syndrome?? do you remember anything like that?

treblechar
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05/30/07 - 10:13 PM

fox
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06/01/07 - 12:50 PM

doyoudig wrote:
u know what ur right, I was thinking of protein C but culd not make the assciation, did prot C def have any relation to Budd Chiari Syndrome?? do you remember anything like that?

yes you are right:

http://www.emedicine.com/med/topic2694.htm

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