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  #1  
Old 03-31-2010
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Default 62 y oldwoman with worsening abdominal pain

A 62-year-old woman presents with worsening abdominal pain that started 16 hours ago. Since then, she has vomited 2 times. Now the pain is localized in the right lower quadrant (RLQ). Her past medical history is remarkable for mitral valve replacement 8 years ago, because of rheumatic heart disease. She is on warfarin therapy. Abdomen is soft, nondistended, and tender with rebound in the RLQ. Psoas sign is positive. Bowel sounds are diminished. Her Temperature is: 37.4C(99.4F), axillary and 38.2C(100.9F), rectally. Upright abdominal x-ray is normal. Ultrasound is positive for several stones in the gall bladder.

Laboratory is:
WBC 17,700cmm
Hb 10.8
PT 32 sec
INR 2.5
Platelet count 120,000
The next step of the management should be?
A. Start antibiotics and vitamin K
B. Infuse protamine sulfate
C. Infuse fresh frozen plasma
D. Start heparin in prophylactic dose
E. Perform laparotomy
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  #2  
Old 03-31-2010
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Tho not sure , but i think its C ... Fresh frozen plasma .....
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  #3  
Old 03-31-2010
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Cool

E. Perform laparotomy
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Old 03-31-2010
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Question

Quote:
Originally Posted by shahra View Post
E. Perform laparotomy
why you say so?
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  #5  
Old 03-31-2010
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The dilemma here is whether to perform appendectomy in a patient on chronic anticoagulation regime. Although warfarin interferes with the vitamin K pathway, administration of vit-K should take time to act, which in not a plausible option in this setting. So I would agree with dr.FSUSTC and go for FFP (which acts much faster than Vit-K by readily replenishing the inactivated clotting factors) before rushing the pt to the OR.
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Old 03-31-2010
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Quote:
Originally Posted by aungawa View Post
why you say so?
My bad.I was thinking about gal stone ileitis.On 2nd thought,I agree with FFP
as The next step of the management.
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Old 04-01-2010
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i think the answer is c - Infuse fresh frozen plasma
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