laproscopy on 17 year old girl?

Discussion in 'Clinical Rotations' started by Vasiley Zaitsev, Feb 7, 2002.

  1. Vasiley Zaitsev

    Vasiley Zaitsev Senior Member
    10+ Year Member

    Joined:
    Mar 5, 2001
    Messages:
    220
    Likes Received:
    0
    17 yr old girl..history of heavy bleeeds (every other month), and severe cramping. The doc wants a lap. Why would a doc want to do this? Endometriosis? Or what? I'm really stupid when it comes to OB/GYN things.

    Thx in advance,

    owcc16
     
  2. Winged Scapula

    Winged Scapula Cougariffic!
    Staff Member Administrator Physician Faculty Lifetime Donor Verified Expert Verified Account 15+ Year Member

    Joined:
    Apr 9, 2000
    Messages:
    38,787
    Likes Received:
    27,127
    Status:
    Attending Physician
    Endometriosis would certainly be on the differential diagnosis given the limited information you've given me. Sometimes the best way to ascertain the cause of a problem, when all non-invasive techniques have been used, is to simply take a look.

    Not being the physician in question, I (nor anyone else) cannot speculate on his exact reasons for doing a laparoscopic exploration of the abdomen but it is an accepted diagnostic and treatment tool in certain conditions.
     
  3. Vasiley Zaitsev

    Vasiley Zaitsev Senior Member
    10+ Year Member

    Joined:
    Mar 5, 2001
    Messages:
    220
    Likes Received:
    0
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Kimberli Cox:
    <strong>Endometriosis would certainly be on the differential diagnosis given the limited information you've given me. Sometimes the best way to ascertain the cause of a problem, when all non-invasive techniques have been used, is to simply take a look.

    Not being the physician in question, I (nor anyone else) cannot speculate on his exact reasons for doing a laparoscopic exploration of the abdomen but it is an accepted diagnostic and treatment tool in certain conditions.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Thanks Kim..

    but what would some of those conditions (under which it is an accepted diag and trt tool) be?

    owcc16
     
  4. navs

    navs Member
    10+ Year Member

    Joined:
    Oct 16, 2001
    Messages:
    98
    Likes Received:
    1
    Hi owl,

    There are numerous OB/GYN indications for a diag. lap.

    Here are just a few that I could remember of the top of my head:

    1. Endometriosis
    2. Fibroids
    3. Ectopic preg.
    4. Ovarian cyst
    5. CA ovary

    This is just from memory, so I am sure I am missing a ton more!!

    Pretty much anything to look at: the uterus from the outside, the ovaries, or the adnexal tissue.

    Hope this helps.
     
  5. Vasiley Zaitsev

    Vasiley Zaitsev Senior Member
    10+ Year Member

    Joined:
    Mar 5, 2001
    Messages:
    220
    Likes Received:
    0
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by navs:
    <strong>Hi owl,

    There are numerous OB/GYN indications for a diag. lap.

    Here are just a few that I could remember of the top of my head:

    1. Endometriosis
    2. Fibroids
    3. Ectopic preg.
    4. Ovarian cyst
    5. CA ovary

    This is just from memory, so I am sure I am missing a ton more!!

    Pretty much anything to look at: the uterus from the outside, the ovaries, or the adnexal tissue.

    Hope this helps.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">thanks..I know it's not a preg, but everything else helps.

    BTW...

    this is realyl embarassing, but I'm having a colonscopy on monday..looking for cancer, among other things. I'm scared ****less. How bad is the procedure? no laughing pls.. :(

    owcc16
     
  6. Mindy

    Mindy Senior Member
    10+ Year Member

    Joined:
    Jun 10, 2001
    Messages:
    475
    Likes Received:
    20
    Ugghhh... doesn't sound like fun :( Most people I know that have been scoped have reported that it is embarrassing rather than truly physically uncomfortable. I wish you well and hope everything's okay.

    Mindy
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  7. Winged Scapula

    Winged Scapula Cougariffic!
    Staff Member Administrator Physician Faculty Lifetime Donor Verified Expert Verified Account 15+ Year Member

    Joined:
    Apr 9, 2000
    Messages:
    38,787
    Likes Received:
    27,127
    Status:
    Attending Physician
    Actually most patients are somewhat uncomfortable (not uncommon to hear a fair bit of moaning and groaning) DURING the procedure but thanks to sedation provided usually remember little of the event. Embarassing yes, but if there is a question of CR CA having a look is the best way to go.

    Best of luck to you...
     
  8. navs

    navs Member
    10+ Year Member

    Joined:
    Oct 16, 2001
    Messages:
    98
    Likes Received:
    1
    Hey owl,

    I would figure it would be a little uncomfortable, as u could imagine, physically.

    But with the sedation they give I wouldn't be too scared!!

    Good luck.
     
  9. Kadyra

    Kadyra Will drive for music.
    7+ Year Member

    Joined:
    Nov 22, 2001
    Messages:
    836
    Likes Received:
    0
    Status:
    Medical Student
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by owcc16:
    <strong>17 yr old girl..history of heavy bleeeds (every other month), and severe cramping. The doc wants a lap. Why would a doc want to do this? Endometriosis? Or what? I'm really stupid when it comes to OB/GYN things. </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I had this exact procedure done when I was 19. I had a history of extreme abdominal cramping/pain but nothing more specific than that. I was referred to an OB/GYN guy (evil man) and he did a laproscopy looking for endometriosis and a variety of other female problems. He didn't find anything and my pain continued. I went to a general surgeon who did another laproscopy and discovered I had a smouldering appendicitis.

    So, you're on the right track with your thinking. Kim Cox and the others have given you a nice list of what other things the doc could be looking for. I'm just telling you to be cautious, since the problem might not be what you think it is. What can I say? I'm paranoid ever since I was walking around with appendicitis for 8 months and a surgeon missed it <img border="0" title="" alt="[Wink]" src="wink.gif" />
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  10. Vasiley Zaitsev

    Vasiley Zaitsev Senior Member
    10+ Year Member

    Joined:
    Mar 5, 2001
    Messages:
    220
    Likes Received:
    0
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Kadyra:
    <strong> </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by owcc16:
    <strong>17 yr old girl..history of heavy bleeeds (every other month), and severe cramping. The doc wants a lap. Why would a doc want to do this? Endometriosis? Or what? I'm really stupid when it comes to OB/GYN things. </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I had this exact procedure done when I was 19. I had a history of extreme abdominal cramping/pain but nothing more specific than that. I was referred to an OB/GYN guy (evil man) and he did a laproscopy looking for endometriosis and a variety of other female problems. He didn't find anything and my pain continued. I went to a general surgeon who did another laproscopy and discovered I had a smouldering appendicitis.

    So, you're on the right track with your thinking. Kim Cox and the others have given you a nice list of what other things the doc could be looking for. I'm just telling you to be cautious, since the problem might not be what you think it is. What can I say? I'm paranoid ever since I was walking around with appendicitis for 8 months and a surgeon missed it <img border="0" title="" alt="[Wink]" src="wink.gif" /> </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">thanks...I'm not the one having a lap, I'm a guy. haha..that's a girlfriend of mine....

    I'm the colonoscopy cuz..yikes!

    owcc16
     
  11. Voxel

    Moderator Emeritus 7+ Year Member

    Joined:
    Nov 5, 2001
    Messages:
    658
    Likes Received:
    2
    A smoldering appendicitis for 8 months? The natural history of that disease is usually much shorter.

    But I digress... If this is a true Ob/Gyn problem, they should do pelvic (transvaginal) ultrasound to look for fibriods, ovarian cysts/cancer, endometriosis, ectopic pregnancy, etc. If they find that this is a case of fibriods causing the problem, interventional radiologists are doing uterine fibriod embolization. They give you local anesthesia so it will not be painful. Then, they make a small puncture in the femoral artery (thigh)and thread a catheter to the artery feeding the fibriod(s) and then they inject coils to cut off that blood supply. In most cases, the fibriods shrink and the pelvic pain and bleeding goes away. No need for hysterectomy (especially if you want a family) or living with the pain and bleeding anymore!
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  12. Kadyra

    Kadyra Will drive for music.
    7+ Year Member

    Joined:
    Nov 22, 2001
    Messages:
    836
    Likes Received:
    0
    Status:
    Medical Student
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Voxel:
    <strong>An smoldering appendicitis for 8 months? The natural history of that disease is usually much shorter.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Yeah. It happens. It didn't burst, but it was infected and nasty and obviously elongated according to the surgeon who removed it. They missed it for that long because my white count never rose and abdominal pain is sometimes kind of nonspecific. I still like to talk smack about the gynecologist who was actually examining my large intestine (as stated in his notes from surgery) and missed it. I guess that could happen, too though. But jeez! I still don't feel any better about it.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  13. navs

    navs Member
    10+ Year Member

    Joined:
    Oct 16, 2001
    Messages:
    98
    Likes Received:
    1
    Hi Voxel,

    Yeah ur right they could do that, but just because ur a future radio. guy doesn't mean it is the ONLY way to handle this case.

    I believe MOST OB/GYN would still like to try drugs before going to an interventional approach (Endometriosis).

    But good thinking!!
     
  14. Billie

    Billie An Oldie but a Goodie...
    10+ Year Member

    Joined:
    Nov 30, 1998
    Messages:
    348
    Likes Received:
    0
    As one who has had a colonoscopy I can attest to the fact that it actually is not that bad. You are sedated and do not remember the procedure. I told my gastroenterologist that I wanted a case of the sedation drugs to take home as I thought it was fabulous!

    This was years ago, long before I even thought of going to med school, though I was interested in medicine even then. Because of this, he let me look through the scope twice while he was doing the procedure. Luckily I do remeber that part of the procedure as I thought it was a big thrill to be able to see that! So 2 memories, but no memory of the discomfort or embarrasment! :D
     
  15. navs

    navs Member
    10+ Year Member

    Joined:
    Oct 16, 2001
    Messages:
    98
    Likes Received:
    1
    Voxel,

    My bad, I looked at ur post again, I guess u were talking about interventional approaches for a fibroid.

    In that case ur idea is a sounds like a great alternative for women still wanting to complete a family!!
     
  16. Vasiley Zaitsev

    Vasiley Zaitsev Senior Member
    10+ Year Member

    Joined:
    Mar 5, 2001
    Messages:
    220
    Likes Received:
    0
    Got my colonscopy...sweet drugs, so it wasn't that bad..

    however, teh doc biopsied a growth......now I'm freaking out. I'm only 19, so hwo could I have cancer in my colon!?

    owcc16
     
  17. Voxel

    Moderator Emeritus 7+ Year Member

    Joined:
    Nov 5, 2001
    Messages:
    658
    Likes Received:
    2
    If you are talking about polyps, just remember there are many different types of polyps with little to no cancerous potential. He most likely biopsied a hyperplastic polyp which does not have any malignant potential. Just ask him what he found and if there is any risk of cancer. There are some syndromes which predispose the colon to many polyps and colon cancer, but these are much rarer than hyperplastic polyps. So that's why one needs to know how many polyps were seen and biopsied and what the pathology report says.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  18. Vasiley Zaitsev

    Vasiley Zaitsev Senior Member
    10+ Year Member

    Joined:
    Mar 5, 2001
    Messages:
    220
    Likes Received:
    0
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Voxel:
    <strong>If you are talking about polyps, just remember there are many different types of polyps with little to no cancerous potential. He most likely biopsied a hyperplastic polyp which does not have any malignant potential. Just ask him what he found and if there is any risk of cancer. There are some syndromes which predispose the colon to many polyps and colon cancer, but these are much rarer than hyperplastic polyps. So that's why one needs to know how many polyps were seen and biopsied and what the pathology report says.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">tenks voxel..he said the report will be in within a few days. Thing I don't understand, is that he already scheduled another colonoscopy for 3-4 wks from now..

    owcc16
     

Share This Page