Doctors tend to over look things that sometimes a nuse can see

[wrightLPN]

So I know we are all nurse and we cannot diagnose an illness or disease. But I'm not asking for either of these. I am asking for advice. Here is the dilemma:

24 y/o female, with 2 children. First pregnancy went fine. Sometime between her first and second child she became ill. Had been hospitalize several times for extremely high bp (140/189) and excessive vomiting.

After she had gotten pregnant with her second child she was hospitalized about 2 times a month. Each time for hbp, nausea and vomiting. All signs point to preeclamsia (which was her diagnosis) They told her to terminate her pregnancy. She however did not, and during her pregnancy got extremely ill yet again in her 2rd trimester and they then did surgery and took out her gallbladder.

She eventually had a healthy baby. The labor process was bad. Her bp went threw the roof and she projectile vomited across the room. The thought she might die. She was eventually better and was sent home. But the illness did not stop there. She spends just about 1 week every month in the hospital. They ruled out mental illness. It gets so bad she has to be tube fed. Now they want to take out her pancreas. And they are saying that the reason she has hbp is due to stomach ulcers. They gave her pain meds and a nitroglycerin due to her hbp.

I google and googled and I cannot find a correlation with these events. The doctors are dumbfound. They told her they cannot figure out why this keeps happening.

Idk, they are pretty much saying she has some kind of mystery disease that is causing all these problems.

She does not have any std, or blood born pathogen.

Has anyone ever came across such a thing during the years they have worked? And if so, what sort of diagnosis have you heard of?

[Blackheartednurse]

Well I definitely agree with you..just because doctors have more schooling than nurses do that doesnt exclude them from making wrong judgement calls or being clueless about what is wrong with their patients..docs are human too and often their diagnose based on a trial and errror method...I dont envy their job as I think of their job as a game of puzzles,and they play with different piece and spend long hours figuring out how to put the whole picture together...that is my view on doctors,of course there are awsome docs as well as awsome nurse,just right behind them there are bad apples docs and bad apples nurse like in any profession and then rarely you can come across a really devoted,brilliant,passionate MD that can diagnose rare syndroms,not too many of those doc are out there,but I guarantee you some are hinding in the shadow of unrecognition and only patients know how awsome they trully are..to sum up I equate a nurse of many years of exprience behind her belt with an experienced doctor,you might not agree with me but I believe that a well-rounded,expert nurse can distinguish but cannot propose/suggest the medical diagnoses and her wits and capabilitied are often misunderstood by the eyes of the public and the rest of the medical world..anyway as always I say we nurses are the eyes and ears of MDs and we are rather their partners in crime than their devoted servants,LOL

[norman1]

i hate to be "that guy", but considering the title of your thread, you really should spell the word "nurse" correctly.

[ktwlpn, LPN]

Norman! Shame on ya...you beat me to it...

[RedhairedNurse, BSN, RN]

I would get 2nd, 3rd, OPINIONS if it were me or someone I knew!!

My husband use to projectile vomit and he had a severe hiatel hernia and the food wasn't getting to his stomach at all. He had a very heavy object that fell on his chest that caused this injury. I hope she gets okay.

[lucyapple]

Hmmmm...possible disorders to consider:

pituitary tumor

renal vascular disease

abnormality of adrenal glands

hyperthyroidism

hyperparathyroidism

lead poisoning

hyperaldosteronism

excessive black licorice consumption

to name a few......

[questionsforall]

I always think neurological when I think about projectile vomiting, but the hiatal hernia that was mentioned sounded good too.

[RhiaRN75, RN]

Was the gallbladder so bad she developed pancreatitis and then a necrotic pancreas/infarct? Did eclampsia alone cause pancreatitis? Or was the pancreatitis subacute and the first thing that happened early on?

Is the nitro solely for the HTN, or are they thinking there is a bowel/pancreatic infarct? Say, for whatever reason:

1. pt developed pancreatitis in early pregnancy, it was first though to be hyperemesis gravidarum

2. she didn't get better, eventually enzymes became abnormal, so it was though to be eclampsia and then gallbladder

3. chole didn't help, pt still sick and eclamptic

4. eclampsia and pancreatitis cause vascular and inflammatory changes, along w/ protein shift, and each condidtion exacerbates the other

5. pt goes into labor and the stress of labor along with subacute/chronic pancreatitis is just another straw on the camel's back, so to speak

6. post-delivery WBC is elevated, but not abnormal in and of its self- labor is an inflammatory process.... so the ?unknown subacute pancreatitis remains masked

7. microvascular changes eventually cause pancreatic necrosis/infarct, which may ironically respond to nitro as well as the HTN

8. now they want to take out the pancreas.

It makes my hands itch to hold the chart! Neurological does make sense- I had a pt who had a bleed post-delivery present in a similiar manner, but it was over the course of hours, not weeks. Luckyapple also has good ideas, I'd want to see all the endocrine tests as well, and a head to pelvis CT/MRI.

I've also seen some pretty wicked vomiting from pancreatitis and/or pancreatic duct obstruction.

Things not mentioned... IDK- long shots, but what about carcinoid syndrome?

Or maybe some autoimmune hepatitis or primary biliary cirrosis? You say 'mental illness was ruled out', making me wonder that maybe she was behaving odd at some point? Liver disease could cause all the symptoms of 'alcoholic cirrosis' without the pt having ever had a drop to drink. Hepatic encephalopathy= confusion, plus portal HTN can cause all kinds of bad things. Did her liver enzymes improve after the chole?

MEN I or II?

Pheochromocytoma?

Zollinger-Ellison syndrome?

Some other neuro/endocrine/GI-oma?

CSF leak w/ intercranial hypotension? Some are spontaneous, some from trauma, and a few from spinals- did she have anything happen between pregnacies? Or maybe she had a bad spinal that never healed correctly after the first delivery and it didn't cause a problem until pressure changes from pregnancy #2?

Autoimmune? Lupus? Vascularitis?

Then there are unlimited genetic metobolism-issue syndromes.

I'm so sorry your pt is going through all of this- I hope she pulls through and has a good outcome!

[wrightLPN]

First of all, thanks to those of you who had intelligent input. As for the others who want to nit pick at a serious subject- get a life. It was a typo get over yourself!

Ok, so to update. I r/o mental illness because at first the doctors were looking at eating disorders. This woman used to be 125lbs and after her second child and throughout the illness she has went down to 110lbs and now is currently at around 155lbs. She is about 5'4.

Anyhow, since my first post. This pt. has been re-admitted to the hospital about 2x's a month. She is seeing specilist. They are wanting to get a medical team together to try and figure out her illness. But she does not have insurance-go figure. So anyway, She has recently found out that she has a hiatal hernia. The doctors have also removed polyps from her colon. Her potassium levels were at a deathly, she was hospitalized over it. Every time she eats anything with alot of fat content she is hospitalized by the next day. I will keep those of you who are interested updated. Thus far, nothing promising...

btw- she is not just a patient, she is my family

[traumaRUs, MSN, APRN]

Per our terms of service, we can't provide medical advice. I agree with above posters - please cont to seek another medical opinion. We wish you the best.