Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Discussion:
Discuss the questions that would be important to include when interviewing a patient with this issue
One important question that would be important to ask this patient is the location of the abdominal pain. The location of the abdominal pain is important, as it can help narrow your differential diagnosis. For example, diffuse abdominal pain may represent gastroenteritis, whereas localized right lower quadrant pain is classic for but not limited to appendicitis (Shian & Larson, 2018). Another important question involves asking her to describe more of the pain in terms of things such as the onset, characteristics, severity, aggravating factors, or any other thing that makes the pain better. The purpose of asking these questions is to gather crucial subjective data from the patient that can lead to possible differential diagnosis and help the healthcare team create a plan that will address her concerns and promote health. Also, it is of great importance to ask the patient about her last pelvic exam and Pap test. Knowing this information is important to know if the patient has previously been diagnosed with gynecologic-related complications, and may also help give clues to the cause of the discomfort and pain she is experiencing.
Describe the clinical findings that may be present in a patient with this issue
There are various clinical findings that may present in patients with pelvic pain. Common symptoms include the following (Gopchade, 2018).
i. Lower abdominal pain or crumps before or during periods
ii. Feeling pain during or after sex
iii. Painful ovulation
iv. Constipation or diarrhea
v. Blood seen with bowel movements
vi. Low back pain
vii. Painful urination
viii. Bloating or gas
Are there any diagnostic studies that should be ordered on this patient? Why?
Various diagnostic studies that should be ordered on this patient include the following.
Urine pregnancy test – The patient menstrual period was one month ago and she is currently sexually active with no form of birth control. Besides, she reports symptoms of nausea, vomiting, and pelvic pain, all which suggest pregnancy.
Pap test-thin test with HPV testing – Pap test should be done with HPV testing because her lap pap test, which was done three years ago, showed abnormal cells in the tissue that lines the outer part of the cervix.
Urinary dipstick – This would be important to help rule out a urinary tract infection (UTI).
Pelvic ultrasound – An ultrasound is important to evaluate a possible pelvic mass, the size of the uterus and ovaries, to confirm the location of a pregnancy, or to rule out an inflammatory or infectious process.
HIV and RPR – Both tests should be done as part of the STI screen. RPR is important to rule out syphilis.
List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
Cervicitis – The condition is mostly caused by chlamydia or gonorrhea, and may present with lower abdominal pain and vaginal discharge.
Urinary tract infection – UTIs usually presents with symptoms such as dysuria and urinary frequency. Besides, UTIs may present with lower abdominal pain.
Vaginitis – Bacterial vaginosis may presents with symptoms such as vaginal discharge, vaginal itching with thick, and white discharge.
Primary diagnosis – Ectopic pregnancy – The patient is sexually active and is not using any form of contraceptive. Ectopic pregnancy is characterized by bright or dark red discharge, as well as pelvic pain and vaginal bleeding. Besides, the patient reports symptoms of missed period, nausea, and breast tenderness.
Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.
The first management plan for this patient is to prescribe pain relieving medications such as aspirin, Ibuprofen or acetaminophen to provide partial relief from her pelvic pain. The pain relieving medications should be accompanied by antidepressants such as amitriptyline to help improve her pain as well as provide antidepressant effects. Also, it would be important to encourage her to use protections (condom) every time she has sex to help prevent sexually transmitted diseases. Physical therapy such as stretching exercises, massage and other relaxation techniques would also help improve her pain (Mayo Clinic, 2021). The patient needs to be referred to a physical therapists to help her develop coping strategies for the pain and a psychiatrist to help her cope with possible intimate partner violence.
Reference
Gopchade, C. A. (2018). Pelvic Inflammatory Disease in Women of Child Bearing age Group: A Prospective Study.
Mayo Clinic (July 17, 2021). Chronic Pelvic Pain in Women. mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371
Shian, B., & Larson, S. T. (2018). Abdominal wall pain: clinical evaluation, differential diagnosis, and treatment. American family physician, 98(7), 429-436.
