– 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.
Discuss the questions that would be important to include when interviewing a patient with this issue
Kayla is a 16-year old female who presents with complaints of pelvic pain and previously diagnosed with pelvic inflammatory disease. When interviewing an adolescent presenting with these symptoms, it is crucial to ask questions related to social history in privacy (Smorgick & As-Sanie, 2018). Such questions should cover the home situation, school and other activities and potentially sensitive domains of substance abuse, sexual activity, depression, eating behaviors, and safety. In particular, it would be important to ask whether she had experienced any sexual assault in school or at home and if any, whether she noticed any bleeding during the assault. Another important question to ask is whether she has noticed any discharge and the color of the discharge. A normal vaginal discharge is clear and usually odorless. However, changes in the color, amount, or smell of the vaginal discharge may indicate a problem. For example, a white discharge that is clumpy and looks similar to cottage cheese may be a sign of yeast infection, which may cause symptoms such as burning on urination or vaginal itching. Similarly, a yellow/green discharge can be a sign of STIs or bacterial infection, and which can cause pain in the pelvic (Stratton, 2019).
Describe the clinical findings that may be present in a patient with this issue
The most common symptom of pelvic inflammatory disease is pain or tenderness in the stomach or lower abdomen. Other symptoms include abnormal vaginal discharge, usually yellow or green with an unusual odor, fever, tiredness, pain and bleeding during sex, burning sensation upon urination, and pain in the upper abdomen. Other clinical findings include tenderness of fallopian tubes and ovaries and tenderness of the cervix.
Are there any diagnostic studies that should be ordered on this patient? Why?
There are several diagnostic studies that should be ordered on this patient. A pelvic exam should be ordered first to examine her reproductive organs and look for signs of infection. Vaginal culture can also be taken to check possible bacteria, while the urine test may help to rule out urinary tract infection, which causes similar pelvic pain. Also, the doctor could order for an ultrasound to get clearer images of the reproductive system or CT scans to help detect abnormal structures or growth. Another diagnostic study to be ordered is laparoscopy to view the pelvic organs and check for abnormal tissues or signs of infection.
List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each
Primary diagnosis – Pelvic inflammatory disease – The patient is sexually active and admits to having multiple sexual partners without using a condom. Besides, she has admitted pain and tenderness in the lower abdomen.
Urinary tract infection – Having multiple sexual partners and sometimes without a condom could have caused urinary tract infection.
Ovarian torsion – The patient has come with symptoms of severe pelvic pain that she rates as 10 out of 10.
Endometriosis – The patient admits abdominal cramping and pain in the lower abdomen and pelvis.
Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.
The main goal in the management plan of this patient is to alleviate symptoms and improve her quality of life. The patient needs some pain relievers such as ibuprofen or acetaminophen to provide partial relief from her pelvic pain. The patient may also need some antibiotics to help in case of any infection. In addition, the patient may be prescribed antidepressants to help improve the pelvic pain. Also, the patient needs to be educated about the benefits of practicing safe sex, particularly using condoms every time she has sex and to limit the number of sexual partners (Sanfilippo et al., 2019). She should also be advised to make an appointment for regular screening of sexually transmitted diseases and request her partners to be also tested. Also, the patient can be referred to physical therapists to help her develop coping strategies for the pain. Such include stretching exercises, massage, and other relaxation techniques.
Stratton, P. (2019). Evaluation of acute pelvic pain in non-pregnant adult women. UpToDate. Updated May, 9.
Sanfilippo, J. S., Smith, J. P., & Solnik, M. J. (2019). Chronic pelvic pain and endometriosis. In Sanfilippo’s Textbook of Pediatric and Adolescent GynecologySecond Edition (pp. 214-228). CRC Press.
Smorgick, N., & As-Sanie, S. (2018, March). Pelvic pain in adolescents. In Seminars in reproductive medicine (Vol. 36, No. 02, pp. 116-122). Thieme Medical Publishers.