Repro- Case Study : Woman with Abdominal Pain-PID

CHIEF CONCERN: Vomiting and abdominal pain

INSTRUCTIONS
Purpose of Project: Given the case study assigned, examine specific pathology and symptomatology of the disease or disorder. Analyze information from history, physical and diagnostic tests as appropriate to discuss the questions of the case. This assignment address all four course objectives.

GRADING CRITERIA

20 points: Summary of the case study is presented in a clear, concise and well organized manner. Only pertinent information from the case study is presented.

50 points: Questions related to the case study are discussed fully. Pathophysiology and information presented is accurate.

15 points: Presentation of the discussion was clear, well organized, and easily understood. HIPPA guidelines were followed and patient data was not identifiable.

10 points: Audiovisuals used in the presentation were appropriate, professional, and added to the understanding of the case study. AV used appropriate and readable font /size, no paragraph or long sentences, were clear, easily seen and well organized. Images were referenced and all references used were appropriate.
Any professional presentation format is acceptable. The emphasis is on the content; however, you are graded on your professionalism of the presentation.

FOCUS is on answering the questions accompanying the case study and NOT to discuss ALL details of the case.
HISTORY OF PRESENTING ILLNESS:

Cathy, a 20 y/o college sophomore, visits the student health center complaining of nausea, vomiting, and extreme abdominal pain. She says the pain came on suddenly after a meal, so she is concerned about food poisoning. During the patient history, Cathy discloses that she is sexually active and has more than 10 sexual partners per year. She uses oral contraceptives as her primary method of birth control and does not rely on her partners to use condoms.

PAST MEDIAL HISTORY:

Vulvovaginitis, cervicitis, and numerous STDs (chlamydia, syphilis, and genital herpes)

SURGICAL HISTORY: Appendectomy as a child

SOCIAL HISTORY (SH): Denies smoking, social alcohol use and occasional marijuana use.

Parents divorced, lives w/mother when not at college.

FAMILY HISTORY (FH): No significant family history

ALLERGIES: NKDA

MEDICATIONS: Does not take any regular medications.

REVIEW OF SYSTEM:

Recently she has noticed a whitish vaginal discharge with a strong odor that has increased in quantity over the past week.

Gen: Anxious, appears stated age, well developed and nourished

Gynecological Examination:

Palpation of the abdomen reveals abdominal guarding, rebound tenderness, and an enlarged, painful uterus.

External genitalia appear slightly edematous but are otherwise normal.

Vagina and the cervix are slightly inflamed, and a purulent discharge is noted.

Movement of the cervix creates abdominal discomfort, and the rectovaginal examination confirms the uterine enlargement noted upon palpation.

All other systems are negative.

DIAGNOSTIC STUDIES:

Blood tests reveal leukocytosis but no HIV antibodies.

Pap smear: negative

Cultures: positive for Chlamydia and Neisseria gonorrhoeae.

Pregnancy test (HCG assay): negative.

Ultrasound of pelvic cavity: Enlargement of the uterus and uterine tubes without pregnancy.

ASSESSMENT / IMPRESSION:

Based on these test results, Cathy is diagnosed with pelvic inflammatory disease (PID).

PLAN:

Cathy is prescribed a combination of antibiotics and bed rest for 10 days.

During this treatment period, she is told to refrain from intercourse.

Notify her partners about her condition and to encourage them to seek treatment.
Return for a follow-up after completing her medication to ensure that infections are controlled.

Encouraged to insist on condom use to minimize her chances of contracting STDs in the future. Because of her history of numerous STDs, she is warned that she is at increased risk for infertility.

QUESTIONS:

1. Which of Cathy?s signs and symptoms are common to both PID and appendicitis?

Why is it important to rule out appendicitis?

2. What signs and symptoms support the diagnosis of PID?

3. Suppose Cathy says that in spite of her ?wildness? in college, she just wants to ?get it all out of my system, and then settle down and have kids after I graduate.? What is the relevance of her present behavior to her family plans?

4. What is the relationship between PID and STDs?

5. Why do Cathy?s signs and symptoms rule out cervical, endometrial, and ovarian cancer?