Diagnosis of a Pelvic Inflammatory Disease Essay
Diagnosis of a Pelvic Inflammatory Disease Essay
Diagnosis of a Pelvic Inflammatory Disease Essay
Why did you choose ectopic pregnancy as the primary dx and not ovarian torsion?
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Attached you will see my discussion where I chose Ectopic Pregnancy as the primary diagnosis.Diagnosis of a Pelvic Inflammatory Disease Essay
Important questions to include when interviewing a patient with this issue include:
• Does your pelvic pain turn worse or better getting involved in an activity?
• Any improvement in your pelvic pain since it started?
• How can you describe the kind of pain you are experiencing?
• Have you ever experienced pelvic pain before?
• Does the pain seem to come from another region, if so, where?
• Have you recently visited a clinic; if so, what medications were you prescribed?
• What are the events surrounding the pelvic pain?
• Is your pelvic pain superficial or deep inside?
• How severe is the pain on a scale of 0-10?
• Do you have bleeding between your menses?
• Do you have pain with intercourse?
• How long do your periods last?
• Are your breasts tender?
• Have you been diagnosed with a pelvic inflammatory disease?
• Is there a chance your pregnant now?
• Have you ever been pregnant?
• Has there been any trauma to the pelvis?
• Also, are there any urinary symptoms?Diagnosis of a Pelvic Inflammatory Disease Essay
The clinical findings that may be present in a patient with this issue
Clinical results such as missed menstrual cycles, abdominal pain presented with palpation, tachycardia, vaginal discharge, vomiting, and acute pelvic pain would be shown when there is tubal pregnancy (Michigami et al., 2020). According to Schuiling & Likis (2016), abdominal, vaginal discharge, pelvic/LLQ pain, and amenorrhea are typical clinical symptoms for ectopic pregnancy.
Diagnostic studies ordered on this patient
A doctor would perform these diagnostic tests based on the recorded client history. They include – plasma human chorionic gonadotropin (HCG), liver function test (LFT), blood type and screen, obstetric ultrasound, progesterone, urinalysis (UA), and complete blood count (CBC) (Schuiling & Likis, 2016). A physician will be able to rule out some differential diagnoses and other complications. For instance, pelvic pain/bleeding from endometriosis, or low H&H from blood loss (Michigami et al., 2020).
The primary diagnosis and three differential diagnoses for this patient
Ectopic pregnancy could be the primary diagnosis because the client said she engaged in unprotected sexual intercourse. Ovarian cyst, spontaneous abortion, and endometriosis are the other three differential diagnoses (Schuiling & Likis, 2016). Ultrasound test results confirmed the presence of ectopic pregnancy. The type of differential diagnosis to perform as determined by the test performed and the client’s present symptoms. The appearance of dyspareunia, irregular menses, and unilateral pelvic pain suggested ovarian cyst (Schuiling & Likis, 2016). Symptoms like dysmenorrhea, irregular vaginal or uterine bleeding, and chronic intermittent pelvic would indicate endometriosis. Lastly, spontaneous abortion presents with pelvic pain, sometimes back pain, and vaginal discharge.
The management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups Diagnosis of a Pelvic Inflammatory Disease Essay
My management plan for this client would involve monitoring for signs and symptoms of ectopic mass rupture, maintaining her hemodynamic levels, and determining if the patient requires surgical or medication intervention depending on her condition level. Surgical alternatives available are either salpingectomy or salpingostomy. Salpingectomy is the removal of the oviduct, while salpingostomy creates an opening in the oviduct (Shatkin Hamish et al., 2020). Methotrexate drugs would be prescribed in she does not go for a surgery. According to Shatkin Hamish et al. (2020), medication is advantageous over the surgical method since the patient will terminate her early pregnancy stage using Methotrexate (MTX) dosage to stop cells from dividing and multiplying without undergoing an excruciating pain. After two days, I would follow up with OB/GYN if treated with MTX for repeat bloodwork, ultrasound, and plasma HCG. I will advise the patient to go for ER in case the symptoms worsen.
Pelvic inflammatory disease is an infection which causes wide variety of infection from upper to lower genital tract.(1) It ascends from cervix or vagina to peritoneal cavity include endometritis, salpingitis, parametritis, oophoritis, tuboovarian abscess and pelvic peritonitis. (2,3) PID is a major problem in public health consequences because it is related to fallopian tube inflammation which can lead to infertility as a final complication.(1) PID is polymicrobial disease, so some sexually transmitted microorganisms are associated with PID. These are Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoea, and bacterial vaginosis, predominantly anaerobes. (4, 7) PID can be prevent by regular screening for Chlamydia infection and appropriate treatment of it. (4) There is no single diagnosis or finding that can do specific diagnosis of PID. The diagnosis is based on the result of pelvic organ tenderness. Mild-to-moderate PID patients are treat as out patient which include tolerated antibiotic regimens against common microorganism in PID Clinically severe PID treatment done as hospitalization of the patient. (11) Sexually active women especially at the reproductive age and under the age of 25, are at the highest risk for acquiring this disease through sexually transmitted bacteria. The intrauterine devices (IUDs) are also increased risk in women who have this device in their uterus for contraception.(6)Diagnosis of a Pelvic Inflammatory Disease Essay
Pic: The female anatomy (6)
Differential diagnosis:
In case of PID the clinician should concern about differential diagnosis before confirm the diagnosis.
The differential diagnosis PID of can be as follows (3):
Ectopic pregnancy
Endometritis
Salpingitis(8)
Cervicitis (8)
Ovarian cyst torsion, rapture or malignancy
UTI
Appendicitis
Clinical Diagnosis of PID:
Clinical diagnosis of PID is based on the combination of patients clinical history, physical examination and some laboratory studies.(2,5)
The following findings are important for diagnosis of PID:
Physical or general finding: Low grade temperature, lower abdominal pain, abnormal intermenstrual bleeding or metrorrhagia, abnormal cervical discharge, postcoital pain and bleeding, urinary frequency, low back pain, nausea and vomiting.(5,8)
Bimanual pelvic examination: Cervical and uterine motion tenderness or adnexal tenderness should present for confirming the diagnosis of PID.(10).
Laboratory finding: Leucocytosis more than 10 x 109 WBC/L , elevated C-reactive protein, elevated ESR, Gram negative intracellular diplococcic on gram stain, and positive Chlamydia test.(5)Diagnosis of a Pelvic Inflammatory Disease Essay
Some definitive diagnosis: Endometrial biopsy for endometritis, transvaginal sonography or ultrasonography for pelvic or tubo-ovarian complex and the laparoscopic abnormalities associated with PID.(5)
Management
The PID management include short term and long term treatment. Short term treatment help to reduce or eliminate the sign symptom of patients. On the other hand long term treatment help to decrease the further complications.
Outpatient therapy: As aforementioned that mild-to-moderate PID patients are given treatment as out patient therapy (5)
Recommended Regimen:
ceftriaxone 250 mg im as one dose + doxycycline 100 mg orally 12 hourly for 14 days
or
Azithromycin 500 mg orally followed by 250 mg orally
daily for a total of 7 days Diagnosis of a Pelvic Inflammatory Disease Essay
+
metronidazole 400 mg orally 12 hourly for 14 days
Inpatient therapy: Clinically severe PID treatment done as hospitalization of the patient. (11)
Recommended Regimen(5):
Clindamycin 900 mg intravenously every 8 hours for 14 days
PLUS
Ceftriaxone 1g intravenously every 12 hours for 14 days
Alternative Regimens(12)
Cefoxitin 2 g intravenously every 6 hours for 14 days
OR
Cefotetan 2 g intravenously every 12 hours for 14 days
PLUS
Doxycycline 100 mg orally or intravenously every 12 for 14 days
hours
OR
Ampicillin/sulbactam 3 g intravenously every 6 hours for 14 days
PLUS
Doxycycline 100 mg orally or intravenously every 12
hours for 14 days
Indications for hospitalisation
If the patients are required intravenous therapy for serious clinical condition, then patient should be hospitalised. The following patients should be hospitalised, clinically severe patients, pregnant woman with PID, surgical emergency such as appendicitis, ectopic pregnancy, failure of out patient therapy and immunodeficiency patient. (5)
Removal of IUCD
The intrauterine devices (IUDs) increased the risk of PID. So IUCD should remove if there is any clinical evidence of PID.(6)
Complication of PID:
Delay in diagnosis and treatment, or inadequate treatment increase the rate of complications.(13)Diagnosis of a Pelvic Inflammatory Disease Essay
The complications are (13):
Chronic lower abdominal pain
Ectopic pregnancy
Increased risk of PID in future
Tubo-ovarian abscess.
Infertility
The points should known to patients (5):
It can be acquired other than sexually transmitted and the partners also should be tested and treated for sexually transmitted infections. The nature of infection and complication should be known to patients and they should know the importance of follow up.
Contact tracing
Contact tracing is finding and notifying the person with the infection so they can have counselling, testing and treatment and it is important for prevention the long term health problem.(9)
Follow-up
Close follow up is necessary for prevention of complications.(5)
Prevention:
Prevention of STD is necessary to prevent PID. So early detection of any lower genital infections is necessary to prevent PID. (14) Cervical Chlamydial infection identification and treating can make smaller the incidence number of PID. (4) Finally, sex partners of women with PID should be examined and treated for gonococcal and Chlamydial infection for prevention the spread of STDs in the community.(14)Diagnosis of a Pelvic Inflammatory Disease Essay
There is no one test that can accurately diagnose pelvic inflammatory disease. Instead, your doctor will rely on a combination of findings from:
Your medical history. Your doctor will likely ask about your sexual habits, history of sexually transmitted infections and method of birth control.
Signs and symptoms. Tell your doctor about any symptoms you’re experiencing, even if they’re mild.
A pelvic exam. During the exam, your doctor will check your pelvic region for tenderness and swelling. Your doctor may also use cotton swabs to take fluid samples from your vagina and cervix. The samples will be tested at a lab for signs of infection and organisms such as gonorrhea and chlamydia.
Blood and urine tests. These tests may be used to test for pregnancy, HIV or other sexually transmitted infections, or to measure white blood cell counts or other markers of infection or inflammation.
Ultrasound. This test uses sound waves to create images of your reproductive organs.
If the diagnosis is still unclear, your doctor may recommend additional tests, such as:
Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.Diagnosis of a Pelvic Inflammatory Disease Essay
Endometrial biopsy. During this procedure, your doctor inserts a thin tube into the uterus to remove a small sample of endometrial tissue. The tissue is tested for signs of infection and inflammation.
More Information
Pelvic exam
Ultrasound
Urinalysis
Treatment
Prompt treatment with medicine can get rid of the infection that causes pelvic inflammatory disease. But there’s no way to reverse any scarring or damage to the reproductive tract that PID might have caused. Treatment for PID most often includes:
Antibiotics. Your doctor will prescribe a combination of antibiotics to start immediately. After receiving your lab test results, your doctor might adjust your prescription to better match what’s causing the infection. You’ll likely follow up with your doctor after three days to make sure the treatment is working. Be sure to take all of your medication, even if you start to feel better after a few days.
Treatment for your partner. To prevent reinfection with an STI, your sexual partner or partners should be examined and treated. Infected partners might not have any noticeable symptoms.
Temporary abstinence. Avoid sexual intercourse until treatment is completed and symptoms have resolved.
If you’re pregnant, seriously ill, have a suspected abscess or haven’t responded to oral medications, you might need hospitalization. You might receive intravenous antibiotics, followed by antibiotics you take by mouth.Diagnosis of a Pelvic Inflammatory Disease Essay
Surgery is rarely needed. However, if an abscess ruptures or threatens to rupture, your doctor might drain it. You might also need surgery if you don’t respond to antibiotic treatment or have a questionable diagnosis, such as when one or more of the signs or symptoms of PID are absent.
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Coping and support
Pelvic inflammatory disease can bring up difficult or stressful feelings. You may be dealing with the diagnosis of a sexually transmitted infection, possible infertility or chronic pain. To help you cope with the ups and downs of your diagnosis, consider these strategies:
Get treatment. PID is most often caused by a sexually transmitted infection. Finding out that you have an STI can be traumatic for you or your partner. Nevertheless, you and your partner should both seek immediate treatment to lessen the severity of PID and to prevent reinfection.Diagnosis of a Pelvic Inflammatory Disease Essay
Be prepared. If you’ve experienced more than one episode of pelvic inflammatory disease, you’re at greater risk of infertility. If you’ve been trying to get pregnant without success, make an appointment with your doctor for an infertility evaluation. Ask your doctor to explain the steps for infertility testing and treatment. Understanding the process may help reduce your anxiety.
Seek support. Although sexual health, infertility and chronic pain can be deeply personal issues, reach out to your partner, close family members or friends, or a professional for support. Many online support groups allow you to maintain your anonymity while you discuss your concerns.Diagnosis of a Pelvic Inflammatory Disease Essay