Pamela Flowers is a female patient who consults a doctor because of vaginal bleeding that is accompanied by pelvic pain. In addition to that, the woman experiences breast tenderness, cramps, and her mood alters without any reason. There is a possibility that her vaginal bleeding can be explained by a heavy period that is why the main issue under discussion will be pelvic pain that may be connected to gynecologic issues. To find out what is wrong, it will be advantageous to ask the patient the following questions:
- What is the normal duration of your periods? (It is vital to have some starting point to identify issues and anomalies).
- Are they often heavy or painful? (This information is needed for the identification of patient’s normal condition and allows finding out if the issue is acute or chronic).
- Does your pain worsen? When? (Different diagnoses can be considered).
- Do you have any problems during intercourse? (Different gynecologic problems can be considered).
- Do you experience breast tenderness? (It can be associated with periods or be a symptom of another health condition).
- Do you have any experience of unprotected sex? (There is a possibility of pregnancy and sexually transmitted diseases).
- Do you take any oral contraceptives? (The patient may have issues with pregnancy).
- Do you or your family members have a history of sexually transmitted diseases? (Maybe they were untreated).
- Have you recently had rough or painful intercourse? (Both pain and bleeding can be connected with it).
- Do you have headaches, problems with vision, hearing, or swallowing? (Maybe the patient experiences other health issues that can explain her symptoms).
- Do you experience nausea, diarrhea, chest pain, discomfort, muscle, or joint pain? (Maybe the patient experiences other health issues that can explain her symptoms).
Various clinical findings can present a patient with pelvic pain. For instance, a patient may have excessive vaginal bleeding, which can relate to gynecologic problems. This kind of pain and mood changes can also be associated with adenomyosis. Interstitial cystitis can be the main reason for pelvic pain as well. The presence of different gastrointestinal symptoms in addition to the discussed issue may present deflecting sigmoid adhesions. A patient may also reveal that they experience dysesthesia and vulvodynia (Singh, 2015). Then, one is likely to suffer from pudendal neuralgia. Associated tachycardia may be seen as a reaction to pain or as a separate symptom.
To provide Flowers with a diagnosis and treat her appropriately, it is vital to interview her regarding the peculiarities of her pain and health history. Then, a physical exam should be performed to check her pelvic region. A lot of attention should be paid to both abdomen and the woman’s organs. Lab tests will be required (NIH, 2016). A blood test will reveal general information about the patient’s condition while a urine test can be used to check if she is pregnant. Pelvic ultrasound or MRI will give medical staff an opportunity to find out if there is a problem with Flowers’ organs. A colonoscopy may be needed to assess the condition of her bowel.
Considering the woman’s condition, she may suffer from the following health issues:
- Endometriosis. Flowers experience pelvic pain during her period and it lasts for 24 hours already, which means that it may continue. She also has excessive bleeding that is not usual for her but it happens sometimes (Stoppler, 2016).
- Ovarian cysts. The patient has pelvic pain that worsens because of movement and is experienced during the period. In addition to that, she suffers from breast tenderness (Wilson, 2017).
- Spontaneous abortion. The woman has vaginal bleeding that is accompanied by cramps. In addition to that, she suffers from pain (Sepilian, 2017).
Regardless of these three differential diagnoses, the final one is an ectopic pregnancy. Flowers experience pelvic pain that varies in intensity because of movement. She has vaginal bleeding that can be compared to a heavy period. Moreover, she has tenderness in her breasts (Gaither, 2016).
To treat this patient, a healthcare professional should follow a particular management plan. First of all, one should assess her hemodynamic stability. Bleeding should be stopped so that further operations can be maintained. Flowers should be in a stable state and ready to receive follow-up care. Thus, it is critical to check her condition and ensure that no signs of impending ectopic-mass rupture are observed. Focusing on her state and test results, the healthcare professional should think of indications and contradictions to both medical and surgical treatment. Based on this evaluation, one may discuss the next steps of immediate treatment. In case of the necessity of surgical management, several options are possible.
For instance, Flowers may need salpingostomy or salpingectomy. Medical management, on the other hand, should be focused on the intake of methotrexate. Still, in this vary case, intramuscular injections of methotrexate are likely to be the most appropriate treatment option that should be tried initially because surgical interventions may lead to hemorrhage (Sepilian, 2016). The effectiveness of methotrexate may differ in various cases that is why the necessity to administrate single or multiple injections should be considered with the course of time.
References
Gaither, K. (2016). Ectopic pregnancy symptoms and when to call 911. Web.
NIH. (2016). How is pelvic pain diagnosed? Web.
Sepilian, V. (2016). Ectopic pregnancy treatment & management. Web.
Sepilian, V. (2017). Miscarriage. Web.
Singh, M. (2015). Chronic pelvic pain in women clinical presentation. Web.
Stoppler, M. (2016). Endometriosis symptoms, causes, treatments, and prognosis. Web.
Wilson, D. (2017). Ovarian cysts. Web.