A 23-year-old female patient came in for a consultation because of midline suprapubic abdominal pain that had lasted for five days and had moved to the left lower quadrant (LLQ) less than 24 hours ago. The pain increases when the patient stands up or moves. In addition to that, she experiences chills/sweating, reduced appetite, nausea, and dizziness. The woman has never been pregnant. Her last period was three weeks before the visit, and she has no abnormal vaginal bleeding or any issues associated with the urinary tract.
To provide the patient with an opportunity to improve her health condition, health care providers should ask her a set of questions that will allow diagnosing the patient properly. In the context of the presented case, it may be helpful to ask her the following:
- How can you describe your pain? (Different kinds of pain may indicate various pathogenic processes).
- Do you have any problems with urination? If yes, what are the problems? (Urinations complications can be revealed).
- Have you ever had vaginal discharge or bleeding? (The current problems may be the reoccurrence of previous diseases or a complication of previous conditions).
- How have you treated related issues? (If the patient has a history of similar health problems, future treatment can be based on her answer to this question).
- Do you experience any changes in the frequency of urination? (Issues with urinary tract can be revealed).
- Have you ever been pregnant? (The patient may have issues related to pregnancy).
- Are you taking any medications now? (They may cause the symptoms or hide some other symptoms).
- Have you had unprotected sex recently? (The patient may be pregnant or have a sexually transmitted disease).
- Do you have any diet/appetite changes? (Other health issues may be involved).
- Do you have any other complaints, such as headaches, swallowing problems, nausea, or diarrhea? (The patient may have other health problems).
The chief complaint of the patient is an LLQ abdominal pain. It may be a symptom of numerous conditions, including constipation and poisoning. It can also be associated with ectopic pregnancy. The main symptom of the pelvic inflammatory disease is often related to the LLQ abdominal pain, too (Morris, 2017). It may be caused by diverticulitis that often turns into sepsis if it is not treated as soon as possible. In addition to that, a patient with LLQ abdominal pain may suffer from endometriosis, but its intensity is usually dependent on the period (Payne, 2017). What is even more critical is that such a simple symptom as pain can indicate the development of a crucial problem that affects the entire organism and can hardly be treated; for example, it can be associated with colon cancer.
To identify the issue (out of those discussed above) that the patient is facing, health care providers should administer a range of diagnostic studies. First of all, different kinds of blood tests should be performed. They allow confirming or disconfirming that the patient is pregnant and that she has any infections or clotting issues. It can also be revealed if some organs function abnormally or if oxygen availability is not sufficient; also, there may be a lack of electrolytes. One more test should focus on urine because signs of certain bacteria can be found. Various imaging tests can be needed to reveal the condition of the patient’s organs (Mayo Clinic, 2017). For instance, X-ray, computerized tomography, or ultrasound can be administered.
Based on the patient’s tests and symptoms, several differential diagnoses can be considered:
- Pelvic inflammatory disease. The patient experiences chills. She suffers from pain in the LLQ of her abdomen.
- Ectopic pregnancy. Since The patient has not been pregnant, she might be unable to recognize this condition. Her pain and nausea can be the signs that reveal this problem (Healthwise, 2015).
- Diverticulitis. The patient suffers from pain in the LLQ of her abdomen. She also has nausea and vaginal discharge. In addition to that, the patient has no appetite, which is common for this problem (Weng, 2016).
Although these diagnoses seem to be suitable, the patient is more likely to suffer from sepsis that was probably caused by a certain abdominal infection. As a result, she has fever and experiences chills (Kim & Sullivan, 2017). She is in pain and does not eat properly. Moreover, she looks ill and feels dizzy. It is also important to take into consideration that the pain has lasted for five days and then moved.
The patient should receive sepsis therapy as soon as possible. First of all, her hemodynamic instability should be addressed. Four boluses of crystalloid fluids and vasopressors should be administered (Ramsdell, Smith, & Kerkhove, 2017). Antibiotic therapy should be provided. Then, the possibility of pregnancy should be ruled out upon additional tests. Finally, tomography and surgical consultation should be provided. Surgical drainage is needed to streamline the process of recovery. It is needless to say that hospital admission is required in this case. The patient should spend several days under the supervision of health care practitioners so that it can be ensured that no further complications occur or can be expected. Further, the patient should be educated regarding the prevention of sexually transmitted diseases and the necessity to consult medical staff in case abdominal pain lasts for a long time. Additional consultations after the discharge should be recommended.
References
Healthwise. (2015). Ectopic pregnancy. Web.
Kim, S., & Sullivan, D. (2017). Sepsis. Web.
Mayo Clinic. (2017). Sepsis. Web.
Morris, G. (2017). 12 causes of left lower quadrant pain in men and women. Web.
Payne, J. (2017). Left lower quadrant pain: Common causes. Web.
Ramsdell, T. H., Smith, A. N., & Kerkhove, E. (2017). Compliance with updated sepsis bundles to meet new sepsis core measure in a tertiary care hospital. Hospital Pharmacy, 52(3), 177-186.
Weng, M. (2016). Diverticulitis. Web.