"Pelvic Inflammatory Disease, Miscarriage and Vaginitis" is a delightful example of a paper on symptoms. Considering the history of the patient and her symptoms, it can be declared with certainty that discomfort is not due to urinary tract pathology; the absence of urinary frequency and dysuria point towards this fact. The obstetric history of the patient is however complicated and the patient’ s age, history, and presenting symptoms presented in this case appear to be pointing towards the following three differential diagnoses; Pelvic Inflammatory Disease A patient of pelvic inflammatory disease is more likely to manifest symptoms like abdominal tenderness, elevated ESR, and fever (Soper, 2010).
On physical examination, uterine tenderness and adnexal tenderness can be easily elicited. The severity of tenderness can provide a clue regarding the severity of the disease in general. Adnexal tenderness can be considered the most reliable indicator of this condition which therefore points towards the presence of PID. Body temperatures higher than 101 degrees Fahrenheit may be detected. Vaginal examination, which should be an essential part of this physical exam, may reveal mucopurulent or bloody discharge. Cervical motion tenderness can be regarded as being highly suggestive of pelvic inflammatory disease. In cases where the pathology has already extended to the peritoneum, there is a high likelihood of eliciting the rebound tenderness of the lower abdomen.
Peritonitis may also lead to involuntary guarding. Adnexal tenderness that is more marked unilaterally may be an indicator of the presence of an underlying pathology like a tube-ovarian abscess. Miscarriage A pelvic examination is necessary for the diagnosis of a miscarriage, and keeping in view the scenario given in this case, it is essential that the cause of bleeding be determined earlier during the course of treatment (Raine-Fenning, 2004).
An examination of the cervix is likely to reveal the underlying pathology; since a dilated/open cervix can possibly indicate a miscarriage. The presence of a tissue protruding out of the cervix can be regarded as evidence of a miscarriage. The severity of the bleeding may be judged by measuring the vitals of the patient. Lowered blood pressure and elevated heart rate may point towards a possible hemodynamic compromise. An abdominal examination may provide additional information about the underlying pathology.
Abdominal tenderness may be an indicator of miscarriage, but other causes of tenderness should also be ruled out. In the given scenario, the presence of an ectopic pregnancy is not a possibility since ectopic pregnancies typically occur 6-8 weeks after menstruation. Confirmation with ultrasonography should follow the physical examination. Vaginitis Although vaginal bleeding is not present in every case of vaginitis, its presence may not rule out this condition. In patients with suspected vaginitis, physical examination should include the exam of the external genitalia, vagina, and cervix. External genitalia may show signs of excoriations or discharge.
The presence of satellite lesions should arouse the suspicion of this diagnosis (Berek, 2002). As far as the vaginal examination is concerned, it is essential to note the consistency, color, odor, and adherence characteristics of the discharge that is evident. The discharge may also be evident at the cervical os. A dipstick may be used to measure the pH of the discharge; in this case, the sample should be taken from the vaginal sidewalls and not from the posterior fornix.
Berek, J. S. (2002). Novak's gynecology package. Philadelphia, Pa: Lippincott Williams & Wilkins.
Raine-Fenning, N. (2004). Clinical assessment in gynecology. Current Obstetrics & Gynaecology, 14(1), 34-43.
Soper, D. E. (2010). Pelvic inflammatory disease. Obstetrics & Gynecology,116(2, Part 1), 419-428.