PEER RESPONSE WEEK 3

answer to each classmate 
1 reference per classmate resonse.
4 sentence per classmate response is fine 

Case Presentation:
A patient that is 32 yo and has been married to her husband for 10 years, come in complaining of pelvic pain that is new, constant and worsening for about 3 weeks.  She states she did not come in sooner because her husband works out of town for long periods and she did not have anyone to take care of their 3 children while she comes in to see you. He is home now and they tried having sex last night but she stated it was too painful and they had to stop.  She reports a small amount of post-coital bleeding after their attempt.  She states she has not had this kind of pain before but denies any dysuria or problems with defecation with this pain.  She also denies any GI symptoms at this time.  Her Temp is 100.3 today, P 82, BP 102/74, O2 SAT100%.  Abdominal exam negative for HSM or any mass, but mild LQT noted without guarding.  Pelvic exam reveals normal external genitalia, vaginal walls pink and a moderate amount of thin gray vaginal discharge is noted in the posterior fornix, but otherwise normal.  Bimanual exam is significant for positive CMT and left adnexal pain.
CC: “I have pain in my pelvis”.
classmate 1
1.  What is the differential diagnosis for this scenario?

The primary differential diagnosis is Pelvic Inflammatory Disease. 

“Cervical motion tenderness alone can add to the differential diagnosis of any process that has peritoneal involvement across different organ systems such as, appendicitis , diverticulitis , inflammatory bowel disease , hernia , perforated abdominal viscus , abdominal wall hematoma,  ureteral lithiasis, interstitial cystitis, ectopic pregnancy, endometriosis , endometritis, tubo-ovarian abscess, ovarian or adnexal torsion, chronic pelvic cellulitis , vaginitis, cervicitis, pelvic thrombophlebitis”(Cortes, 2021). 

classmate 2

2.  What are the most common organisms that can cause PID?
In 85% of cases, the infection is caused by sexually transmitted bacteria. The most common pathogens are the bacteria Neisseria gonorrhoeae or  Chlamydia trachomatis. Approximately 10% to 15% of women with endocervical  N. gonorrhoeae or  C. trachomatis will develop PID ( Jennings & Krywko, 2021).

classmate 3

 What are the presenting symptoms of PID? 
Women with PID may present with lower abdominal or pelvic pain, vaginal discharge, dyspareunia, and/or abnormal vaginal bleeding (Mitchell & Prabhu, 2013).  
classmate 4 
How do you manage PID?

Initial management should include broad spectrum antibiotics including ceftriaxone 1-gram IV Q24 hr., plus doxycycline 100 mg PO or IV Q12h, plus metronidazole 500 mg PO or IV Q12h. Management should include abstaining form sexual intercourse till antibiotic therapy is complete, and sex partners need to be treated. Women should be tested for sexually transmitted diseases including gonorrhea, HIV, Syphilis, and chlamydia.