A 26 yrs married female c/o 3mts ammenorhea with severe pelvic pain and right illiac region lower abdominal pain .her pregcolour test is negative, USG suggest mild fatty change liver rest all WNL. but TLC COUNT 11.3thousand/mm3 suggestive of inflammation. reports r attached. pls suggest diagnosis and further followup.
- 3 months amenorrhea - do Urine complete see for UTI if so treat accordingly - D/D pain in RIF ? Appendicitis can be - clinically Tenderness ? - high resolution USG , for inflamed Appendix as, TC is high acute infection - don't use Doxycycline - antibiotics inj. Cefoperazone+sulbactam, Mikacin 500 - anafortan as antispasmodic
Pain in pelvic region & RIF is indicative of PID with chronic appendicitis. Fatty liver, borderline hypercholesterolemia, elevated SGOT.
Get TVS and urine RE to rule out Uti or pid Do hormonal assay to find out cause of amenorrhea Give her antibiotic and pain killers and anti inflammatory.
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Tab.dicyclomine abdominal pain Tab.nsainds inflamattion Tab.atorva for fatty Tab.udiliv Tab.antibiotic
?pid rule out cuase of it TB or chlamydial infection . Send Endometrium -Tb pcr Treat hypercholestrol.
?pID,is there any white discharge or h/o dyspareunia ?treat with anti spasmodics initially, do tvs and urine routine examn also. Do tft to find the cause for amenorrhea and treat accordingly.
Pl do a thorough examination,. Start doxycycline I'bd, deflocort I'bd, Tindazoleibd for 5days. Reassess the cae
Get a Thyroid profile done apart from above mentioned management. AMH should not be advised unless other causes of amenorrhea are ruled out
PID
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Common causes of abdominal pain Abdomen pain or abdominal pain is usually experienced in the area between the chest and the stomach. This kind of pain usually comes as a dull cramp that also produces shooting stabs of pains intermittently, or it may be a localised pain in one side of the stomach. This may also be accompanied by inflammation, and other diseases related to organs like intestines, kidneys, pancreas, liver, spleen and stomach. So what are the causes of stomach or abdomen pain? Read on to find out: Food Poisoning: Food poisoning can be caused due to dirty water or contaminated food. This can give rise to various infections as well as conditions like traveller's diarrhoea or loose motions. Gastro Intestinal Conditions: GERD or gastroesophaegal reflux disease and gastroenteritis, among various others can also lead to abdomen pain as a symptom along with severe acidity and nausea. Irritable bowel syndrome is another major ailment which can leave you with persistent abdominal pain. Generalised Pain: This kind of pain occurs in the overall area all around the stomach and may point at the presence of conditions like Crohn's Disease, a traumatic injury, appendicitis, flu, or even a urinary tract infection. Further, when the gas settles and tightens the stomach due to the inability to pass a motion on a normal, regular basis, this may be termed as constipation. This also leads to abdomen pain. Localised Lower Abdomen Pain: Pain that is found specifically in the lower area of the abdomen can be caused due to appendicitis, obstruction or blockage in the intestine or colon, and other ailments. This pain can also be accompanied by nausea and vomiting. Localised Upper Abdomen Pain: This kind of pain may emanate due to the presence of gallstones, liver inflammation or hepatitis, pneumonia, or even in the middle of a heart attack. Localised Centre Abdomen Pain: Pain in the centre part of the stomach or abdomen may be caused due to gastroenteritis, an injury or even the accumulation of waste products in the body, otherwise known as uraemia. Abdomen Pain and Women: For women, such localised pain may be caused due to pelvic inflammatory disease, urinary tract infection, endometriosis, ectopic pregnancy, menstrual cramps which are also called dysmenorrhoea, and fibroids. Miscarriages can also cause pain in this part of the abdomen, for women. Renal Stones: Renal stones or stone in kidney is one of the most common cause of abdomen pain. The pain caused by kidney stone is such that it can make a patient roll in bed and this pain may radiate to toward the groin as well. Persistent pain and nausea that come with vomiting and finally give rise to blood in the vomit or stool should be checked by the doctor immediately, so as to rule out any serious ailment. Imaging tests, ultrasound and an X-Ray can help in diagnosis.
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Pelvic Inflammatory Disease(PID) Pelvic inflammatory disease (PID) may be the inflammation of the upper genital tract relating to the fallopian tubes as well as the ovaries. The soreness is often bilateral because most from the PID is caused by the ascending or blood borne infection and also the close anatomic association from the ovaries with the fallopian tubes favors the bilateral involvement, though one tube might be more affected compared to other. The Pelvic inflammatory disease treatment aims to lessen this inflammation and stop further damage to the organs. Pelvic inflammatory disease causes The most typical cause of PID is std's (STD) Most common being gonococcal and chlamydial infections 60-75% of PID is brought on by STD, of which gonorrhea accounts for about 30% within the developed countries Gonoccoci and Chlamydia travel in the genital tract across the mucous membrane to reach the fallopian salpingo-oophoritis Other organisms directly ascend across the lining of the genital tract Other organisms that create PID include mycoplasma, tubercular bacillus, viruses and E. coli. Both aerobes and anaerobes are implicated in PID Pelvic inflammatory disease Pathology Acute Salpingitis The fallopian tube is swollen, edematous and hyperaemic with visible dilated vessels around the peritoneal surfaces. The sure manifestation of salpingitis (inflammation of the fallopian tube) may be the discharge of seropurulent fluid in the fimbrial end of the tube. The inflammatory exudate is discharged in to the lumen of the tube resulting in adhesions and tubal blockage or narrowing from the lumen which may be the cause of ectopic pregnancy or infertility. Pelvic abscess might be formed due to pus collection within the pelvic cavity. The ovaries are participating and a tubo ovarian abscess or mass may result. In rare cases the problem may spread upwards to result in generalized peritonitis, paralytic ileus and even sub diaphragmatic and perinephric abscess. In PID following postabortal and puerperal infection, the problem spreads through the cervix via lymphatics towards the cellular tissue causing cellulitis. The fallopian tube is affected externally and the mucous membrane last but not least. Pelvic inflammatory disease treatment within the acute stage helps limit the problem and prevent long term harm to the fallopian tube and ovaries resulting in adhesions formation, infertility etc. In early stage pelvic inflammatory disease treatment may require administration from the antibiotics but in the later stage surgical drainage from the abscess and adhesions breakdown may be required. Pelvic inflammatory disease symptoms and signs The most typical symptom of acute PID is gloomier pelvic pain. Pain is bilateral and limited to lower abdomen. Pain spreads upwards if general peritonitis ensues. Pain is severe in acute stage and it is followed by a high temperature. Vomiting could also follow. Discharge from the vagina and dysuria also occur. Menstrual irregularity if any, is a result of preceding endometritis in case of ascending infection in order to the antecedent abortion or delivery. The patient may develop uterine bleeding at any given time when menstruation isn't expected and the bleeding is usually profuse and prolonged. In case of pelvic abscess, the individual develops severe diarrhea because of rectal irritation. Investigations in Pelvic inflammatory disease Haemoglobin, leucocyte count and ESR. Cervical and vaginal swab culture for both aerobic and anaerobic organisms. Blood culture if bacteraemia takes hold. C reactive protein distinguishes between infective and non infective mass. Ultrasound: Tubo-ovarian abscess appears around the ultrasound. Computed tomography shows a spherical or tubular structure having a low attenuation center. Pelvic inflammatory disease treatment Pelvic inflammatory disease treatment aims to lessen the inflammatory process thereby arresting the development of the organisms resulting in the disease. Since 60-75% of PID come from Sexually transmitted diseases, treatment consists of pharmacological therapy (antibiotics) to eradicate the causative organisms together with supportive therapy for the control over other symptoms. Surgical treatment are usually necesary in case of extensive damage. Pelvic inflammatory disease treatment in Acute stage: Pelvic inflammatory disease treatment within the acute stage includes removal of the causative organisms by proper administration from the antibiotics. Mild cases are treated at home with antibiotics. Moderate and severe cases of Pelvic inflammatory diseases may require hospitalization. Hospital management includes: Rest Intravenous fluids within the presence of dehydration or vomiting and correction of electrolytic imbalance. Antibiotics are mandatory to become instituted at the earliest for the pelvic inflammatory disease treatment before the diagnosis is made. 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Short wave diathermy is really a deep heating modality, produces heat both in deep and superficial tissues. Within the acute stage very mild or pulsed short wave diathermy can be used to promote healing and lower pain. For the Pelvic inflammatory disease treatment short wave diathermy could be given for 5-10 minutes for a time of three days a week while using cross- fire method of diathermy. Cross-fire method involves moving the electrodes to some position at right angles for their previous position midway through the treatment. Half the Pelvic inflammatory disease treatment is offered antero-posteriorly through the pelvis using the patients in the lying position and 2nd half in the side lying using the legs curled up or perhaps in sitting position and also the electrodes placed over the pelvic outlets and also the lumbo-sacral area of the spine. 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