Clinical Findings
Important Questions
Some of the important questions to ask the patient include; What does she do to relieve the pain and if there is any medication she has taken since the pain started? Is it the first time she is presenting with this symptom? Are her menstrual periods ever painful, does she have bleeding between periods and are there any other symptoms with her periods? How many times have you been pregnant, have there been any complications in giving birth or conceiving? Have the hormonal stimulation fertility treatments had any side effects on her? Has the patient had an appendectomy done before?
Clinical Findings
Patient could have elevated temperatures, tenderness to palpation on the RLQ, unilateral tender adnexal mass, rebound tenderness. Clinical methods are the skills that doctors use in diagnosing and treating a disease (Drake & Hutchison, 2012).
Diagnostic Studies
Diagnostic Ultrasonography should be done to find out cysts, enlarged ovary and Doppler ultrasound. It helps to determine if blood flow is compromised. Also, do a CT scan and MRI for definitive diagnosis. Additionally, do a Full blood count and differential count to screen for anemia and elevated WBC. On the same note, check the Urinalysis report to differentiate and eliminate appendicitis or urinary tract infections.
Diagnosis
The primary diagnosis is ovarian torsion. It is because of adnexal mass, RLQ pain, rebound tenderness.
Differential diagnosis
Make sure to handle the three processes; Do proper appendicitis because of RLQ pain, rebound tenderness and guarding. Also carry out Ureteral calculi because of RLQ pain {colicky}, tenderness, rebound tenderness. Remember to check on large bowel obstruction because of abrupt pain, tenderness.
Management
Manage pain with NSAIDS, opioids. Laparoscopy and surgery are important for detorsion (Kenny & Bickerstaff, 2017). Carry lab tests as mentioned above. Educate the patient on her condition, possible complications from the disease itself or the management. Follow-up on the patient to establish if there is torsion on the left ovary too and on her progress and full recovery.
References
Drake, W., & Hutchison, R. (2012). Hutchison's Clinical Methods, An Integrated Approach to Clinical Practice With STUDENT CONSULT Online Access,23: Hutchison's Clinical Methods. Amsterdam, Netherlands: Elsevier Health Sciences.
Kenny, L., & Bickerstaff, H. (2017). Gynaecology by Ten Teachers, 20th Edition(20th ed.). Boca Raton, Florida: CRC Press.
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