iHuman Case Study-Ovarian Torsion

 
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A comprehensive analysis of the patient’s health including the medical history should be done during the assessment to ensure appropriate diagnosis is made and a solid platform for disease management is established. Comprehensive analysis aids care providers to detect possible complications that might lead to the death of the patient. Ovarian torsion, for instance, is one of the health conditions that increase the risk of complications among patients. The physician should, therefore, employ a customized approach when dealing with patients suspected of having ovarian torsion.

The paper analyses the case of a 26-year-old woman who has visited the facility complaining of intense abdominal pain. The patient also states she has been experiencing fever nausea and vomiting as well as chills in the last two days.

 Questions to include in patients’ interview

The history and physical attributes of the patient can yield beneficial information to the physician. The physician should, therefore, inquire about the possibility of pregnancy, gynecologic disorders, and presence of adnexal mass, ongoing treatment for infertility, and involvement in strenuous activities (Falcone & Hurd, 2007). The patient should be asked whether she has a history of hypertension, as well as whether she has experienced fever and shortness of breath. The patient should be asked whether the pain is localized or diffuse, whether the pain started suddenly or grew in intensity, as well as whether the pain is aggravated by meals or any activity. The other question that should be included in the patient’s interview is the period, which the patient has presented with abdominal pain. The patient should also be asked whether she has undergone pelvic surgery previously since this operation increases the risk of torsion.


 

The clinical findings present in a patient with ovarian torsion

The most common symptoms in patients presenting with ovarian torsion are an abdominal and pelvic pain. The abdominal pain, which is usually sharp and stabbing can radiate to the back, flank, pelvis and the upper thighs. The patient also experiences nausea and vomiting. The patient has also been experiencing fever and chills. The patient presents with diffuse pain instead of pain focused on the right or left lower quadrant.

Diagnostic studies of ovarian torsion, Why?

Laboratory tests are not helping during the diagnosis of torsion. However, a pregnancy test needs to be carried out. The woman is also presenting with pelvic pain, which is a common symptom of different disorders. Therefore, lab tests such as urinalysis, and tests for STDs should be conducted to determine the possibility of an infection. Ultrasound imaging using Doppler flow studies should be carried out to aid in torsion diagnosis and assist in ruling out other possible causes of intense pelvic pain such as ectopic pregnancy, appendicitis, and Tubo-ovarian abscess (Broder, 2011). Magnetic resonance imaging and computed tomography may also be beneficial in determining other potential causes of abdominal and pelvic pain in addition to revealing signs that are consistent with ovarian torsion (Chang, Bhatt & Dogra, 2008).

The primary diagnosis and three differential diagnoses for this patient.

Primary diagnosis

Ovarian torsion– The patient was diagnosed with ovarian torsion since she presented with symptoms typical of this disorder including acute lower abdominal pain, nausea, and vomiting,


 

Differential diagnosis

Appendicitis– This condition is a possible diagnosis since the patient is presenting with symptoms such as nausea and vomiting, and intense abdominal pain. In appendicitis, these symptoms should persist for less than 48 hours.

Diverticulitis– This condition is typified by various symptoms including nausea and vomiting, intense in the lower left quadrant, bloating and constipation. The patient also experiences changes in bowel sound, which may even diminish.

Ectopic Pregnancy– There is a possibility for the patient to be diagnosed with Ectopic Pregnancy since she has been experiencing intense abdominal pain, nausea, and fatigue. The possibility of ectopic pregnancy is, however, minimal since the patient does not experience vaginal bleeding and increased urination, which are significant symptoms (Benacerraf, Goldstein & Groszmann, 2014).

Management plan for the patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups

Management of the ovarian torsion patient starts with an assessment of the circulation, breathing, and airways capacity of the patient. The patient should be administered with medications such as ibuprofen for the management of pain and Bismuth subsalicylate for nausea. A surgical operation should be done for distortion of the ovaries as soon as possible. Patient education is essential for those at risk of ovarian torsion (Deligdisch, Kase & Cohen, 2013). The patient should be advised to avoid strenuous activities since they increase the risk of torsion significantly. It is also important for the patient to avoid physical activities that involve jumping and bouncing (Deligdisch, Kase & Cohen, 2013). The patient should also avoid fertility treatments that increase the risk of torsion by increasing the size of the ovaries. The patient should be advised to return to the clinic for further evaluation if pain recurs. The patient should be referred to a gynecologist for further assessment and counseling.

 

 

References:

Benacerraf, B. R., Goldstein, S. R., & Groszmann, Y. S. (2014). Gynecologic ultrasound: A problem-based approach. Philadelphia, PA: Elsevier/Saunders.

Broder, J. (2011). Diagnostic imaging for the emergency physician. Philadelphia, PA: Elsevier/Saunders.

Chang, H. C., Bhatt, S., & Dogra, V. S. (2008). Pearls and pitfalls in diagnosis of ovarian torsion. RadioGraphics, 28: 1355-1368.

Deligdisch, L., Kase, N. G., & Cohen, C. J. (2013). Altchek’s diagnosis and management of ovarian disorders. Cambridge ; New York : Cambridge University Press.

Falcone, T., & Hurd, W. W. (2007). Clinical reproductive medicine and surgery. Philadelphia: Mosby.

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