Weekly Clinical Experience

Woman of 48 years with Uterine Fibroid.

Challenges and Successes

Yes, there were both difficulties and achievements. One of the obstacles was getting the patient to provide information because they were in pain and uncomfortable, making it difficult to take their history. The woman was highly resistant and had considerable abdominal pain, so I was unable to check her. Despite the difficulties, I completed my examination with the superb assistance of the medical team.

Signs and Symptoms

Abdominal pain: The patient reported having lower back pain that spread throughout their entire body and got worse when they sat.

Prolonged and severe menstrual bleeding: The patient reported experiencing heavy menstrual bleeding. She states that she typically had three days of period, although she has had up to ten days of menstruation. She claims to have changed four badly soiled sanitary towels/tampons in a span of twelve hours. Weekly Clinical Experience.

Dizziness: The patient also occasionally reported feeling lightheaded. She claims to have experienced mild headaches and dizziness as well.

Distention of the abdomen: The patient reported experiencing abdominal distention for the past few months. Weekly Clinical Experience.

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Assessment

Examining the abdomen, it was observed that the umbilicus was inverted and the abdomen was symmetrically enlarged. There were no visible conventional or surgical markings, and the abdomen moved with breathing. There were no noticeable lumps on either side of the lower quadrant regions with gentle examination. Bimanual palpation revealed firm, immovable lumps that were palpably painful in the lower quadrants. The multitudes were not uniform. Weekly Clinical Experience.

Examining the pelvis digitally revealed that the introitus was normal. The cervix was non-tender and posterior as well. It was also essential to perform a speculum exam, which revealed that the cervix was posterior, the OS was closed, and the vaginal walls were normal. The presence of blood spots from the cervical OS was noteworthy.

Plans of Care Research

Lab Research:

1. a) To assess hemoglobin levels and rule out bacteremia, a complete blood count is required. White blood cells have been criticized for being a useful tool in diagnosing septic shock because patients may have normal WBC counts. This is according to Farkas (2020). Consequently, he suggests using NLR (Neutrophil to Lymphocyte Ratio) in combination, although he advises being cautious when using elements that increase NLR, such as psychological stress and exogenous steroids.
2. b) C-Reactive Protein is a useful indicator of inflammation. Weekly Clinical Experience.
3. c) To look for electrolyte abnormalities, urea, electrolytes, and creatinine will be examined.
4. d) Urinalysis is a good way to rule out UTIs, or urinary tract infections.
5. e) To determine if a woman is pregnant, a pregnancy diagnostic test will be required.

Imaging

1. a) To look for pelvic abnormalities like uterine fibroids, a pelvic ultrasound will be performed.
2. b) To rule out abdomino-pelvic anomalies, CT scans of the abdomen and pelvis will be required.

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Treatment

Pharmacological therapy:

1. a) Tranexamic acid 500 mg IV 12 hours a day;
2. b) Normal saline IV 2 liters in 12 hours;
3. c) Diclofenac 75 mg intramuscular 8 hours a day. Weekly Clinical Experience.

Not pharmacological

According to Santoyo-Sánchez et al. (2015), the patient should be counseled to drink more water and eat foods high in iron, vitamin B12, and folic acid while avoiding foods high in saturated fats.

Surgical

In light of the imaging results, the patient would require a gynecological assessment as well as hysterectomy preparation. Weekly Clinical Experience.

Differential Diagnosis

Uterine fibroid: Duhan (2011) states that the symptoms of uterine myoma, also known as fibroids, include pelvic pressure and pain, heavy or prolonged menstruation, difficulty conceiving, pain during coitus, and frequent urine.

Uterine cancer: The patient also exhibits symptoms such as irregular or heavy menstruation and pelvic pain.

Endometrial polyps: They are growths from the lining of the uterus. An irregular, heavy, or atypical menstrual cycle is one of the main symptoms.

Lessons Learned: I gained knowledge about taking obstetrics and gynecological histories and conducting the appropriate investigations to handle various problems in the same location. Weekly Clinical Experience.

References

Duhan, N. (2011). Current and emerging treatments for uterine myoma–an update. International journal of women’s health, 3, 231.

Farkas, J. D. (2020). The complete blood count to diagnose septic shock. Journal of thoracic disease, 12(Suppl 1), S16.

Santoyo-Sánchez, A., Aponte-Castillo, J. A., Parra-Pena, R. I., & Ramos-Penafiel, C. O. (2015). Dietary recommendations in patients with deficiency anaemia. Revista Médica Del Hospital General De México, 78(3), 144-150.