NAME: KHAN, MD SHAHBAAZ ALI

YEAR AND SECTION: MED- 1

SUBJECT: INTRODUCTION TO CLINICAL MEDICINE

PROFESSOR: JEAN LOUISE C. VITUALLA

INTRODUCTION TO CLINICAL MEDICINE

ASSIGNMENT: CASE 3: ECTOPIC PREGNANCY

 USE THIS FILE TO EDIT AND SUBMIT IN EDMODO.

 DO NOT PM THIS TO ME OR MAM LEY ANN
 MAKE A TABLE OF YOUR DIFFERENTIAL DIAGNOSIS FOR THIS CASE.

DISCUSS EACH dd x ALONG WITH ITS ETIOLOGY, MANIFESTATION,

DIAGNOSTICS AND TREATMENT.

ECTOPIC PREGNANCY

ETIOLOGY:
 An infection or inflammation of the Fallopian tube can cause it to become partially or
entirely blocked.
 Previous surgery in the pelvic area or on the tubes can cause adhesion.
 Abnormal growths or a birth defect can result in an abnormality in the tube’s shape

MANIFESTATION:
Pain on one side of your body

Dizziness or weakness

Pain in your shoulder or neck

 Sharp abdominal cramps

 Upset stomach and vomiting

Light vaginal bleeding and pelvic pain

DIAGNOSTICS:
pregnancy test 

pelvic exam to locate pain, tenderness, or a mass in the abdomen

ultrasound 

HCG level test

TREATMENT:

Methotrexate may be given, which allows the body to absorb the pregnancy tissue and may
save the Fallopian tube, depending on how far the pregnancy has progressed.

If the tube has become stretched or has ruptured and started bleeding, part or all of it may
have to be removed. In this case, bleeding needs to be stopped promptly, and emergency
surgery is necessary.

Laparoscopic surgery under general anesthesia may be performed. This procedure involves a

surgeon using a laparoscopy to remove the ectopic pregnancy and repair or remove the
affected Fallopian tube. If the ectopic pregnancy cannot be removed by a laparoscopy,
another surgical procedure called a laparotomy may be done.

APPENDICITIS:

ETIOLOGY:
Appendicitis happens when the appendix gets blocked, often by poop, a foreign body
(something inside you that isn't supposed to be there) , or cancer.

Blockage may also result from infection, since the appendix can swell in response to any
infection in the body.
 MANIFESTATION:

 Pain in your lower right belly or pain near your navel that moves lower. This is usually the
first sign.
 Loss of appetite
 Nausea and vomiting soon after belly pain begins
 Swollen belly       
 Fever of 99-102 degrees
 Cannot pass gas

Other less common symptoms of appendicitis include:

 Dull or sharp pain anywhere in your upper or lower belly, back, or rear end.
 Painful or difficult peeing
 Vomiting before your belly pain starts
 Severe cramps
 Constipation or diarrhea with gas

DIAGNOSTICS:

 Examination of your abdomen to look for inflammation

 Urine (pee) test to rule out a urinary tract infection
 Rectal exam
 Blood test to see whether your body is fighting an infection
 CT scans
 Ultrasound

TREATMENT:

 Appendectomy
some research shows that treating acute appendicitis with antibiotics may help to avoid
surgery.

RUPTURED OVARIAN CYST:

ETIOLOGY:

The most common causes of ovarian cysts include:

 Hormonal problems:  Functional cysts usually go away on their own without

treatment. They may be caused by hormonal problems or by drugs used to help you
ovulate.
 Endometriosis:  Women with endometriosis can develop a type of ovarian cyst called
an endometrioma. The endometriosis tissue may attach to the ovary and form a
growth. These cysts can be painful during sex and during your period.
 Pregnancy:  An ovarian cyst normally develops in early pregnancy to help support the
pregnancy until the placenta forms. Sometimes, the cyst stays on the ovary until later
in the pregnancy and may need to be removed.
 Severe pelvic infections:  Infections can spread to the ovaries and Fallopian tubes and
cause cysts to form.

MANIFESTATION:

 abdominal fullness, expansion of the abdomen, or bloating

 low back pain

 indigestion

 feeling full after eating only a small amount (early satiety)

 urinary urgency

 difficulty with emptying the bladder completely

 feeling an urge to defecate

 having difficult bowel movements

 pain with sexual intercourse.

DIAGNOSTICS:
Bi-manual examination of the pelvis
  Ultrasound especially trans-vaginal ultrasound

 CT scan or MRI scan

TREATMENT:
painkillers
Laparoscopic or open abdominal incision (laparotomy)

PELVIC INFLAMMATORY DISEASE

ETIOLOGY:
PID is an infection caused by bacteria. When bacteria from the vagina or cervix travel to
your womb, Fallopian tubes, or ovaries, they can cause an infection.

Most of the time, PID is caused by bacteria from chlamydia and gonorrhea. These are

sexually transmitted infections (STI). Having unprotected sex with someone who has an STI
can cause PID.

MANIFESTATION:

 Pain ranging from mild to severe in lower abdomen and pelvis

 Abnormal or heavy vaginal discharge that may have an unpleasant odor
 Abnormal uterine bleeding, especially during or after intercourse, or between
menstrual cycles
 Pain during intercourse
 Fever, sometimes with chills
 Painful, frequent or difficult urination

When to see a doctor

 Severe pain low in your abdomen

 Nausea and vomiting, with an inability to keep anything down
 Fever, with a temperature higher than 101 F (38.3 C)
 Foul vaginal discharge

DIAGNOSTICS:
There is no one test that can accurately diagnose pelvic inflammatory disease. Instead, the
doctor will rely on a combination of findings from:

Medical history. The doctor will likely ask about the sexual habits, history of sexually
transmitted infections and method of birth control.

Signs and symptoms. Tell the doctor about any symptoms you're experiencing, even if
they're mild.

Pelvic exam. During the exam, doctor will check pelvic region for tenderness and swelling.
Doctor may also use cotton swabs to take fluid samples from the vagina and cervix. The
samples will be tested at a lab for signs of infection and organisms such as gonorrhea and
chlamydia.

Blood and urine tests. These tests may be used to test for pregnancy, HIV or other sexually
transmitted infections, or to measure white blood cell counts or other markers of infection
or inflammation.

Ultrasound. This test uses sound waves to create images of your reproductive organs.

If the diagnosis is still unclear, doctor may recommend additional tests, such as:

Laparoscopy. During this procedure, doctor inserts a thin, lighted instrument through a

small incision in abdomen to view your pelvic organs.

Endometrial biopsy. During this procedure, doctor inserts a thin tube into the uterus to
remove a small sample of endometrial tissue. The tissue is tested for signs of infection and
inflammation.

TREATMENT:

Antibiotics. The doctor will prescribe a combination of antibiotics to start immediately.

After receiving the lab test results, doctor might adjust the prescription to better match
what's causing the infection. follow up with the doctor after three days to make sure the
treatment is working. Be sure to take all of medication, even if one start to feel better
after a few days.

Treatment for your partner. To prevent reinfection with an STI, sexual partner or
partners should be examined and treated. Infected partners might not have any
noticeable symptoms.

Temporary abstinence. Avoid sexual intercourse until treatment is completed and

symptoms have resolved.

Surgery is rarely required as in case if antibiotics are not effective there will be need to
drain it surgically.