Question

A  36 year old female, has had lower back pain that radiates to her right abdomen for the last several days. The pain is dull and difficult to localize. As an Olympic shot putter, she had originally attributed the pain to muscle strain. However, today the pain has become persistent and intense. Now she is seeking your expert help.

Part A: Lower back pain may include many body systems that we have studied. For each system listed below, list one disorder that could cause this patient’s pain.

Muscular

Skeletal

Nervous

Digestive

Urinary

Reproductive

Reproductive

Reproductive

Part B: Exam: Her temperature is normal. Respirations 15, Her HR 90 and blood pressure is 135/80.

Hct: 48%, WBC: 12,300, Neutrophils 7500, Bands 1000, Lymphocytes, 3000, Monocytes: 800. She has no cough, incontinence, U/A is normal. She has no nausea, vomiting or diarrhea. Her menses have been irregular for years due to her strenuous work-outs. She has 4 children, including her last, Bruno, who was 11 lb 8 oz and is now 3 years old. She uses a diaphragm as her method of birth control. Her back muscles are not tender, but abdominal palpation is difficult due to guarding and tensing of her considerable abdominal muscles.

Anything in that data that concerns you? __________________________________________________

___________________________________________________________________________________

Suggest some tests that might rule in or out items on your list of possibilities from Part A above.

1.

2.

3.

Did you say pregnancy test? I thought you did.

Her pregnancy test is positive. She says this doesn’t feel like her other pregnancies.

What test or procedure (s) should we do now? ________________________________________

What possible problem are you concerned about? _____________________________________

She is going to undergo surgery for an ectopic pregnancy.

Where is the pregnancy located?

This is an emergency situation because rupture of could cause rapid blood loss and death.   It is also true that she has an increased chance of future ectopic pregnancies now that she has had one. Even if the surgery is successful and only one oviduct is affected, her fertility will likely be reduced. Prior to surgery, it is important to explain potential problems to patients. Sometimes a patient may opt to have a surgery that will change her ability to become pregnant.

If the doctor does a hysterectomy but leaves the ovaries, will Bromhilda have menses? ____

Will she ovulate? ______ Where will the oocyte go? ____________________________

If the doctor does a bilateral salpingo-oophorectomy and hysterectomy will Bromhilda have menses? _____________

Will she ovulate? ___________   

If the ovaries are taken, then the patient immediately experiences the condition called__________________.

She is thinking about having a tubal ligation. What is that?

Answer 1

1 PART A =reproductive

2 A pelvic exam will help to assess the areas of pain and tenderness or mass in the fallopian tube.Further blood tests and Ultrasound will aid in the diagnosis.HCG tests are performed are repeated until the USS rule out an ectopic pregnancy.

3 the problem is normally,a fertilized egg cant develop outside the uterus .Therefore to prevent further life threatening complications ectopic tissue need to be removed.if it is an ectopic pregnancy a laproscopic or abdominal surgery is performed.

4 In most cases ectopic pregnancies occur in the ampulla.The other sites are isthmus,fimbria and cornua.

5Once uterus is removed there will no loger be any period .But if a portion of the cervix or ovary is retained ,miniperiods may occur because of the endometrial lining left back in the cervix.Otherwise since the uterus is removed she can never become pregnant again.Since the ovaries are retained there will be signs of menopause.Menstruation is an event which happens inside trhe body ,but the target organ where the endproduct of menstruation occurs is uterus.if there is no uterus to show the result menstruation doesnt happen.

6 Yes if the ovaries are kept ovulation will occur ,as the ovaries are still producing estrogen.the ovaries will ovulate as usual and it will form its follicles .

7 it will be released into the pelvic cavity and the body and peritoneal cavity will take care of that fluid through reabsorption .

8 The removal of the ovaries is called an oopherectomy and is often compined with hysterectomy.After the removl of ovaries women will go into a period of surgical menopause.Estrogen leel plummet during surgical menopause and can lead to menopausal symptoms.Therefore they might require Estrogen Replacement therapy.

9 No she will not ovulate ,as ovaries are required for ovulation.

10 No menses will not take place as ovulation is not happening.

11 the patient experiences the condition called Surgical menopause.