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Published

Abid

Abid

Published in Health & Medicine
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Transcript

  • 1. Child & Adolescent Health Dr Abid Vatani 28 April 2011
  • 2. • G, 14 yo F• BIB mother on 14 March 2011• Cyclic pelvic pain• Shifting from right to left at times• Pain before period starts• Moderately painful periods
  • 3. • Last time pain worse• Bent over & cried due to the pain• Pain subsided at the time of consultation
  • 4. PMHx:• Menarche at age 12• Regular cycles• Unremarkable medical history• Not sexually active• Not on any medication
  • 5. Differential diagnosis:• Ovulation pain• UTI• GI aetiology• Ruptured ovarian cyst• (Endometriosis)
  • 6. Red flags:• Infection (PID/STD)• Ectopic pregnancy• Appendicitis
  • 7. Ovulation pain more likely• Common• Also known as ‘mid cycle pain’ or Mittleschmetz pain• Usually harmless• Usually resolves with age
  • 8. Management:• Urine m/c/s• NSAID (Naproxen250mg bd)• Return for result and follow up
  • 9. Urine m/c/s 14/3/11• PH 6.0 • epi cells <10• Protein Trace • Culture No pathogen• Glucose Nil• Special Gravity 1.026• Leucocytes 290 * 10*6/L• Erythrocytes <10
  • 10. • Returned with mother on 7 April 2011• First intercourse 4/52 ago• No protection• C/o smelly d/c for 2/52• No itch or soreness• Feels a painful lump ‘down below’
  • 11. • Hurts when wipes• LNMP 2/52 ago• Mother asking for HIV testing
  • 12. O/e:• Abdo: Mild pelvic pain, no palpable mass, BS presented.• PV: Inspection: no obvious erythema or swelling . Palpation: no palpable mass, no cervical excitation. Speculum examination: white/grey d/c ++, whole vagina wall looked lumpy, red and inflamed.• HVS & chlamydia swob taken
  • 13. Differential diagnosis:• Thrush• STD• Vaginosis
  • 14. Management:• Trial of clotriamzole• Review with the results
  • 15. • 11 April 2011• Phone call from Public Health Medical Officer• Chlamydia was detected• Questioning child safety and child abuse• Asked receptionist to call mother to come in to discuss the results.
  • 16. • Later on that day phone call from a Supervisor at S&N• Gonorrhea also detected• Recommended adding on Trichomonas• Advice on treating with Azithromycin and Ceftriaxone +/- Doxycyclin• Also to do bloods for HIV and Syphilis
  • 17. • 12 April 2011• Presented with mother• Sx less severe after clotrimazole• Results given• Treatment plan explained• Mother happy to cover with Doxycyclin
  • 18. • Boy’s mobile obtained• Reassured the confidentiality• Blood form for syphilis and HIV given• Return if any concern
  • 19. • D/w my Supervisor
  • 20. • 15 April 2011• Trichomonas was negative• Sexual partner contacted on his mobile and notified about the STD and advised to see his GP or Sexual Health Service.• Appointment made for the following day
  • 21. • NO show !