Child & Adolescent      Health      Dr Abid Vatani      28 April 2011
• G, 14 yo F• BIB mother on 14 March 2011• Cyclic pelvic pain• Shifting from right to left at times• Pain before period st...
• Last time pain worse• Bent over & cried due to the pain• Pain subsided at the time of consultation
PMHx:• Menarche at age 12• Regular cycles• Unremarkable medical history• Not sexually active• Not on any medication
Differential diagnosis:• Ovulation pain• UTI• GI aetiology• Ruptured ovarian cyst• (Endometriosis)
Red flags:• Infection (PID/STD)• Ectopic pregnancy• Appendicitis
Ovulation pain more        likely• Common• Also known as ‘mid cycle pain’ or  Mittleschmetz pain• Usually harmless• Usuall...
Management:•   Urine m/c/s•   NSAID    (Naproxen250mg bd)•   Return for result and    follow up
Urine m/c/s 14/3/11•   PH 6.0                    •   epi cells <10•   Protein Trace             •   Culture No pathogen•  ...
• 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 sor...
• Hurts when wipes• LNMP 2/52 ago• Mother asking for HIV testing
O/e:• Abdo: Mild pelvic pain, no palpable mass, BS  presented.• PV: Inspection: no obvious erythema or  swelling . Palpati...
Differential diagnosis:• Thrush• STD• Vaginosis
Management:• Trial of clotriamzole• Review with the results
• 11 April 2011• Phone call from Public Health Medical  Officer• Chlamydia was detected• Questioning child safety and child...
• Later on that day phone call from a  Supervisor at S&N• Gonorrhea also detected• Recommended adding on Trichomonas• Advi...
• 12 April 2011• Presented with mother• Sx less severe after clotrimazole• Results given• Treatment plan explained• Mother...
• Boy’s mobile obtained• Reassured the confidentiality• Blood form for syphilis and HIV given• Return if any concern
• D/w my Supervisor
• 15 April 2011• Trichomonas was negative• Sexual partner contacted on his mobile and  notified about the STD and advised t...
• NO show !
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Child & adoloscent health

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  • Child & adoloscent health

    1. 1. Child & Adolescent Health Dr Abid Vatani 28 April 2011
    2. 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. 3. • Last time pain worse• Bent over & cried due to the pain• Pain subsided at the time of consultation
    4. 4. PMHx:• Menarche at age 12• Regular cycles• Unremarkable medical history• Not sexually active• Not on any medication
    5. 5. Differential diagnosis:• Ovulation pain• UTI• GI aetiology• Ruptured ovarian cyst• (Endometriosis)
    6. 6. Red flags:• Infection (PID/STD)• Ectopic pregnancy• Appendicitis
    7. 7. Ovulation pain more likely• Common• Also known as ‘mid cycle pain’ or Mittleschmetz pain• Usually harmless• Usually resolves with age
    8. 8. Management:• Urine m/c/s• NSAID (Naproxen250mg bd)• Return for result and follow up
    9. 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. 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. 11. • Hurts when wipes• LNMP 2/52 ago• Mother asking for HIV testing
    12. 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. 13. Differential diagnosis:• Thrush• STD• Vaginosis
    14. 14. Management:• Trial of clotriamzole• Review with the results
    15. 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. 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. 17. • 12 April 2011• Presented with mother• Sx less severe after clotrimazole• Results given• Treatment plan explained• Mother happy to cover with Doxycyclin
    18. 18. • Boy’s mobile obtained• Reassured the confidentiality• Blood form for syphilis and HIV given• Return if any concern
    19. 19. • D/w my Supervisor
    20. 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. 21. • NO show !

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