Case Study #7
A pregnant (5 mo.) woman is reporting pain and an enlargement in her lower right quadrant comes to seek advice on different ways of imaging the area without endangering her baby. What do you explain and advise?
I would also ask questions as to whether or not she is suffering from any other symptoms. Ordering blood and urine work on her is also an excellent idea. In Amanda’s case study she suggested the pelvic ultrasound. I would take it even a bit further. It is called a “transvaginal ultrasound”.
I would explain to her the benefits and/or risks of using this remarkable device. The ultrasound has been around since the 1950s and is considered safe and non-invasive. However, a transvaginal ultrasound is. (3) Transvaginal ultrasound is a method of imaging the genital tract in women. The ultrasound machine sends out high-frequency sound waves, which bounce off body structures to create a picture. With the transvaginal technique, the ultrasound transducer (a hand-held probe) is inserted directly into the vagina and is, therefore, closer to pelvic structures than with the conventional transabdominal technique (with the probe on the skin of the abdomen), providing superior image quality. This test can be used during pregnancy.
A transvaginal ultrasound takes it a bit further than a regular pelvic ultrasound. In this way, it rules out things like ectopic pregnancy, ovarian cysts, fibroid tumors and other abdominal/pelvic diseases like PID (pelvic inflammatory disease).
The transvaginal ultrasound is even better than the pelvic ultrasound. Doing her ultrasound this way will better pick up any potential problems too small enough for the pelvic ultrasound to catch. I would prefer it this way myself.
Ovarian cysts occur when there is a lot of fluid swelling inside the ovary. However, they usually will dissolve on their own. If an ovarian cyst does not dissolve after the next 1-2 menstrual cycles, the doctor would usually try to monitor their activity. If it enlarges, the doctor may suggest removal of the cyst(s). (1)
Fibroid tumors are usually benign (non-cancerous) tumors found, most often, in the uterus of women in their 30's and 40's, although they occasionally develop on other organs which contain smooth muscle cells. Fibroid tumors are solid tumors, which are made of fibrous tissue, hence the name 'fibroid' tumor. Most often fibroids occur as multiple tumor masses, which are slow-growing and often cause no symptoms. The size of fibroids varies immensely among women and some are so small that a microscope is required to see them.
I would love to come back to Ultrasound to observe more in the future if this is something you two will allow. Let me know!
In regard to her ultrasound, we discussed the finding of an echogenic bowel. I was able to get a verbal report on her quad screen that was screen negative with a risk at 1:7000. Even modifying that risk for echogenic bowel, we would still be better than her age based risk which is overall reassuring. We discussed the other etiologies of echogenic bowel including TORCH infections, cystic fibrosis, and bleeding. She has not had any obvious bleeding where we would suspect fetal swallowing, but it is still a possibility. Her CF screen is negative which reduces this risk significantly. I suggested that she have TORCH titers drawn, both IgM and IgG at her next visit for her Glucola in early
The bulk of the patient interaction is going to take place during the actual ultrasound procedure. “The most appropriate procedure plan seeks to optimize patient safety and comfort, diagnostic ultrasound quality and efficient use of resources, while achieving the diagnostic objective examination” (CITATION). Here it is the job of the sonographer to take all the previously gathered information and develop a diagnostic procedure plan for the patient. It is important for the sonographer to keep the patients age and gender in mind and use professional medical judgment to adapt the procedure to meet the patient’s needs and enhance examination results.
Describe the clinical findings that may be present in a patient with this issue? Symptoms of a patient presenting with ovarian torsion includes pelvic or abdominal pain fluctuating, radiating to loin or thigh, occasionally accompanied with
Obstetric Ultrasound -- a Comprehensive Guide to Ultrasound Scans in Pregnancy. Mar. 2006. Web. 13 Apr. 2011. .
Also assessing if she’s had any gynecological surgeries throughout her life is beneficial in seeing if her symptoms are possibly related to menopause. These surgeries would include a...
Diagnostic imaging is commonly used for ultrasounds for finding out the sex of the baby during pregnancies. Sonography can additionally be used to identify such things as coronary illness, heart attacks, and vascular ailment that can possibly prompt stroke. Which then, brings into the other fields of sonography such as the following: abdominal sonography, musculoskeletal sonography, neuro-sonography, and cardiovascular sonography.
..., it is necessary to describe them in detail to the patient and to give a prognosis, as far as available medical knowledge will allow, regarding the outcome of pregnancy and postnatal development. To assist the patient in making a decision on the disposition of the pregnancy, prognostication should include medically documented risk figures. Ethically, pregnancy termination should not be recommended made to the patient and her family and significant others. This option should be discussed, but the ultimate decision of whether to continue the pregnancy should be left to the patient and her family and significant others. Furthermore, I think, it is better to refer her to the teratogen or genetic counselor to help her by providing the patient with as much information as possible and encourage her to make her own decision regarding whether to continue the pregnancy.
She complains that she is nauseated, vomiting and having headaches. When I completed the psychosocial assessment on her, she was very emotional. Her mother is 37 years old, and her two sisters are 17 years old and 21 years old. Although both her sisters are close in age with her she is not close to them as she feels she should be. Due to not having much support, she feels alone. Therefore, no one is really guiding her in the right direction. She wants better and realizes that she needs to do better when it pertains to her unborn.
Whereas signs and symptoms to the mother can include: rapid uterine contractions, back and abdominal pain, vaginal bleeding, and uterine tenderness. Direct causes sometimes can correlate with direct injury to abdominal wall, rapid loss or excess of amniotic fluid, the mother’s lifestyle choices, hypertension, advanced maternal age, diabetes mellitus, and prior placental abruption. Although, preventive measures for placenta abruption is uncommon, attention to ongoing medical evaluation of fetal and maternal welfare connected with consideration of risk factors, outcomes can be
...e no harm inflicted on the mother and there would be no need to go the hospital in the first place. However, Doctors have many years of experience to know what a woman needs when it comes to medical procedures.
Sarah came in on 2/22/18 complaining of vaginal pain and had a rash. She tested positive for hepatitis. On 2/21/18, Sarah took a bath and went to church. While at church she stated having pain and called Patricia to get her. The next day she still was in pain. The reporter examined Sarah, and she had wet soil dirt in the external of her vagina. She had grass and strass on the internal of her vagina. She had multiple redness blisters on the inside of her vagina. Sarah did not make contact, seem shy, and uncomfortable, this could have been due to having the exam done. Sarah told the reporter that she was sitting on the couch without panties on. She said she was not touched or had intercourse with anyone. Sarah is a little slow
Ultrasounds are the standard procedure for visualizing a fetus to establish certain conditions and to identify abnormalities. Traditionally, two-dimensional (2D) ultrasounds have been used, but in recent years three-dimensional (3D) and real time three-dimensional (4D) have been introduced. With these new options it is important to know the risks and benefits of 2D ultrasounds versus 3D/4D ultrasounds.
There is also a high-resolution ultrasound scanning that can detect chromosomal and physical abnormalities in the first trimester as opposed to the second trimester. A technology such as this can create many ethical problems. Mcfadyen describes the biggest problem as being informed consent. “They may believe that it will provide information only about gestational age and be unaware of the range of abnormalities that can be detected. Recent research suggests that many women are not told beforehand of the first scan’s potential to detect fetal anomalies.”