Question 1

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Medicine

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Apr 3, 2024

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Uploaded by ballerhoward

Class, Great set of questions this week! To name a few, constipation, appendicitis, IBS, ulcerative colitis, Crohn’s disease, and diverticulitis (ACOG, 2023). These all would get diagnosed in different ways, Most common are, CT, X-rays, physical exams, and ultrasounds (ACOG, 2023). Gynecological issues that would cause pelvic pain are PID, ovarian cyst, UTI, and ruptured fallopian tube (ACOG, 2023). They would also get diagnosed in the same manner with a thorough PE and possible ultrasound, CTs, and possible MRIs (ACOG, 2023). Some more causes of chronic pelvic pain would be IBS, pelvic floor discomfort, IBD, endometriosis, and diverticulitis. These can be diagnosed with a thorough PE, patient statements, and laboratories. Yes, menstrual cramping and abnormal ovulations (ACOG, 2023). The pelvic floor tends to become flaccid and lose muscular elasticity over time, in older women. Younger women tend to have abnormal and irregular menses at times (NLM, 2023). Rectal bleeding can be a huge concern with all of the ages listed above as well (NLM, 2023). Although chronic pelvic pain is common some medications and techniques can be used to decrease the symptoms. Often a GYN and GI clinician can be very beneficial in diagnosing these processes. Uterine fibroids are also very common, from what I am learning. Counseling and vast education management can effectively enhance QoL and increase the chances of getting pregnant. During this rotation, I have educated more patients than any other discipline. References: The American College of Obstetricians and Gynecologists. (2023). https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/03/chronic-pelvic- pain National Library of Medicine. (2023). Chronic pelvis pain. https://pubmed.ncbi.nlm.nih.gov/27634190/

Suzanna, The information you provided is very insightful, as always! Endometriosis, despite only affecting 10-15% of women of fertile age, is still an enigmatic disease (Garcia-Fernandez & García- Velasco, 2022). Recent developments in assisted reproductive technology have contributed to a better understanding of where and how endometriosis could compromise fertility (Garcia- Fernandez & García-Velasco, 2022). It is important to note that not all women with endometriosis suffer from infertility. However, the prevalence of the disease is much higher in infertile women (around 30-40%) than in the fertile population (10-15%) (Garcia-Fernandez & García-Velasco, 2022). This does not mean that all women with endometriosis will have difficulty having children, and vice versa, not all infertile women have endometriosis. Young women with endometriotic ovarian cysts showed a similar ovulation rate in the healthy ovary than in the affected ovary (Garcia-Fernandez & García-Velasco, 2022). Many infertile women with endometriosis require assisted reproductive treatment (ART) to get pregnant, and this has been a great learning tool to understand how endometriosis affects fertility (Garcia-Fernandez & García-Velasco, 2022). This disease may affect the reproductive process in almost all aspects, but we will focus on those where the evidence is convincing enough to prove a causal relationship (Garcia-Fernandez & García-Velasco, 2022). Often in the ER, we see returning patients because they do not have insurance to be followed by a specialist, so sad. I also work in hospice, I see patients years down the road in hospice that I have seen in the ER. References: Garcia-Fernandez, J., & García-Velasco, J. A. (2022). Endometriosis and Reproduction: What We Have Learned. The Yale journal of biology and medicine , 93 (4), 571–577. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513434/

Brandie, I really enjoyed the information on the complete workup on your patients and how imperative it is. I read that the major causes of morbidity and mortality experienced by adolescents in the United States can be attributed to preventable causes, including sexually transmitted infections, suicide, unintended pregnancy, accidents, and obesity (Kershnar et al., 2022). Only 39 percent of adolescents received any type of preventive counseling during ambulatory visits (Kershnar et al., 2022). The relationship between physician training in adolescent health care and the delivery of comprehensive health services to teenagers has been well documented, and professional societies, including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG), have recommended increased adolescent medicine training in primary care residencies (Kershnar et al., 2022). For many adolescent patients, pediatricians are their only medical care provider when they enter their teen years. Pediatricians are in a unique position to build upon the continuity, trust, and familiarity that this relationship fosters and initiate patient education and counseling regarding the primary health concerns faced by teens (Kershnar et al., 2022). It is important to provide residents with training and experiences that reflect the stated goals of comprehensive health care for adolescents in order to improve the delivery of health services to adolescents in the future (Kershnar et al., 2022). References: Kershnar, R., Hooper, C., Gold, M., Norwitz, E. R., & Illuzzi, J. L. (2021). Adolescent medicine: attitudes, training, and experience of pediatric, family medicine, and obstetric-gynecology residents. The Yale journal of biology and medicine , 82 (4), 129–141.

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