Patient History and Case Summary
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Patient History and Case Summary
A 32-year-old female patient’s chief complaint is increased body temperatures, anxieties, nausea, vomiting, and vaginal discharge. She confirms that symptoms started 3 days ago but thought it was the flu from the history taking. She has LLQ pain and reports bilateral lower back pain. The patient doesn’t have dysuria, foul-smelling urine, or in frequency. She is married and engages in sexual intercourse with her husband. PMH is negative. The lab results show CBC-WBC 18, Hgb 16, HCT 44, Platelet count of 325, high Neutrophils and Lymphocytes, sedimentation rate of 46 mm/hr., CRP of 67 mg/L.
The patient’s vitals were body Temperature of 103.2 F, Pulse of 120, Respiratory rate of 22, and PaO2 of 99% on room air. A cardiorespiratory assessment showed normal limits except for tachycardia but the absence of murmurs, rubs, clicks, or gallops. The abdominal exam showed no rebound or rigidity, but there was LLQ pain. The pelvic examination revealed copious foul-smelling green drainage with the reddened cervix, positive bilateral adnexal tenderness, and positive chandelier sign. Wet prep test showed positive clue cells, and gram stains identified the gram-negative diplococci.
The Factors That Affect Fertility (STDs)
Infertility involves the inability to conceive after 12 months or more of unprotected sexual intercourse. Female fertility can be associated with several factors, including problems with ovulation, damages to the fallopian tubes, and problems with the cervix. These problems can be genetically influenced or can also be a result of diseases. Infertility in men can be caused by several factors, including sperm disorders, diseases, retrograde ejaculation, obstruction, genetic makeup, and others (Tsevat et al., 2017). Factors such as age, smoking, and other social behaviors also play a role in infertility. Chlamydia and gonorrhea are some of the sexually transmitted diseases which can cause infertility (Tsevat, Wiesenfeld, et al. 2017). In women, these two sexually transmitted diseases, if not treated, can cause permanent damage by forming scars in the female reproductive system. In the male, these STDs, if not treated, can cause damage to the epididymis and urethra, which can be a causative factor of infertility. In the above case, the patient has an STD, one of the causes of infertility because of the wet prep test results, and the pelvic examination results. However, the patient is fertile because she never reported infertility issues during the case history.
Inflammation In STD/PID
An increase in inflammatory markers is one of the common clinical signs of STDs and PID. PID is normally caused by the invasion of bacteria, which ascend to the endometrium and the fallopian tube (Park et al., 2017). These bacterial infections can cause inflammation at any point in the endometrium and fallopian tube, which leads to raised levels of inflammatory markers. In a research study done by Park et al. (2017), chlamydia infection and acute PID showed increased inflammatory markers such as CA-25, ESR, and CRP. The study suggested that the inflammatory markers caused longer periods of hospitalization. There were increased levels of inflammatory mediators and markers such as CRP of 67 mg/L in the above patient.
Prostatitis and Systemic Reaction.
In such a case, prostatitis is caused by bacteria leaking into the prostate gland, leading to its inflammation. The infection starts with a urine leak to the prostate, which might be infected with the bacteria. Therefore, due to acute bacterial prostatitis, the body will react by the production of systemic symptoms such as increased body temperatures, chills, and nausea. Inflammatory mediators and markers play a significant role in triggering the systemic reactions of the body. In the above case, the patient manifested signs of acute bacterial prostatitis caused by the gram-negative diplococci because of the pelvic examination results and high levels of inflammatory markers.
Splenectomy After A Diagnosis Of ITP.
Patients with Immune Thrombocytopenic Purpura, ITP, normally do have an immune response, which destroys platelets. The spleen is the organ responsible for removing the damaged platelets, and its removal will play a significant role in keeping more platelets in blood circulation. Therefore, splenectomy is necessary for patients with ITP to reduce the immune system’s chances of removing platelets from circulation. The patient in the above case has a very low platelet count, which suggests that the patient has immune thrombocytopenic purpura. As a result of this disease, Splenectomy is important as it will reduce the removal of platelets, increasing the number of platelets in the blood.
Types of Anemia
Anemia is a condition in which the blood has a deficiency in healthy red blood cells and hemoglobin in the blood. The most common etiology of this condition is the low levels of iron in the body, and with such a scenario, the anemia is then referred to as iron-deficiency. There are two different kindly of anemia: Microcytic and Macrocytic anemia (Wang 2016). Microcytic anemia involves small and often hypochromic red blood cells in a blood smear characterized by low MCV of as little as 83 microns. Macrocytic anemia, on the other hand, is usually a result of large red blood cells, and these large red blood cells have low hemoglobin. In the above case, the patient doesn’t have anemia because of the normal hematocrit (HCT) of 46mm/hr.
References
Park, S. T., Lee, S. W., Kim, M. J., Kang, Y. M., Moon, H. M., & Rhim, C. C. (2017). Clinical Characteristics of Genital Chlamydia Infection in Pelvic Inflammatory Disease. BMC Women’s Health, 17(1), 1-7. doi: 10.1186/s12905-016-0356-9
Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually Transmitted Diseases and Infertility. American Journal of Obstetrics and Gynecology, 216(1), 1-9. doi: 10.1016/j.ajog.2016.08.008
Wang, M. (2016). Iron Deficiency and Other Types of Anemia in Infants and Children. American Family Physician, 93(4), 270-278.