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-236220-838835Pelvic Pain ScenariosGynecological versus nongynecological pelvic pain scenariosScenario 1A 16-year-old female presents to the office with complaint of pelvic pain. It started yesterday, as a dull ache on the left side. It got so severe last night that she almost went to the ER. She took ibuprofen and finally fell asleep. Today it still hurts, but is less severe. She denies fever and chills. Her LMP was 3 weeks ago. She is not sexually active and never has been.ExamAppears in mild discomfort, but no acute distressPelvic exam: Tenderness and fullness L adnexaAbdominal exam: No rebound or guarding, painful LLQ, normal bowel soundsCBC: NormalCMP: NormalSerum HCG: NegativeSTI screening: NegativePelvic ultrasound: 3 cm. L ovarian cyst with fluid in the cul-de-sacScenario 2A 44-year-old female presents to the office with a chief complaint of pelvic pain. It started about 3 days ago as a dull ache, but is becoming more severe. She has had diarrhea with blood today and is very nervous. This has never happened to her before. She feels like she has a fever but has not taken her temperature. She has an IUD for contraception that was inserted 3 years ago. She has not had any problems since the IUD was placed. She has very light periods once a month. Her LMP was 1 week ago.ExamTemperature: 99.8; rest of vital signs normalAbdominal exam: Hyperactive bowel sounds, diffuse tenderness over lower abdomen/pelvic area, with guarding midline, below umbilicus. No rebound.Pelvic exam: Pain with speculum insertion, pain with bimanual exam. IUD strings visible. No vag bleeding or discharge.Pt refuses rectal exam due to pain. CBC normal except mild WBC elevation, mild anemiaSerum HCG negativeUA negative, culture negativeSTI screening negativeCT scan shows inflammation in the colon with outpouching near the proximal rectal area. ................
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