Less Scary Diagnoses
A disease associated with terminal dysuria, urinary frequency, and sometimes lower back pain.
What is a urinary tract infection (UTI)?
Periumbilical pain that then localizes to the RLQ is associated with this disease
What is appendicitis?
A test to rule out a urinary tract infection (UTI)
What is a urine dipstick?
A population that should be screened for IPV, as recommended by the American College of Ob/Gyn
What is all patients who come to them (family planning patients, all ob-gyn patients, all prenatal patients)?
Two roles of the healthcare provider in the case of IPV
What is:
acknowledge abuse and health implications
support patient
confidentiality
cultural sensitivity
address safety
consider impact of abuse on children
validate the patient, abuse is not the victim's fault
interview the patient alone
create a safe environment (including clinic posters)
Soft stool leaking around an impacted hard stool
What is impaction?
A surgical emergency that is more likely with a history of pelvic inflammatory disease
What is an ectopic pregnancy?
A test that should be performed on any patient physically able to get pregnant
What is a urine pregnancy test?
Three red flags for IPV
What are:
delay in seeking medical care
non-adherence to treatment plan
partner insisting on staying close and answer questions directed to patient
hesitancy or not answer questions or inconsistent/incorrect answers
shyness or reticence in answer questions
explanation of problem or incident does not match severity of findings
State law requires report of this to child protection services
What is a child that has been abused or is at risk of abuse as a result of IPV, either intentionally or unintentionally?
[State laws are unclear about mandated reporting of IPV in the absence of injury or serious risk to the child.]
Health Care Provider Mandatory Reporting of Domestic Violence to Law Enforcement in San Francisco
California Penal Code section 11160 requires health care practitioners who provide medical services for a wound or physical injury inflicted as result of assaultive or abusive conduct, or by means of a firearm, to report that incident by phone, and in writing, to local law enforcement.
A disease characterized by abdominal pain, bloody diarrhea, and frequent stooling
What is inflammatory bowel disease (IBD)?
A disease associated with painful/heavy menstruation and dyspareunia
What is endometriosis?
Imaging to evaluate a pelvic mass, the size of uterus/ovaries, location of a pregnancy
What is a pelvic ultrasound?
Three symptoms or complications that survivors of IPV are more likely to experience
What are:
migraines, frequent headaches
chronic pain syndrome
heart, blood pressure problems
arthritis
stomach ulcers, frequent indigestions, diarrhea, constipation, irritable bowel syndrome, spastic colon
dyspareunia, dysmenorrhea, vaginitis, pelvic inflammatory disease, chronic pelvic pain syndrome, etc. gynecological diagnoses
invasive cervical cancer and preinvasive cervical neoplasia
depression, anxiety, PTSD
Two nonjudgmental ways to ask about IPV
What is:
"Do you feel safe at home?"
"Because violence is so common, I ask all my patients about it. Is anyone now or has anyone in the past hurt you emotionally, physically, or sexually?"
"All couples disagree sometimes. What happens when you disagree?"
"Does your partner ever force you to do things you do not want to do or keep you from doing things you want to do?"
"I often see the type of symptoms that you have in people who are being hurt at home or in a relationship. Do you think that this might be happening to you?"
The Rome IV Criteria helps diagnose this (and give me some examples)
What is Irritable Bowel Syndrome (IBS)?
A single episode of this disease portends you to a 33% chance of tubal adhesions leading to infertility
What is pelvic inflammatory disease (PID)?
Preferred test for evaluating a patient with yellow discharge, abdominal pain, and dyspareunia
What is the chlamydia/gonorrhea DNA probe?
Three signs a child has been exposed to domestic violence
What is:
obvious physical signs of physical or sexual abuse
behavioral or emotional problems (e.g. increased aggression, fear or anxiety, difficulty sleeping or eating, etc. emotional distress)
chronic somatic concerns
Two parts of the IPV safety assessment
What are:
increasing severity of violence
presence of gun in the house
threats to kill or commit suicide by either victim or abuser
use of drugs or alcohol by victim or abuser
victim trying to leave or left recently
harm to children
A syndrome described by vaginal discharge, discomfort, dyspareunia and pelvic pain
What is vaginitis?
What is the ovary (e.g. ovarian torsion, ruptured cyst, ectopic pregnancy)?
A test to diagnose trichomonas, bacterial vaginosis, or yeast vaginitis
What is the KOH/saline wet prep?
Three phases in an escalating cycle of IPV
Tension-building phase
Crisis phase (when overt violence is likely to occur)
Calmer phase (abuser may ask for forgiveness or be affectionate)
[In most cases, the cycle begins again and escalates in severity of violence.]
Three ways of documenting suspected IPV
What is:
documenting abuse history as reported by patient in the subjective
using the patient's own words in quotes
using neutral language (e.g. "patient states...")
describing the patient's appearance, behavioral indicators, injuries and stages of healing, health conditions
taking photos of injuries, including one with the face
drawing injuries on a body map (in blue ink)