GROUP TWO

This is the case of Mrs. OB, 40-year old female seen at the clinic due to post-coital vaginal spotting. Her condition has been progressive for the past 4-5 months already. Recently, there has been a foul smelling vaginal discharge. The patient likewise recently noticed that her right leg seems larger than the left. She has 4 children(G4P4), the youngest is 15 years old.

On examination, the pertinent findings are: flabby abdomen, normoactive bowel sounds, with slight tenderness in the hypogastrium, there is flank tenderness (“kidney punch test”). Pelvic examination shows normal female external genitalia; speculum examination reveals a 1x2 cm erythematous lesion on the surface of the cervix uteri. The circumference of the right thigh and leg are larger than the left. There are some palpable lymph nodes on the inguinal area(both sides).

A consult with their family doctor revealed a possible gynecological malignancy.

Summarize the salient features of the case and attempt to anatomically

explain the signs and symptoms of the patient on the context of a

gynecological complaint.(if possible, propose a pathophysiological

mechanism to anatomically explain the manifestations.

Salient Features

Post-coital Vaginal spotting-progressive for the past 4-5 months

Foul-smelling vaginal dischargeRight leg larger than the left

Post coital bleeding can happen when you are pregnant and when you are not pregnant. Below are the top reasons for bleeding after sex:Infection of the cervix (cervicitis) Infection of the vagina (vaginitis) Abnormal cervical cells Fibroids Trauma of the vagina Trauma of the cervix Cervical polyp Uterine polyp Threatened miscarriage (if you are pregnant) Ectopic pregnancy (if you are pregnant) Penis trauma (from him) Blood in semen (from him)

Discharge Foul Smelling VaginalA discharge, foul smelling vaginal type, can indicate bacterial or viral STD infections such as HPV (genital wart virus). Fishy and unpleasant smell that stems from secretions expelled from the vagina is common and usually associated with malicious secretions that appear due to a variety of causes. The secretions may lead to skin irritation, swelling of the lips, and discomforts in the genitals. A discharge, foul smelling vaginal type, can indicate bacterial or viral STD infections such as HPV (genital wart virus).

Physical examination

Flabby abdomen Normoactive bowel soundsNormal external genitalia

(normal)

SIGNS AND SYMPTOMS

Slight tenderness of the hypogastriumFlank tenderness (+KPT)Speculum examination reveals 1x2cm erythematous lesion on the surface of the cervix uteriCircumference of the right thigh and leg are larger than the leftPalpable lymph nodes on the inguinal area (both sides)

(abnormal)

Pain in other regions of hypogastriumPain localized in other areas of the lower part of abdomen, caused by the disease process within organs in this anatomical region. It may have diverse character and intensification.

What organs are found in the Hypogastrium region?

Bladder, Prostate(male), Ovaries(female), cervix(female), Testes(male), Penis(Male), Colon, and the Anus.

Flank pain: A feeling of distress and agony caused by the stimulation of pain nerve endings in the flank.

The clinician must consider urinary tract disorders, vascular disease, gastrointestinal processes, obstetric or gynecologic conditions, pulmonary illnesses, musculoskeletal problems, dermatologic entities, and neurologic pathology in the differential diagnosis.

Erythematous Lesion: Redness of the cervix uteri surface caused by dilatation and congestion of the capillaries, often a sign of inflammation or infection.

Most of the time, early cervical cancer has no symptoms.

Symptoms that may occur can include:

Continuous vaginal discharge, which may be pale, watery, pink, brown,

bloody, or foul-smelling Abnormal vaginal

bleeding between periods, after intercourse, or after menopause

Periods become heavier and last longer than usual

Symptoms of advanced cervical cancer may include:Loss of appetite Weight loss Fatigue Pelvic pain Back pain Leg pain Single swollen leg Heavy bleeding from the vagina Leaking of urine or feces from the vagina Bone fractures

Cervical cancer is a malignancy of the cervix. Worldwide, it is the second most common cancer of women. It may present with vaginal bleeding but symptoms may be absent until the cancer is in advanced stages, which has made cervical cancer the focus of intense screening efforts utilizing the Pap smear. Most scientific studies point to human papillomavirus (HPV) infection as a necessary pre-requisite for development of cervical cancer. Treatment is with surgery (including cryosurgery) in early stages and chemotherapy and radiotherapy in advanced stages of the disease. An effective vaccine for the two most common strains of HPV has recently been licenced

Cervical cancers start as an abnormality of cells on the surface of the cervix. These abnormalities are not cancerous. They include dysplasia, squamous intraepithelial lesions (SIL) and carcinoma in situ. If undetected or untreated, these pre-invasive abnormalities eventually may invade normal cells of the cervix. As a result, cancer may develop, invading surrounding tissues or lymph nodes and possibly spreading to other parts of the body.

If these lesions have not invaded normal cells of the cervix, treatments may be relatively simple and straightforward.Pre-cancerous changes of the cervix usually don't cause pain. In fact, they generally don't cause symptoms and aren't detected unless a woman has a pelvic exam and a Pap test.Symptoms usually don't appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding, which may start and stop between regular menstrual periods or may occur after sexual intercourse, douching or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual.Bleeding after menopause also may be a symptom of cervical cancer. Increased vaginal discharge is another symptom of cervical cancer.