Name : Mrs. Maggie Meriwether Age : 56 years old Gender : Female Description Mrs
ID: 136676 • Letter: N
Question
Name: Mrs. Maggie Meriwether
Age: 56 years old
Gender: Female
Description
Mrs. Meriwether is a 56-year-old woman, who was apparently in good health until six months ago, at which point she started noticing an uncontrollable urge to urinate when she was exercising, lifting weights, sneezing, or coughing. The embarrassing part for her is that, although she has tried to suppress the urge, she has voided in her underwear very often. The problem has become more frequent, and she has to wear a sanitary pad constantly. The patient also shares that she has something protruding through her vagina. She is anxious because she thinks she has a tumor. After conducting a thorough medical interview and physical examination, the doctor diagnoses stress urinary incontinence and cystocele.
Our patient is a mother of four children with vaginal deliveries complicated by shoulder dystocia. During her last pregnancy, she had a whitish and cottage cheese-like vaginal discharge. A year ago, Mrs. Meriwether had an episode of gastroenteritis accompanied by profuse vomiting and diarrhea, which produced moderate dehydration and electrolyte and acid-base imbalances. Our patient also indicates she has had two episodes of right renal colic produced a renal lithiasis. Patient has no history of smoking or alcohol intake.
On physical examination we found:
Remarkable Signs on Physical Exam by Systems
Urinary system: Leakage of urine through the urethra during Valsalva maneuver
Reproductive system: Soft mass protruding through the vagina, mostly when the patient is pushing
Lab Tests
Complete blood count (CBC)
Urinalysis
Pelvic ultrasound
Cystourethrogram
Based on the case study provided, respond to the following questions:
Identify and differentiate the symptoms from the signs in this patient.
Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis?
What results do you expect to find in the tests ordered?
What are some future complications the patient is at risk of developing?
Explanation / Answer
1 Signs is a phenomenon noticed by someone other than the individual .The signs are leakage of urine through the urethra during Valsalva maneuver and soft mass protruding through the vagina when the patient is pushing and also she had a whitish and cottage cheese like vaginal discharge during her last delivery..Symptoms is a phenomenon that is noticed by the individual affected with the disease.Symptoms in this case are when the patient started noticing an uncontrollable urge to urinate when she was excercising,lifting or sneeezing.She also noticed something protruding through the vagina.
2 As per the scenario Mrs Maggie is the mother of four children with a history of complicated deliveries.Pregnancy ,number ofchildbirths are all connected to urinary inontinence.As the number of pregnancy increases the risk of incontinence also increases.The main reason for lack of bladder control is caused by pelvic organ prolase .During each pregnancy the bladder wall becomes weaker and result in droooping of bladder and result in cystocele.So the expected diagnosis is Uterine prolapse.but she had two episodes of renal colic too .So urolithiasis cannot be ruled out.
3 Normally to determine the stress incontinence doctors suggest urinalysis,CBC,Pelvic ultrasound,Cystourethrogram.It is also done to rule out UTI,abnormal growths in the pelvic area,lack of pelvic support due to repeated pregnancy,injury or surgery in the pelvic region.Urinalysis to detect for sign of bacterial infection and cystourethrogram to detect bladder problems.Pelvic ultrasound will clearly give the cause of the problem.it could be a cystocele or uterine prolapse.
4 The patient had a history of two episodes of renal colic and chances of urolithiasis may occur in the future.
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