NRP 563 DQ 7

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Gastrointestinal conditions, such as appendicitis, genitourinary issues like urinary tract infections(UTIs), and musculoskeletal problems, including muscle sprains, can result in various distressingsymptoms that require careful evaluation (Schuiling & Likis, 2022).A range of targeted tests can be used to diagnose these conditions effectively. For appendicitis,we can assess tenderness at McBurney's point and conduct a CT scan of the abdomen forconfirmation. In the case of UTIs, a urinalysis revealing the presence of nitrates can helpestablish the diagnosis. For muscle sprains, particularly those resulting from pelvic trauma,gathering a detailed patient history along with a comprehensive physical examination is crucial(Schuiling & Likis, 2022).Causes of gynecologic acute pelvic pain include abortion, ectopic pregnancy, and uterinefibroids. To diagnose these conditions, a positive pregnancy test usually indicates an abortion. Atthe same time, vaginal bleeding may be present in case of infection, along with elevated whiteblood cell count (WBC) and erythrocyte sedimentation rate (ESR) (Schuiling & Likis, 2022).Chronic pelvic pain can be caused by several conditions, including irritable bowel syndrome(IBS). To be diagnosed with IBS, a person must experience abdominal pain at least once a weekfor three months, along with two of the following symptoms: pain related to bowel movements,changes in the frequency of bowel movements (more than three times a day or fewer than threetimes a week), and changes in stool appearance (harder, softer, or more liquid). These criteriamust be met for at least three months, with symptoms beginning at least six months beforediagnosis (Rome Foundation, 2024). For Crohn's disease, an accurate diagnosis typicallyinvolves endoscopy, which allows doctors to examine the digestive tract directly. This is oftencombined with lab tests, physical exams, and a review of medical history (NTH: National

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Institute of Diabetes and Digestive and Kidney Diseases, 2024). Celiac disease is confirmedthrough an intestinal biopsy, which examines the small intestine for damage caused by gluten.Proper diagnosis is essential for effective treatment of both conditions Celiac DiseaseFoundation, 2025).Common non-gynecologic causes of pelvic pain in adolescents include genitourinary,gastrointestinal, musculoskeletal, and psychological disorders. A prospective observational studywas conducted to investigate the potential role of endometriosis as an etiological factorassociated with unexplained infertility and chronic pelvic pain (CPP) in a cohort of 100 womenof reproductive age. Following laparoscopic examination, it was determined that 33% of theseparticipants were diagnosed with endometriosis. Among those diagnosed, significant associationswere identified with several factors, including the experience of dysmenorrhea, a history of priorpelvic surgery, and elevated levels of CA-125. This biomarker is correlated with the severity ofendometriosis. For perimenopausal women, pelvic pain considerations are low back pain, sleepdisorders, and chronic fatigue. Older women are undergoing considerable changes. Theresearchers found that women with CPP experienced significantly more depression, infertility,miscarriages, and terminated pregnancies, cesarean births, multiple somatic symptoms, fatigue,and decreased quality of life, compared to women without CPP (Schuiling & Likis, 2022).

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References:Celiac Disease Foundation. (2025). Diagnosis, https://celiac.org/about-celiac-disease/screening-and-diagnosis/diagnosis/NIH: National Institute of Diabetes and Digestive and Kidney Diseases (2024). Diagnosis ofCrohn's Disease, https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/diagnosisRome Foundation. (2024). ROME IV diagnostic criteria. For disorders of gut-brain interaction(DGBI). https://theromefoundation.org/wp-content/uploads/Rome-Foundation-Diagnostic-Criteria-Booklet-2019.pdfSchuiling, K. D., & Likis, F. E. (2022). Gynecologic health care: With an introduction to prenataland postpartum care (4th ed.). Jones & Bartlett Learning.How would you diagnose ectopic pregnancy?According to Tulandi (2024), the majority of ectopic pregnancies occur in the fallopian tube;nontubal sites include cervical, interstitial, ovarian, and abdominal pregnancy. Otherabnormally implanted pregnancies, including hysterotomy, cesarean, myomectomy, scarpregnancies, can also occur. In rare cases, a multiple gestation may be heterotopic (includeboth an intrauterine and extrauterine pregnancy). Rupture of an ectopic pregnancy can result inlife-threatening hemorrhage. Clinical presentation of ectopic pregnancy is first-trimester vaginalbleeding and/or abdominal pain and may also be asymptomatic. In addition, Tulandi (2024)wrote that clinicians should consider ectopic pregnancy as a diagnosis in any patient ofreproductive age with vaginal bleeding and/or abdominal pain who has the followingcharacteristics: pregnant but does not have a confirmed intrauterine pregnancy, pregnant and

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conceived with in vitro fertilization, pregnancy status uncertain, particularly if amenorrhea of >4weeks preceded the current vaginal bleeding, and in patient who presents with hemodynamicinstability and an acute abdomen that is not explained by another diagnosis in rare cases.Ectopic pregnancy typically appears six to eight weeks after the last normal menstrual period.However, it may occur later, especially if the pregnancy is at an extrauterine site other than thefallopian tube. Normal pregnancy discomforts such as breast tenderness, frequent urination,and nausea are sometimes present. Early pregnancy symptoms may be less common inpatients with ectopic pregnancy because progesterone, estradiol, and human chorionicgonadotropin levels may be lower than in normal pregnancy.The diagnosis of ectopicpregnancy can be confirmed by visualization of an extrauterine gestational sacwith a yolk sac or embryo (with or without a heartbeat) on TVUS, a positive serumhCG, and no products of conception on uterine aspiration with subsequent risingor plateauing hCG levels, and visualization at surgery with histologic confirmationfollowing resection of ectopic pregnancy tissue.According to Tulandi (2024), most ectopic pregnancies occur in the fallopian tubes, but they canalso happen in places like the cervix, ovaries, or abdomen. Occasionally, a woman may haveboth an intrauterine and an extrauterine pregnancy, known as a heterotopic pregnancy. A rupturecan lead to serious bleeding. Signs of ectopic pregnancy typically include vaginal bleedingand/or abdominal pain during the first trimester, although some may have no symptoms. Doctorsshould consider this diagnosis if a patient is bleeding, is pregnant without a confirmed normalpregnancy, conceived through in vitro fertilization, or is uncertain about their pregnancy status,especially if they've missed their period for over four weeks. Ectopic pregnancies are usuallynoticeable about six to eight weeks after the last normal menstrual period, but they can appearlater. Normal pregnancy symptoms like breast tenderness, frequent urination, and nausea mightbe less common due to lower hormone levels. Diagnosis involves checking for an extrauterinegestational sac through transvaginal ultrasound, a positive blood test for hCG, and ensuring no

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