Medical professionals: 19 year old female complaining of lower abdominal cramping and brownish vaginal discharge?

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I’m an EMT and first year medical student. If you have an answer, please explain so that I can learn!

This is a hypothetical scenario that my teacher gave me in class the other day. I’m trying to better understand the treatment and diagnoses process.

What would you do for a 17 year old female complaining of lower abdominal cramping and brownish vaginal discharge? She claims not to be expecting her period for another 2 weeks, but describes the pain as similar to that of severe menstrual cramps.
She says that she hasn’t had sex since her last period, so I ruled out pregnancy.
She has no past history of this, is on no medications, and experienced no trauma.

I suspect a vaginal or internal infection. Please tell me if you agree or disagree, and why!

Thanks!

5 Replies to “Medical professionals: 19 year old female complaining of lower abdominal cramping and brownish vaginal discharge?”

  1. It could be a pelvic inflammatory disease perhaps? It sometimes produces a brown discharge. Or some form of vaginal infection.

  2. It’s still important to consider the possibility of pregnancy. You might inquire as to the nature of her previous period… if it was lighter or heavier than usual or if it didn’t occur quite at the usual time, it may have been an episode of abnormal vaginal bleeding from being pregnant and she mistook it for her period. If that’s the case, her current troubles could easily be from miscarriage or tubal pregnancy so be sure to do a pregnancy test.

    If the pregnancy test is negative then you can ignore those possibilities. You’ll want to do a pelvic exam to ensure that there isn’t a lesion in the vagina that could be causing this (in 17 year old girls it almost never is but still…) and you’ll want to see what the cervix looks and feels like (in 17 year old girls, cervicitis is a prime concern) and you’ll want to see if there’s anything suggestive of pelvic inflammatory disease (ditto).

    If all of that is negative you may wish to consider dysfunctional uterine bleeding. Good luck!

  3. You aren’t delivering the diagnosis, so go by that. Your job is to stabilize and transport. You just might make a diagnosis, as in some rare cases. So what you do is find out when she ate and drank last.

    You report these things on the radio connection you have. Include vital signs. include your assessment signs as well.

    In a case of making a diagnosis, do a pregnancy test, ectopic pregnancy, vaginal infection, consider PID, consider normal menstruation since that can sometimes be brown, consider that she is having something else not well seen by your field exam (say a bowel problem).

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