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).
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
 Salient
Features
Post-coital Vaginal spotting
-progressive for the past 4-5
months
Foul-smelling vaginal discharge
Right 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)
Discharge Foul Smelling Vaginal
A 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
 SIGNS AND
SYMPTOMS
Physical
examination
(norm
al)

Flabby abdomen
Normoactive bowel
sounds
Normal external
(abnorm
al)

Slight tenderness of the hypogastrium

Flank tenderness (+KPT)
Speculum examination reveals 1x2cm
erythematous lesion on the surface of the
cervix uteri
Circumference of the right thigh and leg
are larger than the left
Palpable lymph nodes on the inguinal area
(both sides)
Pain in other regions of hypogastrium
Pain 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
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
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
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
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