Orta yaşlı bir kadında çözülmemiş ağrı: entegre bir aile hekimliği yaklaşımı

Year 2023, Volume: 48 Issue: 3, 1193 - 1195, 30.09.2023

Halime Seda Küçükerdem , Olgu İş , Ozden Gokdemır

https://doi.org/10.17826/cumj.1309589

Abstract

47 yaşında kadın hasta COVID-19 şüphesiyle polikliniğe başvurmuştur. Hastanın ateş, ağrı ve anosmi gibi spesifik olmayan semptomları vardır. Aile hekimi Enfluvir, D vitamini, etol-fort tb reçete etmiştir. İlaç tedavisinden sonra bitmeyen ağrıları nedeniyle tekrar kliniğe gelmiştir. İlk başvurduğu aile hekimi, hastanın en az iki buçuk yıldır otururken ağrılarının olduğunu ve son zamanlarda ağrı kesici kullanmasına rağmen ağrılarının daha fazla olduğunu söylemesi üzerine sakroiliak bölge için Manyetik Rezonans Görüntüleme istemiştir. Sakroiliak eklemin kontrastsız MRG'sine göre: "eklem yüzeyleri düzensizlik ve daralma gösterir. Yağ baskılı aksiyel ve koroner sekanslarda sağda posteriorda daha belirgin eklem yüzeylerinde fokal kemik iliği ödemi ve sakroiliit aktivasyonu mevcuttur. Kesitler içerisinde sağ adneksa 8 cm'lik kistik görünümdedir. MR ve alt batın USG önerilmektedir.". Romatoloji ve jinekoloji konsültasyonları ile birlikte laboratuvar ve ayrıca IV kontrastlı pelvis MRG ve ultrasonografi planlandı.

Keywords

ağrı, aile hekimliği, menopoz öncesi

Project Number

yok

Unresolved pain in a middle-aged woman: an integrated family medicine approach

Abstract

47 years old woman had applied to the outpatient clinic as she was suspicious because of COVID-19. The patient has non-specific symptoms such as fever, pain, and anosmia. The family physician has prescribed Enfluvir, vitamin D, etol-fort tb . After the medication, she has come to the clinic again because of the not finished pain. The family physician that the first one consulted has ordered Magnetic Resonance Imagining for the sacroiliac region as the patient told that the pain when she was sitting for at least two and half years and nowadays her pain was more although she was taking her painkillers. According to the non-contrast, MRI of the sacroiliac joint: “ joint surfaces exhibit irregularity and narrowing. In the posterior, more prominent articular surfaces on the right in the fat-suppressed axial and coronary sequences, there is focal bone marrow edema and sacroiliitis activation. The right adnexa within the sections showed an 8 cm cystic appearance. MRI and USG of the lower abdomen are advised.”. The lab and also with IV contrast, MRI of the pelvis, and ultrasonography were planned with the rheumatology and gynecology consultations.

Keywords

premenaopose, women health, pain management, primarycare, family medicine

Supporting Institution

yok

Project Number

yok

Thanks

All of the authors would like to thank Mr Simon Mumford for his English language editing.

References

• Cubaka VK, Dyck C, Dawe R, Alghalyini B, Whalen-Browne M, Cejas G et al. A global picture of family medicine: the view from a WONCA Storybooth. BMC Fam Pract. 2019;20:129.
• Fukuta H, Ohte N, Mukai S, Saeki T, Asada K, Wakami K et al. Elevated plasma levels of B-type natriuretic Peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J. 2009;50:301-12.
• van der Heide I, Snoeijs S, Quattrini S, Struckmann V, Hujala A, Schellevis F et al. Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project. Health Policy. 2018;122:36-43.
• Moro F, Esposito R, Landolfo C, Froyman W, Timmerman D, Bourne T et al. Ultrasound evaluation of ovarian masses and assessment of the extension of ovarian malignancy. Br J Radiol. 2021;94:1125.
• Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 2013;26:191-6.
• Gokdemir O, Kartal M. Community-based screening: reaching the target population. Turkish Journal of Family Medicine and Primary Care. 2020;14:368-76.
• Schreuders EH, Ruco A, Rabeneck L, Schoen RE, Sung JJ, Young GP, Kuipers EJ. Colorectal cancer screening: a global overview of existing programmes. Gut. 2015;64:1637-49.
• Aygün O, Gökdemir Ö, Bulut Ü, Yaprak S, Özçakar N. Evaluation of women’s beliefs about pap smear screening using the health belief model scale. Journal of Istanbul Faculty of Medicine. 2020;83:421-6.
• Batur ÜB. Aile hekimliğinde erişkin kolon, meme, serviks kanseri taramaları. in Aile Sağlığı Merkezi Yönetimine Güncel Yaklaşım (Ed Ö Gökdemir):107-117. Ankara, Akademisyen Kitabevi, 2021.