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15 year old wakes up with abdominal pain, bloating, nausea and vomiting. What are the possibilities?

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We're writing a screenplay and want to find out the correct procedure. A 15 year old girl wakes up one morning with her abdomen quite bloated and she's throwing up and nauseated. She goes to the hospital. Would the doctor suspect a pregnancy, and if so, would he ask her if she's sexually active? Would a parent be present during the examination? And if she said she wasn't sexually active, would the doctor do an x-ray, ultra-sound, or MRI? c
Posted Thu, 30 May 2013 in Women's Health
 
 
Answered by Dr. Timothy Raichle 2 hours later
Hello, I would be happy to help you with your question.

So the scenario is a 15 year old female who awakes with abdominal pain, bloating, nausea and vomiting. The possibilites for something like this would include:
1. Pregnancy
2. Appendicitis
3. Ruptured ovarian cyst
4. Bowel obstruction

Of course, in any reproductive aged female, one has to suspect pregnancy. The thing arguing against pregnancy is that the "bloating" appeared so suddenly, but you could pose a scenario where she was hiding it from her mother and has now gone into labor, but is pitching it to her mother as "all of a sudden". I have actually taken care of patients in this exact scenario a couple of times.

The doctor might ask the daughter "is there a chance that you might be pregnant?", but the daughter (and the mother) are likely to say "that is not possible". And yes, the daughter could not be seen or treated without the mother present. The doctor would then do the following labs:
1. CBC - "complete blood count"
2. HCG = "blood pregnancy test"
3. Ultrasound of the abdomen and pelvis

And if she was NOT pregnant, then they would get "abdominal films" or "plain films of her belly". If these were negative, then they would probably get a CT of her belly. If her pregnancy test were negative, and they strongly suspected appendicitis, then they would probably just get a CT scan.

I hope that this helps. If you want me to help you further with the actual script, just let me know.
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Follow-up: 15 year old wakes up with abdominal pain, bloating, nausea and vomiting. What are the possibilities? 2 hours later
There's no reply. Why?
 
 
Answered by Dr. Timothy Raichle 1 hour later
It sounds like you may not have seen my answer to your questions. Please let me know if you specifically have more questions.

So the scenario is a 15 year old female who awakes with abdominal pain, bloating, nausea and vomiting. The possibilites for something like this would include:
1. Pregnancy
2. Appendicitis
3. Ruptured ovarian cyst
4. Bowel obstruction

Of course, in any reproductive aged female, one has to suspect pregnancy. The thing arguing against pregnancy is that the "bloating" appeared so suddenly, but you could pose a scenario where she was hiding it from her mother and has now gone into labor, but is pitching it to her mother as "all of a sudden". I have actually taken care of patients in this exact scenario a couple of times.The doctor might ask the daughter "is there a chance that you might be pregnant?", but the daughter (and the mother) are likely to say "that is not possible". And yes, the daughter could not be seen or treated without the mother present. The doctor would then do the following labs:
1. CBC - "complete blood count"
2. HCG = "blood pregnancy test"
3. Ultrasound of the abdomen and pelvis

And if she was NOT pregnant, then they would get "abdominal films" or "plain films of her belly". If these were negative, then they would probably get a CT of her belly. If her pregnancy test were negative, and they strongly suspected appendicitis, then they would probably just get a CT scan.I hope that this helps. If you want me to help you further with the actual script, just let me know.
Above answer was peer-reviewed by
 
Follow-up: 15 year old wakes up with abdominal pain, bloating, nausea and vomiting. What are the possibilities? 24 hours later
It's possible I may not have seen your answer on my phone, but then when I went on my computer it was there. So, thank you for responding.

Great answer, that helps us a lot. We're trying to be as accurate as possible with these doctor scenes and this is a great resource for our research. We'll keep this discussion open because I'm sure we'll have a few more questions.

Our story involves a 15 year old virgin who inexplicably becomes pregnant then discovers after the baby is born that it's not entirely human.

Thanks again!
 
 
Answered by Dr. Timothy Raichle 43 minutes later
Sounds good - let me know how I can help.
Above answer was peer-reviewed by
 
Follow-up: 15 year old wakes up with abdominal pain, bloating, nausea and vomiting. What are the possibilities? 18 hours later
Okay, let's say our 15 year old girl wakes up (before the bloated abdomen and nausea) and discovers she's been bleeding profusely from her vagina over the course of the night, soaking her pajama bottoms.

Her dad takes her to the ER.

What would the doctor check her for? What would he ask her? What might be the cause of the bleeding?

Could there be any logical reason for this amount of blood.
If blood tests are taken, how long does it usually take to get the results back?
 
 
Answered by Dr. Timothy Raichle 2 hours later
It is starting to sound a little bit like the movie Alien with Sigourney Weaver!

So the unsuspecting, average family goes to be one night, nothing out of the usual. In the middle of the night, the parents are slightly annoyed by the moonlit silhouette of their 15 year old daughter standing at the bedside. The father grumbles an utterance as he switches on a light to see that her daughter is drenched in blood from the waist down. She is speechless and scared, and the father immediately lifts her up and rushes her down to the car and his wife's scream is heard in the background as she discovers the bloody footprints leading into the bedroom. They place her into the back of the car with the mother and drive frantically the local ER.

They pull into the ER parking lot and the father starts to rush her to the ER doors which electronically open to stunned ER staff. "Trauma room #1 STAT" he hears. The nurses grab the daughter and the doctors immediately try to get information from the parents:

"When did this start?"
"Was she complaining of anything?"
"Is she sexually active?"
"Could she be pregnant?"

The parents are, of course, of no help, but deny any chance that 'their' daughter could be pregnant. Little do they know, they are right, but something more terrifying is going on.

The doctor rushes into Trauma Bay #1 where the nurses have layed the daughter onto a narrow gurnee. Blood has tracked onto the cart and a small puddle is now forming on the ground. They have begun to hook her up to heart monitors and another doctor frantically starts an IV and begins pushing fluids. They begin to ask the daughter the same questions, but this is interrupted by the fact that she has slowly slipped into unconsciousness.

The doctor screams orders for labs:

"I want a CBC, and type and cross her for 4 units, fluids wide open, chem panel...oh yeah and make sure they do a pregnancy test STAT".

Several minutes pass and while she is still unconscious, the bleeding has subsided. The doctor begins to slow things down and says "we need to do a full assessment" and they start cutting off her clothes. When her nightgown is removed, the entire room looks stunned as they notice the extreme bloating of her stomach, changing shapes and contorting in a way they have never seen.

About 5 minutes later, a nurse bursts into the room and screams "the pregnancy test....its...."

Her final words are muted by the sound of a crying fetus that is just delivering, but it is not the normal sound of a newborn, it's cries are odd and unfamiliar...............


How is that?
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Follow-up: 15 year old wakes up with abdominal pain, bloating, nausea and vomiting. What are the possibilities? 44 hours later
Earlier in our story, we have this small creature crawling up the girl's vagina while unconscious and the cause of the bleeding is when this "thing" crawls back out when she's asleep a few days later (her stomach isn't bloated yet).

How would the doctor inspect for trauma to her vagina/uterus? Would it be an MRI or would they insert a scope/camera inside her? And would they be able to see scrapes along the vaginal wall?

And she's stopped bleeding when she goes to the hospital.
A follow up question to the previous scenario of our main character arriving at the ER unconscious and bleeding, would the doctor order a rape kit?

 
 
Answered by Dr. Timothy Raichle 4 hours later
If someone is having bleeding from the vagina, they would do a 'speculum' exam. This involves inserting a speculum which allows visualization of the vaginal walls. An MRI is not used to evaluate the vagina.

Yes, they would be able to see 'scrapes' in the vaginal wall.

If a patient arrived in the ER unconscious and with vaginal bleeding, a rape kit is not the first thing they would do. They would do labs, start an IV, start blood (O-negative) and get imaging of the abdomen and pelvis (Xray and CT).

Assuming that she was stabilized, and they wanted to evaluate the vaginal bleeding, then they would finally do a speculum exam.

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