Differential Diagnosis for a 19-year-old Female with Vaginal Bleeding and Abdominal Pain
- Single most likely diagnosis:
- Ectopic Pregnancy: This is the most likely diagnosis given the patient's symptoms of sudden onset abdominal pain, vaginal bleeding, and a history of a missed menstrual period. The physical examination findings of right adnexal tenderness and blood from the cervical os further support this diagnosis.
- Other Likely diagnoses:
- Ovarian Cyst Rupture: The patient's symptoms of sudden onset sharp abdominal pain and vaginal bleeding could also be consistent with an ovarian cyst rupture. The tenderness in the right lower quadrant and right adnexal tenderness support this possibility.
- Pelvic Inflammatory Disease (PID): Although the patient denies fever and chills, PID could still be a consideration, especially if the patient has a history of sexually transmitted infections. The presence of right adnexal tenderness and vaginal bleeding could be consistent with PID.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Ruptured Ovarian Cyst with Hemorrhage: This is a life-threatening condition that requires immediate surgical intervention. The patient's symptoms of sudden onset abdominal pain, vaginal bleeding, and signs of hypovolemic shock (diaphoresis, pallor) make this a critical diagnosis not to miss.
- Ectopic Pregnancy with Rupture: Similar to a ruptured ovarian cyst, a ruptured ectopic pregnancy is a life-threatening emergency that requires immediate surgical intervention. The patient's symptoms and physical examination findings make this a critical diagnosis to consider.
- Rare diagnoses:
- Molar Pregnancy: Although rare, a molar pregnancy could present with vaginal bleeding and abdominal pain. However, this diagnosis is less likely given the patient's symptoms and physical examination findings.
- Adenomyosis: This condition is rare in a 19-year-old female and typically presents with heavy menstrual bleeding and dysmenorrhea. However, it could be considered in the differential diagnosis if other more likely causes are ruled out.