Lower Abdominal Pain

1. Identify emergencies and refer immediately to a hospital, such as septic abortion, intestinal obstruction, ruptured bowel, appendicitis or ectopic pregnancy.

2. Pelvic inflammatory disease (PID) can cause pain during intercourse in addition to lower abdominal pain; heavy or prolonged menstrual bleeding, dysmenorrhoea, nausea, and vomiting.

3. On speculum exam, an open cervix indicates pregnancy or abortion.

4. Look for other signs of STI like ulcers or vaginal discharge.

5. Ask the patient if she is using an IUCD, as women using IUCDs have a higher risk of pelvic inflammatory disease.

Complications of STIs

1. Infertility in both men and women

2. Pelvic Inflammatory Disease. (Mostly caused by Chlamydia and Gonorrhoea)

3. Chronic Pelvic pain

4. Cervical cancer caused by Human papilloma virus (5-30yrs after the initial infection)

5. Higher risk of Ectopic pregnancy due to PID

6. Epididymitis in men caused by Chlamydia or gonorrhea which may lead to infertility.

7. Spontaneous abortion, stillbirth and perinatal death due to syphilis infection spreading to the amniotic sac and infecting the fetus.

8. OpthalmiaNeonatorum due to gonorrheal and chlamydial infection present in the vagina or cervix.

9. Pneumonia in the infant due to Chlamydia infection.

3.5.2 Human Immunodeficiency Virus (HIV) Infection

HIV infects cells in the immune and central nervous system. One of the main types of cells that HIV infects is the T- Helper lymphocytes. These cells play an important role in the immune system. A large reduction in the number of T- Helper cells seriously weakens the immune system.

        HIV infects the T- Helper cell because it has the protein CD4 on its surface. Once it infects a cell it produces new copies of itself which can then proceeds to infect other cells. Eventually, HIV infection leads to the reduction in the number of T – Helper lymphocytes available to help fight diseases. This can be determined by a test called CD4 count/test. It can be take several years before the CD4 count declines to the point that an individual is said to have progressed to AIDS.

         HIV infection is generally classified into 4 stages: -

• Primary infection

• Clinically asymptomatic stage

• Symptomatic infection

• Progressive AIDS stage

Primary infection – the stage last for a few weeks and is often accompanied by a short flu- like illness (sore throat, fever etc). At this stage there is a large amount of HIV in the peripheral blood and the immune system begins to respond to virus by producing HIV antibodies and cytotoxic lymphocytes. This process is known as seroconversion. If an HIV antibody test is done before seroconversion s complete then it may not be positive.

Clinically asymptomatic stage – it averagely last for ten years and it is without symptoms, although there may be swollen glands. The level of HIV in the peripheral blood drops to low level but people remain infectious and the HIV antibodies are detectable in blood. HIV is not dormant during this stage but is very active in the lymph nodes. Viral load test can be done, as it is important in the treatment.

Symptomatic stage – over time the immune system becomes severely damaged by HIV. This is thought to happen for 3 main reasons.

1. The lymp nodes and tissues become damaged or burn – out because of the years of activity.

2. HIV mutates and becomes more pathogenic leading to more CD4 destruction.

3. The body fails to keep up with replacing the helper cell that are lost.

     As the immune system fails, symptoms develop. Initially many of the symptoms are mild, but as the immune system deteriorates the symptoms worsen. The symptoms emerges mainly due to opportunistic infection

Test item – Write assignment on the HIV counselling and testing

STUDENTS’ ACTIVITY;

Topic: Reproductive Health Disorders

Learning outcome: The student will be able to

• Define Menstrual Disorders

• Describe Menstrual Disorders

• Describe Sexual Dysfunction

• Discuss Infertility

• Discuss the Syndromic Approach to STI management

Task: In small groups, brainstorm and describe the management of the different reproductive disorders.

UNIT 4.0

TOPIC - ABORTION

Instructional Materials

• White board and maker

• Projector/ Laptop

• Pictures

• Videos

• Posters 

Teaching methods

• Lecture 

• Discussion

• Brainstorming  

Type of Assessment

• MCQ

• Assignments

• Essay 

Learning Objectives: At the end of the lesson, learners will be able to:

• Define Abortion

• Identify the classifications of Abortion

• Enumerates the complications of Abortion

• Describe post abortion care