29. Acute pelvic pain Flashcards
50% of causes of acute pelvic pain consistent of what ddx
pid
cervicitis, candidiasis
bartholin abscess
RF for ectopic
prior
pid
pelvic surgery
IUD
Assisted repro tech: what is risk of ectopic?
1:1000
as compared to BL 1:30 000
PID ST risk
toa
LT risk of PID
impaired fertility
chronic pelvic pain
increased risk of ectopic
DDX pelvic pain in women - main categories (7)
repro tract
pregnancy related - first trim
second and third trimester
intestinal tract
urinary tract
vascular
msl
neuro/psych other
List 6 causes of pelvic pain - repro tract
Ovarian torsion
Ovarian cyst
Pelvic inflammatory disease
Salpingitis
Tubo-ovarian abscess
Endometritis
Endometriosis
Uterine perforation
Uterine fibroids
Dysmenorrhea
Vulvar/vaginal trauma
Neoplasm
List 6 causes of pelvic pain -first trimester vs 2nd/3rd
Ectopic pregnancy
Threatened abortion
Nonviable pregnancy
Ovarian hyperstimulation syndrome
Placenta previa
Placental abruption
Round ligament pain
Labor or Braxton Hicks contractions Uterine rupture
List 6 causes of pelvic pain - intestinal tract
Appendicitis Diverticulitis Ischemic bowel
Perforated viscus
Bowel obstruction
Incarcerated or strangulated hernia Fecal impaction or constipation Inflammatory bowel disease Gastroenteritis/colitis
Irritable bowel syndrome
Name 3 causes of pelvic pain - Urinary tract
pyelo
cystitis
urethral stone
Name 5 vascular causes of acute pelvic pain
Septic pelvic thrombophlebitis
Ovarian vein thrombosis
Sickle cell disease
Pelvic congestion syndrome
Name 4 MSK causes of acute pelvic pain
Muscular strain or sprain Hernia
Abdominal wall hematoma Pelvic fracture
Name 5 causes of neuro/psych/”other” per rosen’s box 29.1 for causes of pelvic pain in women
Depression
Domestic violence
Sexual abuse Abdominal migraine Herpes zoster
Constellation of what 3 PE findings typical for PID
cervical motion tenderness, uterine tenderness, and adnexal tenderness
What is KEY in acute pelvic pain in a female
bhcg
What dx is ultrasound helpful for ?
pregnancy related
toa
torsion
ruptured cyst
3 key ways to divide ddx for acute pelvic pain in female
- pregnant y/n
- unilateral sx y/n
- UTI complaints +/- urinalysis
Management in an undifferentiated unstable pt
resus with IVF +/- blood
abx
cbc, vbg
early gyne consult if thought to be appropriate
fast exam
