33) Acute Abdomen in Gynecology

Question 1

What are the Gynecological Reasons for Acute Abdomen?

Answer 1

• Adnexal Torsion
• Ruptured Cyst / or Corpus Luteum
• Perforation of Uterus
• Pelvic Inflammatory Disease and Tubo-Ovarian Abscess

Question 2

What is Adnexal Torsion? - include CF, Dx, Tx

Answer 2

• Twisting of the adnexa at the axis of infundibulo-pelvic ligament
• Due to ovarian / fallopian tube enlargement at 10 - 12cm
• resulting in infarction of tube + ovary
• CFs = Acute Pain in LR Lower Quadrant; N/V; Low-Grade Fever (necrosis); Positive + Blumberg Sx
• Diagnosed with Ultrasound
• Tx = Salpingo-oopherectomy; Laparoscopy

Question 3

Describe a Ruptured Cyst - include CF, Dx, Tx

Answer 3

• It’s the rupture of a Follicular Cyst –> leading to Acute Pain
• IF Rupture of Corpus Luteum –> may cause life-threatening Hemorrhage –> lead to Abdominal Distension
• CFs = Acute Pain in LR Lower Quadrant; N/V; Low-Grade Fever (necrosis)
• Diagnosed with Ultrasound and perform Pelvic Examination; Positive + Blumberg Sx
• Tx = Emergency Laparatomy

Question 4

Describe a Perforated Uterus - include CF, Dx, Tx

Answer 4

• Usually happens as a complication of any intrauterine procedure - such as Abortion, Coil Insertion, or Hysteroscopic Procedures
• Can be associated with injury to surrounding BVs / viscera - e.g. bladder, or intestine
• IF NOT TAKEN CARE WitH can result in Massive Hemorrhage or Sepsis
• Risk Factors = Infection, Recent Pregnancy, or Post-Menopause
• Types = (A) Anteverted (Posterior) Uterus; (B) Retroverted (Anterior)

NB! IMMEDIATE Treatment includes - Insert Urinary Catheter, Antibiotics + Observation

Question 5

Describe Pelvic Inflammatory Disease (PID) and Tubo-Ovarian Abscess - include CF, Dx, Tx

Answer 5

• Due to bacterial infection of the Upper Genital Tract
• Px with Tubo-Ovarian Abscess = Have history of Pelvic, or Abdominal Pain; Fever indicating Leukocytosis
• Diagnosis includes Pelvic Examination = reveals pelvic + cervical motion tenderness w/ adnexal mass; US + CT

NB! IMMEDIATE Treatment includes - Surgical Intervention, or drainage with laparoscopy

Question 6

What are the Obstetrics Reasons for Acute Abdomen?

Answer 6

• Ectopic Pregnancy {Refer to Essay 34}
• Ruptured Uterus
• Placental Abruption
• Chorioamnionitis (Infection of Amniotic Sac)
• Torsion
• Rupture