4: DD of Pelvic Pain Flashcards
What is the differential diagnosis?
Unilateral crampy pain that is often continuous
Ectopic pregnancy
What is the differential diagnosis?
- Tender abdomen with PE and localized rebound tenderness in lower abdominal quadrants
- Most important sign: large pelvic mass on PE
- Mild temperature elevation
- Mild elevated WBC
Adnexal torsion
What is the differential diagnosis?
- Often asymptomatic, can have increased uterine bleeding, pelvic pressure or pain, and dyspareunia (pain with intercourse)
- Acute pain with torsion or rupture
- Note: may be confused with subacute salpingo-oophoritis
Uterine fibroids
What is the differential diagnosis?
- Pain is mild to moderate and self-limiting unless it is due to a hemorrhagic corpus luteum cyst, which can result in significant blood loss and hemoperitoneum
- Onset of pain is usually sudden and midcycle.
Ovarian cysts
What is the differential diagnosis?
- Lower abdominal, uterine adnexal, and cervical motion tenderness
- Pain is often described as dull or achy and may radiate to back or upper thighs
- May have nausea and vomiting due to pain
PID
What is the differential diagnosis?
- Pain intensity is related to position
- Abdominal tenderness increases when abdominal wall is tensed
Abdominal wall hernia
What is the differential diagnosis?
- Results in ischemia and rapid onset of acute pelvic pain
- Pain is usually severe and constant unless torsion is intermittent, in which case the pain will come and go
- Pain may worsen with lifting, exercise, and intercourse
Adnexal torsion
What is the differential diagnosis?
Sharp pain sometimes radiates to lower back
Abdominal wall hernia
What is the differential diagnosis?
- Low-grade fever
- Purulent discharge
- Elevated WBC
- Elevated ESR
PID
What is the differential diagnosis?
- Significant abdominal distention
- Bowel sounds are abnormal: at onset they are high pitched during pain and later will decrease and may be absent due to ischemia
- Elevated WBC and fever are noted as the condition progresses
Intestinal obstruction
What is the differential diagnosis?
- May have low-grade fever
- High fever if ruptured
- Chills
- Rebound tenderness
- Positive psoas sign
- Positive obturator sign
- Rovsing’s sign elicited
- May observe leukocyte shift to left
Appendicitis
What is the differential diagnosis?
- Usually vaginal bleeding is present
- May have very slight elevation of temperature
- ESR and WBC may be slightly elevated
- Serum β-hCG is positive
- US may help with diagnosis
- PE may reveal an adnexal mass
Ectopic pregnancy
What is the differential diagnosis?
- PE findings may be absent or limited
- Laparoscopy with biopsy is the gold standard for diagnosis
Endometriosis
What is the differential diagnosis?
- Severe, colicky pain in suprapubic area and in pelvis
- Urinary frequency
- Dysuria
- Nausea, vomiting
Ureteral lithiasis
What is the differential diagnosis?
- Abdominal pain with palpation
- May note blood with stool and/or rectal bleeding
IBS
