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
What is the differential diagnosis?
- Acute abdominal pain (may also cause chronic pelvic pain)
- Bloating
- Urgency of defecation
- Diarrhea
- Constipation
IBS
What is the differential diagnosis?
- Colicky abdominal pain
- Abdominal distention
- Vomiting
- Constipation and obstipation
Intestinal obstruction
What is the differential diagnosis?
Crampy, intermittent pain that is in the midline or bilateral lower abdomen
Abortion: threatened, inevitable, or incomplete
What is the differential diagnosis?
- Vomiting
- Diarrhea
- Abdominal cramping and pain
Gastroenteritis
What is the differential diagnosis?
- Often asymptomatic
- May experience abdominal bloating, constipation, and diarrhea
- Severe LLQ pain
Diverticulitis
What is the differential diagnosis?
- Palpation of abdomen reveals mass(es) arising from uterus
- May note tenderness with palpation
- May have elevated temperature and WBC
Uterine fibroids
What is the differential diagnosis?
- Diffuse abdominal pain, generally periumbilical
- Anorexia, nausea, vomiting
- Pain usually in RLQ (McBurney’s point)
- Chills
Appendicitis
What is the differential diagnosis?
- Often asymptomatic
- Most common symptoms are dysmenorrhea, deep dyspareunia, and sacral backache during menses
Endometriosis
What is the differential diagnosis?
- May have systemic toxicity such as fever and tachycardia
- Marked abdominal tenderness with palpation
Gastroenteritis
What is the differential diagnosis?
- Pregnancy test usually positive
- Vaginal bleeding usually present
- If infection: elevated WBC and ESR
Abortion: threatened, inevitable, or incomplete
What is the differential diagnosis?
- Lower abdominal or pelvic pain usually midline
- Dysuria, urinary urgency and frequency
Cystitis
What is the differential diagnosis?
Urine dipstick positive for leukocyte esterase or nitrite
Cystitis
What is the differential diagnosis?
- Hypovolemia only if there is hemoperitoneum
- Most critical sign is significant abdominal tenderness, often associated with rebound tenderness due to peritoneal irritation
- May be able to palpate a mass during the pelvic examination if not entirely ruptured
Ovarian cysts
What is the differential diagnosis?
- Hematuria
- Flank and costovertebral angle pain
Ureteral lithiasis
What is the differential diagnosis?
- Distended abdomen with LLQ tenderness with palpation
- Localized rebound tenderness
- May palpate a doughy, mobile mass in the LLQ
- Hypoactive bowel sounds
- May see elevated WBC
Diverticulitis
