[40] Acute Pelvic Pain Flashcards
What is acute pelvic pain in a woman of reproductive age with a positive pregnancy test, until proven otherwise?
Ectopic pregnancy
What questions need to be asked in acute pelvic pain history?
- SQITARS
- LMP
- Contraception
- Recent unprotected sexual intercourse
- Risk factors for ectopic preg
- Vaginal discharge/bleeding
- Bowel symptoms
- Urinary symptoms
What needs to be checked on examination in acute pelvic pain?
- Haemodynamically stable?
- Abdomen
- Pelvic
Why do you need to check a patient with acute pelvic pain is haemodynamically stable?
Risk of bleeding from ectopic
What needs to be checked on abdominal examination in acute pelvic pain?
- Acute abdomen?
- Masses
What needs to be checked on pelvic examination in acute pelvic pain?
- Discharge
- Cervical excitation
- Adnexal tenderness
- Masses present?
What investigations may be done in acute pelvic pain?
- Urinary/serum hCG
- MSU
- Triple swabs
- FBC, G&S, and CRP
- Pelvic USS
- Abdominal x-ray, CT, or MRI as appropriate
- Diagnostic laparoscopy
What is involved in the immediate management of acute pelvic pain?
- Resuscitate if necessary
- Analgesia
- Specific treatment will depend on cause of pain
What are the gynaecological causes of acute pelvic pain?
- Early pregnancy complications
- PID
- Ovarian cyst accident
- Adnexal pathology
- Mittelschmerz
- Pregnancy complications
- Primary dysmenorrhoea
- Haematometra/haematocolpos
- Acute exacerbation of chronic pain
What early pregnancy complications can cause acute pelvic pain?
- Ectopic pregnancy
- Miscarriage
- Ovarian hyperstimulation syndrome
What ovarian cyst accidents can cause acute pelvic pain?
- Torsion
- Haemorrhage
- Rupture
What adnexal pathology can cause acute pelvic pain?
- Torsion of fallopian tube/parafimbral cyst
- Salpingo-ovarain asbcess
What is mittelschmerz?
One sided, lower abdominal pain associated with ovulation
What pregnancy complications can cause acute abdominal pain?
- Fibroid degeneration
- Ovarian cyst accident
- Ligament stretch
What is haematometra?
Retention of blood in uterus
What causes haematometra?
Obstruction or atresia of the lower reproductive tract (uterus, cervix, or vagina), which would otherwise provide outflow for menstrual blood
What is obstruction leading to haematometra most commonly caused by?
Congenital abnormalities
What congenital abnormalities can cause obstruction leading to haematometra?
- Imperforate hymen
- Transverse vaginal specum
What are some acquired causes of obstruction leading to haematometra?
- Cervical stenosis
- Intrauterine adhesions
- Cervical or endometrial cancer
- FGM
How does haematometra typically present?
- Cyclic cramping pain in midline of pelvis of lower abdomen
- Urinary frequency and urinary retention n
What features are often present in pre-menopausal women with haematometra?
Abnormal vaginal bleeding, including dysmenorrhoea or amenorrhoea
How does haematometra appear on examination?
Uterus will typically feel firm and enlarged
How can the diagnosis of haematometra be confirmed?
Ultrasound
How is haematometra managed?
Cervical dilation to train blood from uterus, and addressing underlying cause
What is haematocolpos?
Blood in the vagina
What is haematocolpos caused by?
Combination of menstruation with imperforate hymen
How is haematocolpos managed?
Surgically, with hymenotomy or other surgery to remove any tissue blocking menstrual flow
What are the non-gynaecological causes of acute pelvic pain?
- Appendicitis
- IBS
- Inflammatory bowel disease
- Mesenteric adenitis
- Diverticulitis
- Strangulation of hernia
What are the urological causes of acute pelvic pain?
- UTI
- Renal/bladder calculi
