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A - MSRA Gynaecology [8] > [40] Acute Pelvic Pain > Flashcards

[40] Acute Pelvic Pain Flashcards

1
Q

What is acute pelvic pain in a woman of reproductive age with a positive pregnancy test, until proven otherwise?

A

Ectopic pregnancy

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2
Q

What questions need to be asked in acute pelvic pain history?

A
  • SQITARS
  • LMP
  • Contraception
  • Recent unprotected sexual intercourse
  • Risk factors for ectopic preg
  • Vaginal discharge/bleeding
  • Bowel symptoms
  • Urinary symptoms
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3
Q

What needs to be checked on examination in acute pelvic pain?

A
  • Haemodynamically stable?
  • Abdomen
  • Pelvic
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4
Q

Why do you need to check a patient with acute pelvic pain is haemodynamically stable?

A

Risk of bleeding from ectopic

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5
Q

What needs to be checked on abdominal examination in acute pelvic pain?

A
  • Acute abdomen?

- Masses

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6
Q

What needs to be checked on pelvic examination in acute pelvic pain?

A
  • Discharge
  • Cervical excitation
  • Adnexal tenderness
  • Masses present?
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7
Q

What investigations may be done in acute pelvic pain?

A
  • Urinary/serum hCG
  • MSU
  • Triple swabs
  • FBC, G&S, and CRP
  • Pelvic USS
  • Abdominal x-ray, CT, or MRI as appropriate
  • Diagnostic laparoscopy
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8
Q

What is involved in the immediate management of acute pelvic pain?

A
  • Resuscitate if necessary
  • Analgesia
  • Specific treatment will depend on cause of pain
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9
Q

What are the gynaecological causes of acute pelvic pain?

A
  • Early pregnancy complications
  • PID
  • Ovarian cyst accident
  • Adnexal pathology
  • Mittelschmerz
  • Pregnancy complications
  • Primary dysmenorrhoea
  • Haematometra/haematocolpos
  • Acute exacerbation of chronic pain
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10
Q

What early pregnancy complications can cause acute pelvic pain?

A
  • Ectopic pregnancy
  • Miscarriage
  • Ovarian hyperstimulation syndrome
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11
Q

What ovarian cyst accidents can cause acute pelvic pain?

A
  • Torsion
  • Haemorrhage
  • Rupture
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12
Q

What adnexal pathology can cause acute pelvic pain?

A
  • Torsion of fallopian tube/parafimbral cyst

- Salpingo-ovarain asbcess

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13
Q

What is mittelschmerz?

A

One sided, lower abdominal pain associated with ovulation

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14
Q

What pregnancy complications can cause acute abdominal pain?

A
  • Fibroid degeneration
  • Ovarian cyst accident
  • Ligament stretch
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15
Q

What is haematometra?

A

Retention of blood in uterus

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16
Q

What causes haematometra?

A

Obstruction or atresia of the lower reproductive tract (uterus, cervix, or vagina), which would otherwise provide outflow for menstrual blood

17
Q

What is obstruction leading to haematometra most commonly caused by?

A

Congenital abnormalities

18
Q

What congenital abnormalities can cause obstruction leading to haematometra?

A
  • Imperforate hymen

- Transverse vaginal specum

19
Q

What are some acquired causes of obstruction leading to haematometra?

A
  • Cervical stenosis
  • Intrauterine adhesions
  • Cervical or endometrial cancer
  • FGM
20
Q

How does haematometra typically present?

A
  • Cyclic cramping pain in midline of pelvis of lower abdomen

- Urinary frequency and urinary retention n

21
Q

What features are often present in pre-menopausal women with haematometra?

A

Abnormal vaginal bleeding, including dysmenorrhoea or amenorrhoea

22
Q

How does haematometra appear on examination?

A

Uterus will typically feel firm and enlarged

23
Q

How can the diagnosis of haematometra be confirmed?

A

Ultrasound

24
Q

How is haematometra managed?

A

Cervical dilation to train blood from uterus, and addressing underlying cause

25
Q

What is haematocolpos?

A

Blood in the vagina

26
Q

What is haematocolpos caused by?

A

Combination of menstruation with imperforate hymen

27
Q

How is haematocolpos managed?

A

Surgically, with hymenotomy or other surgery to remove any tissue blocking menstrual flow

28
Q

What are the non-gynaecological causes of acute pelvic pain?

A
  • Appendicitis
  • IBS
  • Inflammatory bowel disease
  • Mesenteric adenitis
  • Diverticulitis
  • Strangulation of hernia
29
Q

What are the urological causes of acute pelvic pain?

A
  • UTI

- Renal/bladder calculi

A - MSRA Gynaecology [8] (52 decks)

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