Abdominal pain- differentials in obs + gynae

Question 1

differentials for intermittent RIF pain now constant for 4 hours
x2 episode vomiting

(gynaecological)

Answer 1

pregnancy:
ectopic
miscarriage

non pregnancy:
ovarian cyst accident
endometriosis
fibroids 
malignancy
acute PID

Question 2

differentials for intermittent RIF pain now constant for 4 hours
x2 episode vomiting

(non-gynaecological)

Answer 2

appendicitis
IBD
constipation
renal stones
UTI
hernia
malignancy

Question 3

ectopic pregnancy

1. history
2. exam
3. investigations
4. management

Answer 3

History - Non specific pain, dyspareunia, PV Bleeding

Examination - If ruptured may show signs of peritonism and cervical tenderness

Investigations - PT+, Hb Low if Haemoperitoneum, Serum HCG, Ultrasound

Management - Conservative, Medical (Methotrexate) Surgery (Salpingectomy)

Question 4

pelvic inflammatory disease

PID

Answer 4

History - Can be acute of chronic, Recent change in sexual partner, gradual onset, generalised pain, sometimes unilateral, sometimes discharge, dyspareunia

Examination - Pyrexia, Non specific clinical signs

Investigations - Vaginal swabs, WCC & CRP can be elevated, US often normal

Management - Sepsis management, Analgesia, Antibiotics (Dox and Met)

Question 5

ovarian cyst accident

Answer 5

Torsion
Rupture
Size
Local organ obstruction

Question 6

types of ovarian cyst

Answer 6

Physiological - More likely to rupture/resolve
Benign - Haemorrhagic if endometriosis present; Dermoids increased risk of torsion
Malignant - Less likely to tort/rupture

Question 7

ovarian cyst accident
hx
ex
ix
mx

Answer 7

History - Sudden onset severe pain sometimes after gradual pain, unilateral, dyspareunia with large cysts

Examination - Pelvic mass, Peritonism with torsion, Ascites with malignancy,

Investigations - CRP increased with torsion, CA125 elevated in Ovarian malignancy, Ultrasound diagnostic

Management - Conservative (Physiological rupture), Surgical (Torsion, Size, Malignancy)

Question 8

endometriosis
hx
ex
ix
mx

Answer 8

History - Cyclical, Menorrhagia, Gradual onset, Often chronic with acute flare-up

Examination - Non-specific clinical findings

Investigations - Bloods normal, may have borderline elevated CA125, US often normal

Management - Conservative, Medical (hormonal/non-hormonal), Surgical (diathermy/excision)

Question 9

fibroids
hx
ex
ix
mx

Answer 9

History - Cyclical pain and menorrhagia, urinary frequency

Examination - Pelvic mass

Investigations - Hb Low, Ultrasound

Management - Depends on symptoms, Non-Hormonal, Hormonal and Surgical options

Question 10

abdominal pain investigations

Answer 10

abdominal exam
pelvic exam speculum + bimanual
rectal (?)

bedside obs

• pregnancy test
• urinary dip

bloods

• tumor markers
• microbiology

imaging
transvaginal ultrasound