Abdominal Pain in Pregnancy Flashcards
1. Know the clinical presentation of some of the common causes of abdominal pain in pregnancy (acute appendicitis, acute cholecystitis, ovarian torsion, placental abruption, and ectopic pregnancy). 2. Understand that surgery is the best treatment for ovarian torsion. 3. Know that oophorectomy does not necessarily need to be performed in ovarian torsion.
What is the ddx for a pregnant woman who comes in with abdominal pain?
- Appendicitis
- Acute Cholecystitis
- Pancreatitis
- Ovarian Torsion
- Placental Abruption
- Ectopic Pregnancy
- Ruptured Corpus Luteum
How does appendicitis present differently in pregnancy?
Why?
The location of the pain is not limited to the right lower quadrant but can be in the right upper quadrant or near the right flank.
The expanding uterus pushes the appendix further lateral and upward.
How does regular appendicitis present?
When should surgery happen in a pregnant lady?
Right lower quadrant pain that radiates to the umbilicus. They can also have nausea and vomiting with anorexia. They’ll have leukocytosis.
Surgery for any appendicitis pt needs to happen immediately, regardless of how far along in pregnancy (12 weeks vs 27 weeks, does not matter at all). Appendicitis is a surgical emergency.
A pregnant pt comes into the office complaining of this recurrent pain in her right upper quadrant that is brought on after eating a meal. It lasts for a few hours before subsiding. What condition does this presentation hint at?
If imaging confirms our suspicions, what is the next step?
When do we opt for surgery?
Biliary collick.
The next step is to watch it till delivery.
Opt for surgery if there is sign of fever or leukocytosis because this suggests acute cholecystitis which can lead to ascending cholangitis.
What is the most common cause of pancreatitis?
Gallstones.
If pregnant pt has gallstone history, and now develops epigastric pain with elevated lipase, what is the next step?
Order ERCP because we know that the pt has gallstones, which probably led to the pancreatitis, no need for further imaging, other than imaging that can be therapeutic.
A pregnant pt comes to my clinic during her 14th week of gestation complaining of pain in her lower abdomen. She says that the pain comes on for a few minutes and goes away and that she’s been experiencing nausea and vomiting. What is likely causing her symptoms?
What is the next step?
Ovarian torsion.
The next step is to do laparoscopy to unwind the fallopian tube and evaluate the ovary for viability and to resect only the ovarian cyst causing symptoms.
When does ovarian torsion typically occur in pregnancy?
At the 14th week (uterus just passes over the pelvic bone) and immediately after delivery when the uterus involutes.
A pregnant lady has htn that was poorly controlled during her pregnancy, and she smokes. She now presents with severe abdominal pain and massive vaginal bleeding. What is the cause?
Placental abruption.
Ectopic pregnancy pts present as…
What are options for treatment?
Pregnant lady with some vaginal spotting and abdominal pain or has an adenxal mass.
Surgery in hemodynamically unstable pts, rupture of fallopian tube or methotrexate to cause it to pass.
