ACUTE LOWER ABDOMINAL PAIN Flashcards
Causes of Acute Lower Abdominal Pain in Women
Ectopic pregnancy
Appendicitis
Ovarian torsion
STI-related
Non-STI-related (e.g., urinary tract infection)
Septic abortion
Postpartum sepsis
Foreign body, including IUCD
Causes of PID
STI-related
Ascending bacterial infection from non-STI sources
Symptoms of Acute Lower Abdominal Pain in Women
Dysuria or Urethral discomfort
Lower abdominal pain
Dyspareunia
Offensive vaginal discharge
Fever
Signs of lower abdominal pain in women
Lower abdominal tenderness
Cervical motion tenderness on bimanual vaginal examination
Adnexal tenderness
Adnexal mass
Investigations for Acute Lower Abdominal Pain in Women
Pelvic ultrasound
Pregnancy test (if sexually active and amenorrhea present)
High vaginal swab culture and sensitivity
Treatment Objectives
Identify and manage potential life-threatening causes (e.g., ectopic pregnancy)
Treat underlying bacterial infection
Relieve pain and inflammation
Non-Pharmacological Treatment
Surgery where indicated
Remove IUD, if present, 3 days after initiation of drug therapy
Pharmacological Treatment for PID (Mild Cases)
Ciprofloxacin, oral, 500 mg 12 hourly for 3 days
+
Doxycycline, oral, 100 mg 12 hourly for 14 days
+
Metronidazole, oral, 400 mg 12 hourly for 14 days
Pharmacological Treatment for PID (Severe Cases)
Ceftriaxone, IM, 250 mg daily for 3 days
+
Doxycycline, oral, 100 mg 12 hourly for 3 days
+
Metronidazole, IV, 500 mg 8 hourly for 3 days
Then switch to
Doxycycline, oral, 100 mg 12 hourly for 14 days
+
Metronidazole, oral, 400 mg 12 hourly for 14 days
Consider Hospitalization or Referral in the Following Cases
Surgical emergencies cannot be excluded (e.g., ectopic, appendicitis)
Pregnant patient
No clinical response to oral antimicrobial therapy
Unable to follow or tolerate outpatient oral regimen
Severe illness, nausea, vomiting, or high fever
Tubo-ovarian abscess
HIV infection
Youth/adolescents (compliance issues)