Acute pelvic pain Flashcards
Define Acute pelvic pain
Acute Pelvic Pain:
Duration: <30 days
Location: lower abdomen, pelvis, lower back, buttocks
Causes functional disability
Motivates medical help seeking
Define chronic pelvic pain
Chronic Pelvic Pain:
Duration: >6 months
Same location and characteristics as acute ( Location: lower abdomen, pelvis, lower back, buttocks
Causes functional disability
Motivates medical help seeking)
What are the main categories of acute pelvic pain?
- Gynecological:
Pregnancy-related
Non-pregnancy related
- Non-gynecological:
Colorectal
Urological
Musculoskeletal
Neuropathic
List the pregnancy-related causes of acute pelvic pain
- Early Pregnancy Loss (IUP):
Incomplete
Complete
Septic
Inevitable
Anembryonic
- Ectopic Pregnancy:
Ruptured
Unruptured - MSK pain:
Round Ligament Pain
What are the non-pregnancy gynecological causes of pelvic pain?
- Ovarian Origin:
Torsion
Cyst Rupture
Hemorrhage into Cyst
Endometrioma
- Tubal Origin:
PID
Pyosalpinx/Tubo-ovarian Complex
- Uterine Origin:
Degenerating fibroid
Hematocolpos
Endometritis
Cervicitis
List the non-gynecological causes of acute pelvic pain
- Bowel/Colorectal:
Appendicitis
Diverticulitis
Constipation/Fecal Impaction
Thrombosed Hemorrhoids
- Urological:
UTI (Cystitis/Pyelonephritis)
Bladder stone
Nephrolithiasis
- Musculoskeletal:
Post-traumatic muscle/ligament pain
- Neuropathic:
Post-traumatic radiculopathy
Acute radiculopathy
What are the stages of PID (Gainsville Classification)?
Stage I: Acute Salpingitis without Peritonitis
Stage II: Acute salpingitis with peritonitis
Stage III: Tubo-ovarian complex
Stage IV: Ruptured TOC
Note: Can include cervicitis and endometritis in early stages
Outline the treatment approach for PID
Primary Invaders Treatment:
- Ceftriaxone 250mg IMI stat (N. Gonorrhoea)
- Azithromycin 1g po stat (Chlamydia)
- Flagyl 2g po stat (Atypicals)
Secondary Invaders Treatment:
1.Ampicillin 1g 6hrly
2.Gentamycin 240mg daily
3. Flagyl 500mg po tds
Additional Management:
Analgesia
Barrier methods & Partner treatment
STI testing
Contraception consideration
Counseling about complications
What essential investigations are needed for acute pelvic pain?
Basic Investigations:
- Vitals
- Side Ward Tests:
Hb
Pregnostic
Urine dipstick
- Special Investigations:
Pelvic ultrasound (TVS and TA)
FBC
U&E if shock/urological cause
Blood cultures if pyrexial
Crossmatch if bleeding suspected
ABG if in shock
What are key examination and ultrasound findings in ovarian torsion?
Physical Findings:
Severe pain
Difficulty mobilizing
Abdominal tenderness
Guarding in affected side
Adnexal mass/tenderness
Normal cervix on speculum
Ultrasound Findings:
Complex adnexal mass
Poor flow on Doppler
Normal contralateral ovary
