Acute Pelvic Pain Flashcards
DDx for suprapubic pain?
Acute urinary retention UTIs Cystitis PID Ectopic Diverticulitis
DDx for RIF pain?
Appendicitis Diverticulitis PID Ureteric colic Ectopic pregnancy Ovarian torsion Ovarian cyst rupture
DDx for LIF pain?
DIverticulitis PID Ureteric colic Ectopic pregnancy Ovarian torsion Ovarian cyst rupture
Other DDx for plevic pain?
Constipation IBS UC Bowel obstruction Bowel perforation Viral infections Gallbladder disease Hernias Malignancy
What are the most common O&G causes?
Pregnancy - ectopic, miscarriage
Non-pregnant - PID, ovarian torsion, cyst rupture
What is a complete miscarriage?
Confirmed pregnancy but the products of conception are not identifible on US
What is a incomplete miscarriage?
Confirmed pregnancy that miscarriages and products of conception remain
How does bHCG change in early pregnancy?
Doubles every 48 hours
At what bHCG level is there products present in the uterus?
2000
When do you see at gestation sack, fetal ball, and fetal heart?
GS - 5 weeks
Fetal ball - 6 weeks
Fetal heart - 7 weeks
What does an empty uterus + rising bHCG mean?
Ectopic pregnancy
At what stage will urine/serum bHCG be positive?
Urine: Period that is one day late
Serum: Before the miss period
How do you Ix a ectopic?
bHCG
US
Laparoscopy
How do ectopics present?
Pain
Bleeding
Missed period
Why do a salpingectomy over salpingostomy? Why not?
The tube already sick, high chance of another ectopic, still have the other tube
If the other tube is missing, if can’t afford a IVF
How does hHCG change in ectopics and miscarriage?
Ectopic: slow rise, slower than normal
Miscarriage: Rise than stop and drop
When is medical management of ectopics possible?
No pain
How does chlamydia vs gonorrhoea PID differ?
Chlamydia is more insidious, less painful
Gonorrhoea more pain, more local genital symptoms
How does cyst rupture present?
Pelvic pain
What might you find on US in cyst rupture?
Fluid in the pelvic cavity
Remains of cyst
What do you find on US in ovarian torsion?
Reduced blood flow to ovary
Area surrounding the ovary
How does ovarian torsion present?
Sudden onset pain or insidious colicky pain
No peritonism
How is haemorrhage into a cyst identified?
Blood in cyst on US - ground glass pattern
