Acute Pelvic Pain Flashcards
Pelvic pain def’n? What 3 things to think about?
Pain over the lower abdomen lasting less than 3 months
First presentation
Previously undiagnosed
Causes of pelvic pain?
Gastro Urinary GYNE Obs Other
Suprapubic pain DDx?
Acute urinary retention UTIs Cystitis PID Ectopic Pregnancy Diverticulitis
RIF DDx?
Appendicitis Diverticulitis PID Ureteric colic Ectopic Ovarian torsion Ovarian cyst
LIF DDX
Appendicitis (less likely) Diverticulitis PID Ureteric colic Ectopic Ovarian torsion Ovarian cyst
Other causes of DDx pelvic pain
Constipation IBS UC Bowel obstruction, perforation viral infections Gall bladder disease Hernias Malignancy (more insidious)
Most common O&G causes of pelvic pain DDx?
Obs: ectopic, miscarraige
Non-preg: PID, ovarian torsion, cyst rupture
Incomplete miscarriage?
Retained products of conception still
BHCG changes how in preg? Ectopic/miscarriage
Beginning: doubles every 48 hours - normal
When can you see imaging of baby re: BCG?
When BCG is around 2000
If BCG is more than 3000 but no sac then what to worry?
ectopic?
What do you see at 5,6,7 weeks
5- gestation sac
6-fetal pole
7-fetal heart
When can you see fetal heart for first time?
7 weeks
Ectopic investigations ladder
BHCG
Ultrasound
Laparoscopy
Non pregnant pelvic pain DDx?
PID
Ovarian torsion
Cyst rupture
Most common pathogens for PID?
Chlamydia
Gonorrhoea
Mycobacterium
How to Dx PID?
Cervical swab
urine PCR now
Gonorrhoea vs. chlamydia symptoms?
Gonorrhoea more symptomatic: urethritis, and discharge
Cyst rupture DDx?
Ovulation
Can be near a vessel, a bit of blood
U/S findings for ovarian torsion
Reduced flow to ovary
Ring of oedema around ovary
Usually everything else is normal, maybe small raised CRP
Examination of pelvis?
Inspection
Palpation: peritonitis
What sign indicates peritonitis?
Rigidity
Targeted exam for PID GYN cause?
Vaginal examination:
Speculum
Bimanual: cervical tenderness, adenexal mass, uterine size
Common investigations
Blood tests:
Urinanalysis
Swabs high vaginal, cervical
Preg test
Radiology for acute pelvic pain?
U/S
X-ray (not really, mainly bowel obstruction/perforation)
CT (First line now)
Laparoscopy probs?
Invasive
Expensive
Not always available
