Appendix, PID, Ectopic Pregnancy, Ovarian Cysts Flashcards
32yr old woman with 8hr history abdomen pain
pain in RLQ
no fever or dysuria
menstrual hx - regular cycle 5/28
obstetric hx para 1 NVD
no surfers
young and fit
no smoking lies with partner and social drink
nothing on fam history
pain onset location type severity duration and modifying facotrs will help pin point
what systems should you check here
GI sx - N+V hematemesis, anoxeria, diarrhea and constatino blocco stools and meleana
GU sx - dysuria, frequency urgency and haematuria and icnotninence
gyn sx - vaginal discharge, vagianl bleeding
general - fever and lightheadedness
exmaianion of this patient what would you do
general - pallor appearance and distress
vital signs - pulse, BP temp and saturation
cardiac - arrhyias and lungs for pneumonia
abdomen - distension scares, masses, tenderness and rebound and guiding and masses, tympani , bowel sounds and rectal exam
pelvic exam for bleeding and vaginal examination and fullness and discharge
guarding - voluntary - contraction, diminish this by getting patient to flex knees
involuntary - suggests peritoneal irritation
rebound - roving sign appendicitis
what is rovsing sign
Rovsing’s sign (a.k.a. indirect tenderness) is a right lower quadrant pain elicited by pressure applied on the left lower quadran
investigations for this
urinalysis
preg test
IV fluids
NBM
FBC and beta Hcg
US scan
analgesia
eclectrolytes
appendicitis symptoms
periunmbilicla pain, anorexia and N+V
pain localises to RLQ
soem appendicitis are retroceal
pelvic appendicitis can cause suprapubic pain and dysuria
triad of symptoms fore ectopic pregnancy
amenorrhea ( irregular menses too)
pelvic or low abdominal pain
vaginal bleeding
findings on ectopic pregnancy
pelvic and abode pain
abnormal menstruation
aginal bleeding may be scanty or dark brown
abdominal and pelvic tenderness
tenders on abode and vaginal examination especially on motion of the cervix
US scan - absence of an intrauterine gestational sac
extrauterine sac with an embryo or embryonic remnants
free fluid/blood in peritoneum
what are the risk factors for an ectopic pregnancy
previous ectopic
assisted reproduction and infertility
intrauterine device
previous genital infection
previous pelvic or abdomen surgery e.g. ruptured appendices
smoking
c section
tubal surgery
ovarian cysts - torsion and haemorrhage present with what
might have history of it
acute onset severe pelvic pain
may wax and wane
may happen mid cycle or during pregnancy
may look like appendicitis
can have acute rigid abdomen and peritonitis , fever and tachycardia and decreased bowel sounds
important to exclude with US scan
may find mass on examination
US confirms cysts
therefore acute pain with scan showing ovarian cysts - torsion or bleeding into cysts is an emergency
pelvic inflammatory infection is an ascending infection - will have long lasting sequel such as ectopics, infertility or chronic pelvic pain
what are the findings of this
PV discharge with uterine tenderness
cervical motion tenderness on examination - i.e. worse if you move It
positive swab culture - swabs or from urine ?
temp- may not be raised
FBC - raised WBC
ectopic pregnancy you would expect positive pregnancy what is the investigation of choice
what would this show
transvagianl US - demonstatre no intra-uterine pregame, endometrial thickening, free fluid ,adnexal mass and foetal pole not usually visualised
mass separate to ovary
can occur on cerivx in ovaries - different areas
Use bladder to help see structures
negative pregnancy test now wha is causing pain - thinking ovarian cysts what examination
transvaginal( not used if never sexually active) or trans abdominal US
2nd line for clarity - MR used for problem solving and characterising masses
what method do you use for staging ovarian carcinoma
CT
ovarian cysts can be linked to the menstrual cycle - follicular cysts grow inside what happens when the egg is not released
becomes a cyst and swells and is greater than 30mm
this could haemorrhage tort or rupture
what are theca-luton cysts
excessive amounts of circulating gonatrophins such as beta HCG