Common Gynae Presentations - Abdominal Pain Flashcards
Presenting complaint
-key symptoms
SOCRATES
Onset - menstrual, sex, defecation, urination
Character - superficial/deep, sharp/burning?
Radiation - shoulder tip in ectopic
Associated symptoms - N+V in ectopic
Time course - how does the pain relate to your menstrual cycle
Gynecological systemic review
Bleeding
- post-coital
- intermenstrual
- post-menopausal
Discharge
- volume
- colour
- consistency
- smell
Vulva
- rashes
- itching
Other relevant systemic reviews
Systemic
-fever, fatigue, weight loss
GI
- change in bowel habit
- pain on defecation
GU
- urinary frequency
- urgency
- dysuria
Past medical history
- menstrual
- obstetric
- sexual
- contraceptive, cervical smear
- other medical history, medication
Menstrual
- length of cycle, menstruation
- regularity, frequency
- volume
- pain
- LMP
Obstetric
-past pregnancies
Sexual
- sexually active?
- how many sexual partners
- use of protection
- STIs in the past?
Contraceptive, cervical smear
Gynecological conditions, surgery, procedures?
- STIs, endometriosis, malignancy?
- abdo/pelvic surgery, Csection, hysterectomy
Migraine aura, VTE, breast cancer => estrogen medications CI
Family history
Hx of
- ovarian, endometrial, breast cancer?
- blood clots
Social history
Living
- other people
- dependents, carers
- ADLs
Occupation and impacts
Smoking, alcohol, recdrugs
Current BMI and diet
Ectopic pregnancy
- risk factors
- core features
- investigations
- management
Risk factors
- sexually active
- LMP was a while ago
- Hx
Core features
- severe pain => shoulder tip
- vaginal bleeding
- signs of pregnancy
- SHARP INTENSE PAIN, N+V, PALE => RUPTURE
PREGNANCY TEST
Urinedip
Vital signs
Abdo, pelvic exam
FBC, U&E - bleeding
CRP - rule out inflammatory causes
G&S, INR - prep for surgery
US
Medication - methotrexate and repeat bHCG
Surgery - remove ectopic and tube, peritonitis from rupture
Endometriosis
- risk factors
- core features
- investigations
- management
Risk factors
-FHx
Core features
- deep pain on urination, defecation, periods, coitus
- heavy irregular periods
- infertility
Investigations
Abdo, pelvic exam
US/laparoscopy
Management
Analgesia - paracetamol, NSAIDs
COCP
Surgery - removal of endometrial tissue/hysterectomy
PID
- risk factors
- core features
- investigations
- management
Risk factors
-sexually active => STI
Core features
- deep pain on period, coitus
- heavy periods, intermenstrual bleeds
- N+V, fever
- foul smelling, green discharge
Abdo, pelvic exam
Vaginal swab
Pregnancy, urinedip
FBC, CRP - infection
U&E
US, laparoscopy
ABx
PCOS
- risk factors
- core features
- investigations
- management
Risk factors
- FHx
- DM
Core features
- heavy, painful, irregular periods
- weight gain
- acne, hirsutism
- infertillity
Abdo, pelvic exam
Cap glucose, urinedip, pregnancy test
Vital signs - CVD
FSH, LH, O, P, T - high T
Thyroid, AntiTPO, TSH - rule out hypothyroid
Cushing - urine cortisol
HbA1c, lipids
US
Weight loss advice
CVD optimisation
COCP
