Common Gynae Presentations - Abdominal Pain

Question 1

Presenting complaint

-key symptoms

Answer 1

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

Question 2

Gynecological systemic review

Answer 2

Bleeding

• post-coital
• intermenstrual
• post-menopausal

Discharge

• volume
• colour
• consistency
• smell

Vulva

• rashes
• itching

Question 3

Other relevant systemic reviews

Answer 3

Systemic
-fever, fatigue, weight loss

GI

• change in bowel habit
• pain on defecation

GU

• urinary frequency
• urgency
• dysuria

Question 4

Past medical history

• menstrual
• obstetric
• sexual
• contraceptive, cervical smear
• other medical history, medication

Answer 4

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

Question 5

Family history

Answer 5

Hx of

• ovarian, endometrial, breast cancer?
• blood clots

Question 6

Social history

Answer 6

Living

• other people
• dependents, carers
• ADLs

Occupation and impacts

Smoking, alcohol, recdrugs

Current BMI and diet

Question 7

Ectopic pregnancy

• risk factors
• core features
• investigations
• management

Answer 7

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

Question 8

Endometriosis

• risk factors
• core features
• investigations
• management

Answer 8

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

Question 9

PID

• risk factors
• core features
• investigations
• management

Answer 9

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

Question 10

PCOS

• risk factors
• core features
• investigations
• management

Answer 10

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