Gynaecological_Abdominal_Pain_Flashcards

Question 1

What diagnostic workup should be done for all female patients presenting with abdominal pain?

Answer 1

Bimanual vaginal examination, urine pregnancy test, consideration of abdominal and pelvic ultrasound scanning.

Question 2

What reliable method assesses suspected tubulo-ovarian pathology when diagnostic doubt persists?

Answer 2

Laparoscopy.

Question 3

What are the typical features of Mittelschmerz?

Answer 3

Usually mid-cycle pain, sharp onset, little systemic disturbance, may have recurrent episodes, settles over 24-48 hours.

Question 4

What investigations are done for Mittelschmerz?

Answer 4

Full blood count (usually normal), Ultrasound (may show small quantity of free fluid).

Question 5

What is the treatment for Mittelschmerz?

Answer 5

Conservative management.

Question 6

What are the features of Endometriosis?

Answer 6

25% asymptomatic, menstrual irregularity, infertility, pain, deep dyspareunia, pelvic adhesions, intermittent small bowel obstruction, intra-abdominal bleeding, recurrent episodes.

Question 7

What investigations are done for Endometriosis?

Answer 7

Ultrasound (may show free fluid), Laparoscopy (usually shows lesions).

Question 8

What is the treatment for Endometriosis?

Answer 8

Usually managed medically, complex disease often requires surgery, some patients may need formal colonic and rectal resections.

Question 9

What are the features of Ovarian torsion?

Answer 9

Sudden onset of deep-seated colicky abdominal pain, associated with vomiting and distress, adnexial tenderness on vaginal examination.

Question 10

What investigations are done for Ovarian torsion?

Answer 10

Ultrasound (may show free fluid), Laparoscopy (both diagnostic and therapeutic).

Question 11

What is the treatment for Ovarian torsion?

Answer 11

Laparoscopy.

Question 12

What are the features of Ectopic gestation?

Answer 12

Symptoms of pregnancy without evidence of intrauterine gestation, emergency presentation with rupture or impending rupture, sudden onset of abdominal pain and circulatory collapse, small amount of vaginal discharge, adnexial tenderness.

Question 13

What investigations are done for Ectopic gestation?

Answer 13

Ultrasound (showing no intrauterine pregnancy), elevated beta HCG, may show intra-abdominal free fluid.

Question 14

What is the treatment for Ectopic gestation?

Answer 14

Laparoscopy or laparotomy if haemodynamically unstable, usually salpingectomy.

Question 15

What are the features of Pelvic inflammatory disease?

Answer 15

Bilateral lower abdominal pain, vaginal discharge, dysuria, right upper quadrant discomfort (Fitz Hugh Curtis Syndrome), fever >38°C.

Question 16

What investigations are done for Pelvic inflammatory disease?

Answer 16

Full blood count (Leucocytosis), negative pregnancy test, amylase (usually normal or slightly raised), high vaginal and urethral swabs.

Question 17

What is the treatment for Pelvic inflammatory disease?

Answer 17

Usually medical management.

Question 18

Summarise Gynaecological causes of abdominal pain

Answer 18

Gynaecological causes of abdominal pain

A number of women will present with abdominal pain and subsequently be diagnosed with a gynaecological disorder. In addition to routine diagnostic work up of abdominal pain, all female patients should also undergo a bimanual vaginal examination, urine pregnancy test and consideration given to abdominal and pelvic ultrasound scanning.

When diagnostic doubt persists a laparoscopy provides a reliable method of assessing suspected tubulo-ovarian pathology.

Question 19

A 33-year-old woman presents to the emergency department with worsening left-sided abdominal pain. She reports the pain started suddenly 5 hours ago and has been steadily getting worse. The pain started suddenly following intercourse. She is unsure about the date of her last menstrual period as she currently has the Mirena coil fitted. She denies any vaginal bleeding or discharge. Apart from the pain, she has no other symptoms and her observations are stable.

Her lower abdomen is tender on palpation but there is no guarding or rigidity. Pelvic exam including bimanual exam is unremarkable. The Mirena coil threads are clearly visualised.

Ultrasound shows free fluid in the pelvic cavity. Urinary pregnancy test is negative.

What is the most likely diagnosis?

Adnexal torsion
Mittelschmerz
Ruptured ovarian cyst
Ruptured ectopic pregnancy
Appendicitis

Answer 19

Ruptured ovarian cyst

Ruptured ovarian cyst: sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity

Ruptured ovarian cyst presents as sharp unilateral pain immediately following intercourse or strenuous exercise. Bimanual examination in non-severe cases is generally unremarkable but the lower abdomen is tender. Ultrasound shows free fluid in the pelvic cavity.

Ovarian or adnexal torsion can present similarly with sharp unilateral pain often associated with nausea and vomiting. There is a tender palpable adnexal mass on bimanual exam. Ultrasound shows an enlarged, oedematous ovary with impaired blood flow.