Pelvic pain Flashcards
What is the most common cause of pelvic pain?
Primary dysmenorrhoea
What are the features of mittelschmerz?
Suprapubic pain that occurs 2 weeks after menstruation, typically around the time of ovulation.
Lasts for around 24-48 hours
Ultrasound may show a trace of free fluid
Management is via simple analgesia.
If that fails, COCP
If symptoms do not resolvem laparoscopy
What are the features of ectopic pregnancy?
6-8 week history of amenorrhoea
Presents with lower abdominal pain
May have vaginal bleeding
May also have shoulder tip pain and cervical excitation
Investigation:
Serum HCG
TVUSS
Management: Conservative/Medical/Surgical
What are the features of urinary tract infection?
Typically presents with dysuria and frequency, however there may be suprapubic burning linked to cystitis
Investigation:
Urine dip
Management: Trimethoprim, Nitrofurantoin
What are the features of appendicitis?
Pain initial in the central abdomen before localising to the right iliac fossa
Tachycardia, low-grade pyrexia, tenderness in RIF
Rovsing’s sign: more pain in RIF than LIF when palpating LIF
What are the features of PID?
Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria and menstrual irregularities may occur
Cervical excitation may be found on examination
Management: Doxycline + Metronidazole + Ceftriaxone
What are the features of ovarian torsion?
Sudden onset unilateral pain
Typically follows exercise
Nausea and Vomiting
Unilateral, tender, adnexal mass on palpation
Investigation:
TVUSS - “Whirlpool sign” and fluid seen
Management:
Treated via laparoscopy
What are the features of miscarriage?
Vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoea
What are the features of ovarsion cysts?
Unilateral chronic dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain
Large cysts may cause abdominal swelling or pressure effects on the bladder
