ACUTE LOWER ABDOMINAL PAIN

Question 1

Causes of Acute Lower Abdominal Pain in Women

Answer 1

Ectopic pregnancy
Appendicitis
Ovarian torsion
STI-related
Non-STI-related (e.g., urinary tract infection)
Septic abortion
Postpartum sepsis
Foreign body, including IUCD

Question 2

Causes of PID

Answer 2

STI-related
Ascending bacterial infection from non-STI sources

Question 3

Symptoms of Acute Lower Abdominal Pain in Women

Answer 3

Dysuria or Urethral discomfort
Lower abdominal pain
Dyspareunia
Offensive vaginal discharge
Fever

Question 4

Signs of lower abdominal pain in women

Answer 4

Lower abdominal tenderness
Cervical motion tenderness on bimanual vaginal examination
Adnexal tenderness
Adnexal mass

Question 5

Investigations for Acute Lower Abdominal Pain in Women

Answer 5

Pelvic ultrasound
Pregnancy test (if sexually active and amenorrhea present)
High vaginal swab culture and sensitivity

Question 6

Treatment Objectives

Answer 6

Identify and manage potential life-threatening causes (e.g., ectopic pregnancy)
Treat underlying bacterial infection
Relieve pain and inflammation

Question 7

Non-Pharmacological Treatment

Answer 7

Surgery where indicated
Remove IUD, if present, 3 days after initiation of drug therapy

Question 8

Pharmacological Treatment for PID (Mild Cases)

Answer 8

Ciprofloxacin, oral, 500 mg 12 hourly for 3 days
+
Doxycycline, oral, 100 mg 12 hourly for 14 days
+
Metronidazole, oral, 400 mg 12 hourly for 14 days

Question 9

Pharmacological Treatment for PID (Severe Cases)

Answer 9

Ceftriaxone, IM, 250 mg daily for 3 days
+
Doxycycline, oral, 100 mg 12 hourly for 3 days
+
Metronidazole, IV, 500 mg 8 hourly for 3 days
Then switch to
Doxycycline, oral, 100 mg 12 hourly for 14 days
+
Metronidazole, oral, 400 mg 12 hourly for 14 days

Question 10

Consider Hospitalization or Referral in the Following Cases

Answer 10

Surgical emergencies cannot be excluded (e.g., ectopic, appendicitis)
Pregnant patient
No clinical response to oral antimicrobial therapy
Unable to follow or tolerate outpatient oral regimen
Severe illness, nausea, vomiting, or high fever
Tubo-ovarian abscess
HIV infection
Youth/adolescents (compliance issues)