*Low abdominal and pelvic pain Flashcards
Sudden sharp pain in pelvis becoming more generalised indicates?
Ruptured
●Ectopic or
●Ovarian cyst
Recurrent sharp, self limiting pain in pelvis indicates?
Ruptured Graafian follicle (Mittelschmerz)
Afferent pathway of pelvic viscera
Sensory nerves from
T10-12, L1, S2-4
*Ectopic pregnancy c/f
- Low abd pain Rt/lt iliac fossa
- Missed period - secondary amenorrhoea
- AUB
- Circulatory collapse - ruptured
- Pain radiates to rectum, butt, back thigh
- Signs of preg (breast tenderness) CAN BE NEGATIVE
Exam:
1. Cervical motion tenderness
2. Palpable adnexal mass/tenderness
Dxt of ectopic pregnancy
Initial:
Urine preg test + (mostly)
Next:
●Beta-hCG >2000IU/L - Transvaginal USG
●Beta-hCG <2000IU/L - cannot see anything on USG (no USG findings until at least 5 wks of preg)
… ●Serial B-hCG done every 2nd day
If IUP+ - B-hCG will be >double
If ectopic - no rise in B-hCG
Mx of ectopic pregnancy
Observe
Medical - if
No active bleed, B-hCG not very high, small in size
IM Methotrexate
Sx - if bleed, rupture, large
Salpingectomy - ruptured
Salpingostomy - unruptured
PID
- Endometritis, salpingitis, pelvic peritonitis, ovarian abscess
- Young, sexually active, pelvic pain
- Complications - infertility, ectopic preg, chronic pain
- Acute: Fever, mod-sev pelvic apin, nausea, vomiting, abn discharge
- Chronic: dysparunia
- Unusual vaginal warmth
Cervical motion tenderness
Adnexal tenderness - Purulent discharge
Causative organisms of PID
- Chlamydia trachomatis - mcc
- N. gonorrhoea
- Mycoplasma genitalium
*Dxt of PID
Endocervical swab - PCR
for above 3 organisms
Mx of PID
STI - mild-mod
Ceftriaxone IV or IM single dose+
Metronidazole x14days +
Doxy x14days (Azithromycin if preg 1dose/wk)
M. genitalium - Moxifloxacin x14days
Treat sexual partner
Mx of post procedural/intrumental infection
Amoxiclav x14days
If penicillin allergy:
Trimethoprim +
Sulfamethoxazole +
Metronidazole
No sex for 1wk
Graafian follicle rupture (mittelschmerz) pain vs distension of ovarian capsule
After ovulation
Graafian follicle rupture …
follicle fluid + blood … Pouch of douglas
Sometimes peritonism
Mid cycle pain, HORSE KICK PAIN, u/l radiating to centre
Better when sitting forward, lasting hours
No mx needed, analgesics
Ovarian capsule distension - u/l pain, before ovulation
Ruptured ovarian cyst
- 15-25yrs
- Pain - sudden onset, iliac fossa, per-rectal
- Nausea, vomit maybe. No systemic signs
- Transvaginal USG -
<4cm cyst: conservative rx
>4cm, simple cyst, pain: needle vaginal drainage
Large, complicated, external bleed: Laparoscopic sx
Torsion of ovarian cyst
- mc dermoid cyst
- Pain: *Diffuse (unlike ovarian cyst rupture), severe, cramping lower abd, radiating to back/thigh
- More severe symptoms than ruptured cyst
- Signs- lump, tenderness, guarding
- Dxt- pelvic USG
- Rx- always sx.. laparoscopic cystectomy
Ovarian cancer etiology, a/w with which cancers, r/f, protective factors
- > 45yrs, can happen any age
- A/w breast, colorectal CA
- R/f:
Age, fam h/o
Nulliparous
BRCA1 or 2 mutation - Protective factors:
CHC pills
Pregnancy
