acute pelvic pain

Question 1

what is the most common cause of pelvic pain in women?

Answer 1

primary dysmenorrhoea

Question 2

what is a Mittelschmerz?

Answer 2

transient pain the middle of the menstrual cycle secondary to ovulation

Question 3

• female with a hx of 6-8 weeks amenorrhoea
• presents with lower abdo pain
• later develops vaginal bleeding
• shoulder tip pain and cervical excitation may be seen

dx?

Answer 3

ectopic pregnancy

Question 4

• dysuria and frequency common
• may experience suprapubic pain 2˚ to cystitis

dx?

Answer 4

UTI

Question 5

• pain initial in central abdomen
• localises to RIF
• anorexia common
• tachycardia, low-grade pyrexia, tenderness in RIF
• Rovsing’s sign: more pain in RIF than LIF when palpating LIF

dx?

Answer 5

appendicitis

Question 6

• usually sudden onset unilateral lower abdo pain (LIF pain)
• can radiate to loin, groin or back
• onset may coincide with exercise
• N+V common
• unilateral, tender adnexal mass* on examination
• *can be ovarian cyst or neoplasm → disrupts normal lie of ovary

dx?

Answer 6

ovarian torsion

can also present with low-grade fever, especially for longer durations of torsion where ovarian necrosis may be present

Question 7

• vaginal bleeding
• crampy lower abdominal pain
• following a period of amenorrhoea

dx?

Answer 7

miscarriage

Question 8

• pelvic pain, fever, deep dyspareunia, vaginal d/c, dysuria, menstrual irregularities
• cervical excitation

dx?

Answer 8

pelvic inflammatory disease (PID)