Acute pelvic pain Flashcards
(54 cards)
gynae causes of pain in pregnancy
Torsion of ovarian cyst
Degeneration of fibroids
Flare up of PID
DD of medical and surgical causes of pelvic pain
Constipation UTI Diverticulitis IBS Interstitial cystitis Sickle cell crisis Porphyria
Acute appendicitis Ureteric calculi Cholecystitis Peptic ulcer Pancreatitis Intestinal obstruction Ruptured liver/spleen GI cancers
how might ovarian cyst present
pelvic pain
bloating and early satiety
palpable adnexal mass
scoring system for the identification of women with adnexal torsion
Criteria
Adjusted odds ratio (95%CI)
1
Unilateral lumbar or abdominal pain
4.1 (1.2–14)
2
Pain duration>8 hours
8.0 (1.7–37.5)
3
Vomiting
7.9 (2.3–27)
4
Absence of leucorrhoea/metrorrhagia
12.6 (2.3–67.6)
5
Ovarian cyst>5cm by ultrasound
10.6 (2.9–38.8)
common symptoms of adnexal torsion
Pelvic or abdominal pain,
fluctuating, radiating to loin or thigh
Nausea
Vomiting
what is adnexal torsion
twisting of the ovary and sometimes the fallopian tube, interrupting the arterial supply and causing ischemia.
signs of adnexal torsion
sign seen on US
pyrexia
tachycardia
due to increased inflammatory markers or due to dehydrations due to N/V
Abdominal examination
Generalised abdominal tenderness, localised guarding, rebound
Vaginal examination
Cervical excitation, adnexal tenderness, adnexal mass
WHIRLPOOL SIGN ON US
features of appendicitis
Typically<40years old
Migratory pain, anorexia, vomiting
features of functional ovarian cyst
natural cycles
sudden onset
sharp stabbing pain
types of ovarian cyst
functional
pathological
what are functional cysts and how are they formed
linked to the menstrual cycle
does not release an egg, or does not discharge its fluid and shrink after the egg is released. If this happens, the follicle can swell and become a cyst.
what are pathological cysts and how are they formed
abnormal cell growth and are not related to the menstrual cycle. They can develop before and after the menopause.
Pathological cysts develop from either the cells used to create eggs or the cells that cover the outer part of the ovary.
They can sometimes burst or grow very large and block the blood supply to the ovaries.
in what medical conditions can you see cysts in
endometriosis
PCOS
If ovarian cyst is found in menopause women then what happens and why
US scans and blood tests every 4 months for a year as they have a higher chance of ovarian cancer
what is OHSS
ovarian hyperstimulation syndrome
serious complication of fertility treatment especially IVF
Mild OHSS featrues
mild
abdominal swelling
discomfort
nausea
moderate swelling is worse because of fluid build-up in the abdomen. abdominal pain vomiting.
severe
extreme thirst and
dehydration.
- small amounts of urine which is dark in colour
- difficulty breathing because of a build-up of fluid
in your chest.
DVT
moderate Sx of OHSS
swelling is worse because of fluid build-up
in the abdomen.
abdominal pain
vomiting.
severe Sx of OHSS
extreme thirst and
dehydration.
- small amounts of urine which is dark in colour
- difficulty breathing because of a build-up of fluid
in your chest.
DVT
Mx of OHSS
it will usually get better in 7-10 days
if u get pregnant it may persist and get worse
not pregnant when next period it gets better
features of fibroid torsion
constant, severe pain
what are fibroids
Fibroids are non-cancerous growths that develop in or around the womb (uterus).
features of fibroids
usually its asymptomatic but some women may experience certain Sx
- heavy periods or painful periods
- tummy (abdominal) pain
- lower back pain
- a frequent need to urinate
constipation - pain or discomfort during sex
RFs of fibroids
African-Carribean women
overweight or obese women as its associated with higher levels of oestrogen
more children you have the lower the risk
-ncreased patient weight • age in the 40s • hypovitaminosis of vitamin D • hypertension • early menarche (under 10 years) • use of oral contraceptives (if started before age 16 years) • nulliparity • younger age at first birth • poor vitamin A intake • dietary intake high in beef and other red meat • sex hormone exposure • menstrual history • smoking • alcohol consumption
what are the types of fibroids
intramural fibroids – the most common type of fibroid, which develop in the muscle wall of the womb
subserosal fibroids – fibroids that develop outside the wall of the womb into the pelvis and can become very large
submucosal fibroids – fibroids that develop in the muscle layer beneath the womb’s inner lining and grow into the cavity of the womb
