Acute Pelvic Pain Flashcards Preview

B - Gynaecology > Acute Pelvic Pain > Flashcards

Flashcards in Acute Pelvic Pain Deck (29)
1

What is acute pelvic pain in a woman of reproductive age with a positive pregnancy test, until proven otherwise?

Ectopic pregnancy

2

What questions need to be asked in acute pelvic pain history?

- SQITARS
- LMP
- Contraception
- Recent unprotected sexual intercourse
- Risk factors for ectopic preg
- Vaginal discharge/bleeding
- Bowel symptoms
- Urinary symptoms

3

What needs to be checked on examination in acute pelvic pain?

- Haemodynamically stable?
- Abdomen
- Pelvic

4

Why do you need to check a patient with acute pelvic pain is haemodynamically stable?

Risk of bleeding from ectopic

5

What needs to be checked on abdominal examination in acute pelvic pain?

- Acute abdomen?
- Masses

6

What needs to be checked on pelvic examination in acute pelvic pain?

- Discharge
- Cervical excitation
- Adnexal tenderness
- Masses present?

7

What investigations may be done in acute pelvic pain?

- Urinary/serum hCG
- MSU
- Triple swabs
- FBC, G&S, and CRP
- Pelvic USS
- Abdominal x-ray, CT, or MRI as appropriate
- Diagnostic laparoscopy

8

What is involved in the immediate management of acute pelvic pain?

- Resuscitate if necessary
- Analgesia
- Specific treatment will depend on cause of pain

9

What are the gynaecological causes of acute pelvic pain?

- Early pregnancy complications
- PID
- Ovarian cyst accident
- Adnexal pathology
- Mittelschmerz
- Pregnancy complications
- Primary dysmenorrhoea
- Haematometra/haematocolpos
- Acute exacerbation of chronic pain

10

What early pregnancy complications can cause acute pelvic pain?

- Ectopic pregnancy
- Miscarriage
- Ovarian hyperstimulation syndrome

11

What ovarian cyst accidents can cause acute pelvic pain?

- Torsion
- Haemorrhage
- Rupture

12

What adnexal pathology can cause acute pelvic pain?

- Torsion of fallopian tube/parafimbral cyst
- Salpingo-ovarain asbcess

13

What is mittelschmerz?

One sided, lower abdominal pain associated with ovulation

14

What pregnancy complications can cause acute abdominal pain?

- Fibroid degeneration
- Ovarian cyst accident
- Ligament stretch

15

What is haematometra?

Retention of blood in uterus

16

What causes haematometra?

Obstruction or atresia of the lower reproductive tract (uterus, cervix, or vagina), which would otherwise provide outflow for menstrual blood

17

What is obstruction leading to haematometra most commonly caused by?

Congenital abnormalities

18

What congenital abnormalities can cause obstruction leading to haematometra?

- Imperforate hymen
- Transverse vaginal specum

19

What are some acquired causes of obstruction leading to haematometra?

- Cervical stenosis
- Intrauterine adhesions
- Cervical or endometrial cancer
- FGM

20

How does haematometra typically present?

- Cyclic cramping pain in midline of pelvis of lower abdomen
- Urinary frequency and urinary retention n

21

What features are often present in pre-menopausal women with haematometra?

Abnormal vaginal bleeding, including dysmenorrhoea or amenorrhoea

22

How does haematometra appear on examination?

Uterus will typically feel firm and enlarged

23

How can the diagnosis of haematometra be confirmed?

Ultrasound

24

How is haematometra managed?

Cervical dilation to train blood from uterus, and addressing underlying cause

25

What is haematocolpos?

Blood in the vagina

26

What is haematocolpos caused by?

Combination of menstruation with imperforate hymen

27

How is haematocolpos managed?

Surgically, with hymenotomy or other surgery to remove any tissue blocking menstrual flow

28

What are the non-gynaecological causes of acute pelvic pain?

- Appendicitis
- IBS
- Inflammatory bowel disease
- Mesenteric adenitis
- Diverticulitis
- Strangulation of hernia

29

What are the urological causes of acute pelvic pain?

- UTI
- Renal/bladder calculi