Acute Pelvic Pain

~ Acute Pelvic Pain ~

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? Definition:

Acute pain is intense and characterized by sudden onset, sharp rise, and short course.

Acute pain is often occurs in conjunction with profound autonomic reflex responses such as nausea, emesis, diaphoresis, and apprehension.

? Differential Diagnosis:

The character of the pain is helpful in establishing a differential diagnosis:

ª Rapid onset of the pain à perforation of a hollow viscus or ischemia

ª Colic or severe cramping pain à muscular contraction or obstruction of a hollow

viscus, such as intestine or uterus

ª Diffuse abdominal pain à a generalized reaction to an irritating fluid within the

peritoneal cavity.

Visceral Pain:

First perception: a vague, deep, poorly localized sensation with corresponding

autonomic reflex response

Referred pain: well localized, superficial , related to the nerve distribution or

dermatome of the spinal cord segment innervating the involved viscus

Gynecologic Diseases or Dysfunction:

Acute Pain:

Complications of pregnancy:

Ruptured ectopic pregnancy
Abortion, threatened or incomplete
Degeneration of a leiomyoma

Acute infections:

Endometriosis
Pelvic inflammatory disease (acute PID)
Tubo-ovarian abscess

Adnexal disorders:

Hemorrhagic functional ovarian cyst
Torsion of adnexa
Twisted para ovarian cyst
Rupture of functional or neoplastic ovarian cyst

Recurrent Pelvic Pain:

Mittelschmerz (midcycle pain)
Primary dysmenorrhea
Secondary dysmenorrhea

Gastrointestinal:

Gastroenteritis

Appendicitis

Bowel obstruction

Deverticulitis

Inflammatory bowel disease

Irritable bowel syndrome

Genitourinary:

Cystitis

Pylonephritis

Ureteral lithiasis

4. Musculoskeletal:

Abdominal wall hematoma

Hernia

5. Others:

Acute poryphyria

Pelvic thrombophlebitis

Aneurysm

Abdominal angina

? Diagnostic Tests:

Ø Should performed:

CBC/DC
U/A
Pregnancy test
ESR (nonspecific but often the only abnormal finding in female with subacute PID)

Ø Optional:

Culdocentesis
Pelvic ultrasonography
Plain abdomen or KUB
CT
Laparoscopy

? Common Conditions Associated with Acute Pelvic Pain:

　

Diseases

Causes

Clinical Presentations

Diagnosis

Management

Ectopic Pregnancy
　
Abdominal tenderness

Peritoneal signs (+)

Hypovolemic shock

EIA (+)

Sono:

Empty uterus

Ad. mass
　

　

Ovarian Cyst Rupture or

Leakage

Coupus luteum, teratoma, or endo-

metrioma, etc.

Similar to that of ectopic pregnancy

EIA (-)

CBC

Sono

Culdocentesis
　

Adnexal Torsion

Ischemia

Acute abdominal pain

Automonic reflex

Abdominal tenderness

Rebound tenderness

A unilateral pelvic mass

Sono

Surgery:

If no infarct,

Untwist or

Cystectomy

If tissue infarct,

oophorectomy

Acute Salpingo-oophoritis

Gonorrh-

ea

Chlamyd-

ial

Pelvic pain

Tenderness,

Rebound tenderness

Ad. tenderness

Cx. motion tenderness

leukocytosis

S/S

Broad-spectrum

antibiltics

Hospitalization?

R/O TOA

Pregnancy

No resp. in 48 hs

Tubo-ovarian Abscess
　
If ruptured:

Peritoneal signs (++)

S/S

Sono

Unruptured:

Medically with

A/B v.

Ruptured:

Laparotomy

Uterine Leiomyomas

Degenera-

tion, or torsion
　　　

Endometriosis
　　　
If ruptured:

Surgical mx.

Appendicitis
　
Psoas sign

Obturator sign
　
laparotomy

Acute Diverticuluitis
　　
CT

No barium

enema

Surgical intervention

Intestinal Obstruction

Post-OP,

Hernia,

Inf. BD

Cancer

Colicky pain followed by abd. distension, vomiting,

constipation,

and obstipation

High-pitch bowel sound

then progressing to

absent bowel sound

Plain abdomen

Partial:

N/G, IVF

Complete:

Surgery

Ureteral Colic
　
Severe and cramping pain

over costovertebral angle

Hematuria

U/A

IVP

Medical

Surgical

Cystitis
　
Dull suprapubic pain

Frequency

Urgency

Dysuria

U/A

WBC bact.

U/C

Medical

APN
　
Severe and cramping pain

over costovertebral angle

U/A

U/C

Medical

v 各疾病詳細的clinical presentation, diagnosis,與treatment見其它files.

Filename: Acute Pelvic Pain

Diseases	Causes	Clinical Presentations	Diagnosis	Management
Ectopic Pregnancy		Abdominal tenderness Peritoneal signs (+) Hypovolemic shock	EIA (+) Sono: Empty uterus Ad. mass

Ovarian Cyst Rupture or Leakage	Coupus luteum, teratoma, or endo- metrioma, etc.	Similar to that of ectopic pregnancy	EIA (-) CBC Sono Culdocentesis
Adnexal Torsion	Ischemia	Acute abdominal pain Automonic reflex Abdominal tenderness Rebound tenderness A unilateral pelvic mass	Sono	Surgery: If no infarct, Untwist or Cystectomy If tissue infarct, oophorectomy
Acute Salpingo-oophoritis	Gonorrh- ea Chlamyd- ial	Pelvic pain Tenderness, Rebound tenderness Ad. tenderness Cx. motion tenderness leukocytosis	S/S	Broad-spectrum antibiltics Hospitalization? R/O TOA Pregnancy No resp. in 48 hs
Tubo-ovarian Abscess		If ruptured: Peritoneal signs (++)	S/S Sono	Unruptured: Medically with A/B v. Ruptured: Laparotomy
Uterine Leiomyomas	Degenera- tion, or torsion
Endometriosis				If ruptured: Surgical mx.
Appendicitis		Psoas sign Obturator sign		laparotomy
Acute Diverticuluitis			CT No barium enema	Surgical intervention
Intestinal Obstruction	Post-OP, Hernia, Inf. BD Cancer	Colicky pain followed by abd. distension, vomiting, constipation, and obstipation High-pitch bowel sound then progressing to absent bowel sound	Plain abdomen	Partial: N/G, IVF Complete: Surgery
Ureteral Colic		Severe and cramping pain over costovertebral angle Hematuria	U/A IVP	Medical Surgical
Cystitis		Dull suprapubic pain Frequency Urgency Dysuria	U/A WBC bact. U/C	Medical
APN		Severe and cramping pain over costovertebral angle	U/A U/C	Medical