Pelvic pain: Difference between revisions
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[[image: | [[image:elvis.jpg|right|thumb|300px|Elvis is in paaaiiiiiiinnn!]] | ||
===Definition=== | ===Definition=== | ||
Pain in the lower abdomen/pelvis area. | Pain in the lower abdomen/pelvis area. | ||
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[[image:common.jpg]] | [[image:common.jpg]] | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
===Differential Diagnosis=== | ===Differential Diagnosis=== | ||
It's also worth taking a look at [[abdominal pain]]. This where I got most of the differentials from. | It's also worth taking a look at [[abdominal pain]]. This where I got most of the differentials from. | ||
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*[[Salpingitis]] | *[[Salpingitis]] | ||
*[[PID]] | *[[PID]] | ||
=====Dyspareunia===== | |||
Pain during or after [[intercourse]] | |||
*Superficial dyspareunia - pain of the external genitalia. ''Causes'': [[genital infection]], [[Bartholin's cyst]], surgery | |||
*Deep dyspareunia - chronic [[PID]], [[endometriosis]], [[retroverted uterus]], [[IBD]], [[IBS]], chronic [[constipation]], [[pelvic mass]], [[vaginismus]]. | |||
====Non-gynae==== | ====Non-gynae==== | ||
*[[Abdominal abscess]] | *[[Abdominal abscess]] | ||
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*[[Bowel perforation]] | *[[Bowel perforation]] | ||
*[[Appendicitis]] | *[[Appendicitis]] | ||
*Strangulated [[inguinal hernia] | *Strangulated [[inguinal hernia]] | ||
===Clinical and Associated Features=== | |||
[[image:emergency.gif|left]]'''[[Medical Emergencies]] - these conditions are medical emergencies presenting with abdominal pain.''' Scary stuff. Remember - '''acute abdominal pain is surgical until proven otherwise'''. | |||
*[[Appendicitis]] - central abdominal pain moving to the right iliac fossa, fever, rebound tenderness (pain on removing pressure of palpation), tenesmus (feeling of needing to poo), [[nausea]], [[vomiting]], pressure in left IF (iliac fossa) makes pain worse in RIF. Untreated, has a very high mortality as it leads to [[peritonitis]]. | |||
*[[Ectopic pregnancy]] - give a pregnancy test to any woman with acute abdominal pain. Usually presents as for a [[normal pregnancy]]. Pain in the lower abdomen, fever. If they start going into [[shock]] or becoming very unwell, this may be a sign of rupture. | |||
*Irreducible [[inguinal hernia]] - it can develop [[gangrene]] and [[ischaemia]] with fatal consequences. Fatality is generally to be avoided in medicine. | |||
====Not-so-emergency==== | |||
*Dysmenorrhoea - Crampy pain in lower abdomen during period. May be accompanied by [[menorrhagia]]. | |||
*'''Perforation''' - [[pain]] (associated with where perforation is), tenderness, [[peritonitis]], [[shock]] | |||
*'''Renal stones''' - loin-to-groin pain, pain at the tip of the penis/in labia majorum, can lead to [[shock]] and [[peritonitis]] if [[UTI|infection]] develops, flank pain | |||
*PID - usually asymptomatic. Otherwise, [[subfertility]], [[menorrhagia]], lower [[abdominal pain]], deep dyspareunia. | |||
*IBD - alternating [[diarrhoea]] and [[constipation]], [[weight loss]], [[blood in stools]], [[tiredness]] | |||
===Investigations=== | ===Investigations=== | ||
===Management=== | ===Management=== | ||
Latest revision as of 17:07, 18 December 2009
Definition
Pain in the lower abdomen/pelvis area.
Epidemiology
Pathophysiology
Differential Diagnosis
It's also worth taking a look at abdominal pain. This where I got most of the differentials from.
Gynaecological
Dyspareunia
Pain during or after intercourse
- Superficial dyspareunia - pain of the external genitalia. Causes: genital infection, Bartholin's cyst, surgery
- Deep dyspareunia - chronic PID, endometriosis, retroverted uterus, IBD, IBS, chronic constipation, pelvic mass, vaginismus.
Non-gynae
- Abdominal abscess
- Renal stones
- Mesenteric adenitis
- Meckel's diverticulum
- Crohn's
- Bowel perforation
- Appendicitis
- Strangulated inguinal hernia
Clinical and Associated Features
Medical Emergencies - these conditions are medical emergencies presenting with abdominal pain. Scary stuff. Remember - acute abdominal pain is surgical until proven otherwise.
- Appendicitis - central abdominal pain moving to the right iliac fossa, fever, rebound tenderness (pain on removing pressure of palpation), tenesmus (feeling of needing to poo), nausea, vomiting, pressure in left IF (iliac fossa) makes pain worse in RIF. Untreated, has a very high mortality as it leads to peritonitis.
- Ectopic pregnancy - give a pregnancy test to any woman with acute abdominal pain. Usually presents as for a normal pregnancy. Pain in the lower abdomen, fever. If they start going into shock or becoming very unwell, this may be a sign of rupture.
- Irreducible inguinal hernia - it can develop gangrene and ischaemia with fatal consequences. Fatality is generally to be avoided in medicine.
Not-so-emergency
- Dysmenorrhoea - Crampy pain in lower abdomen during period. May be accompanied by menorrhagia.
- Perforation - pain (associated with where perforation is), tenderness, peritonitis, shock
- Renal stones - loin-to-groin pain, pain at the tip of the penis/in labia majorum, can lead to shock and peritonitis if infection develops, flank pain
- PID - usually asymptomatic. Otherwise, subfertility, menorrhagia, lower abdominal pain, deep dyspareunia.
- IBD - alternating diarrhoea and constipation, weight loss, blood in stools, tiredness