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Pelvic pain women

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daju89's version from 2018-04-18 14:27

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Usually acute.
A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding.
Shoulder tip pain and cervical excitation may be seen
Ectopic pregnancy
Usually acute.
Dysuria and frequency are common but women may experience suprapubic burning secondary to cystitis
Urinary tract infection
Usually acute.
Pain initial in the central abdomen before localising to the right iliac fossa.
Anorexia is common.
Tachycardia, low-grade pyrexia, tenderness in RIF.
Rovsing's sign: more pain in RIF than LIF when palpating LIF
Appendicitis
Usually acute.
Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria and menstrual irregularities may occur.
Cervical excitation may be found on examination
Pelvic inflammatory disease
Usually acute.
Usually sudden onset unilateral lower abdominal pain. Onset may coincide with exercise.
Nausea and vomiting are common.
Unilateral, tender adnexal mass on examination
Ovarian tortion
Usually acute.
Vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoea
Miscarriage
Usually chronic.
Chronic pelvic pain.
Dysmenorrhoea - pain often starts days before bleeding.
Deep dyspareunia.
Subfertility.
Endometriosis
Usually chronic.
Extremely common. The most consistent features are abdominal pain, bloating and change in bowel habit.
Features such as lethargy, nausea, backache and bladder symptoms may also be present
IBS
Usually chronic.
Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain.
Large cysts may cause abdominal swelling or pressure effects on the bladder
Ovarian cyst
Usually chronic.
Seen in older women.
Sensation of pressure, heaviness, 'bearing-down.'
Urinary symptoms: incontinence, frequency, urgency
Urogenital prolapse
commonest type of ovarian cyst
due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
commonly regress after several menstrual cycles
Follicular cyst (physiological)
during the menstrual cycle if pregnancy doesn't occur the corpus luteum usually breaks down and disappears. If this doesn't occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
more likely to present with intraperitoneal bleeding than follicular cysts
Corpus luteum cyst (physiological)
also called mature cystic teratomas. Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
most common benign ovarian tumour in woman under the age of 30 years
median age of diagnosis is 30 years old
bilateral in 10-20%
usually asymptomatic. Torsion is more likely than with other ovarian tumours
Dermoid cyst (benign germ cell tumour)
the most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
bilateral in around 20%
Serous cystadenoma (benign epithelial tumour)
second most common benign epithelial tumour
they are typically large and may become massive
if ruptures may cause pseudomyxoma peritonei
Mucinous cystadenoma (benign epithelial tumour)
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