PELVIC PAIN
PELVIC PAIN: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is there a pelvic mass? The presence of a pelvic mass would suggest salpingo-oophoritis, ectopic pregnancy, endometriosis, uterine fibroid, or an ovarian tumor that is twisting on its pedicle.
- Is there fever or purulent vaginal discharge? The presence of fever or purulent vaginal discharge would suggest PID, diverticulitis, and appendicitis.
- Is there a history of metrorrhagia or menorrhagia? The history of metrorrhagia or menorrhagia would suggest ectopic pregnancy, threatened abortion, retained secundinae, uterine fibroids, and endometriosis.
- Is there a positive pregnancy test? The presence of a positive pregnancy test would suggest an ectopic pregnancy or threatened abortion.
- Is the pain related to the menstrual cycle? If the pain is related to the menstrual cycle, mittelschmerz should be considered.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, pregnancy test, urinalysis, urine culture, chemistry panel, VDRL test, and Pap smear. A vaginal smear and culture should also be done routinely.
The next step would logically be a pelvic ultrasound, but it is wise to consult a gynecologist before ordering expensive tests. The gynecologist may proceed with laparoscopy, culdocentesis, and, ultimately, an exploratory laparotomy. A CT scan of the abdomen and pelvis may also be necessary.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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