PELVIC PAIN
Visualizing the anatomy of the pelvic area is the key to forming a list
of the causes of pelvic pain. Starting at the skin and working inward, we
have the muscles and fascia, bladder, peritoneum, uterus, ovaries, fallopian
tubes, intestines, rectum, and spine. The skin helps to recall herpes
zoster, the muscle and fascia suggest contusion and hernia, and the
peritoneum would remind one of peritonitis and endometriosis. The uterus,
ovary, and tubes would prompt consideration of PID, dysmenorrhea, pelvic
congestion, and ectopic pregnancy. Ovarian tumors can also cause pelvic pain
by twisting on their pedicle. A pedunculated uterine fibroid can also twist
on its pedicle causing severe pain. If the pelvic pain is related to the
menstrual cycle, one should recall mittelschmerz. Considering the
intestines, one should recall appendicitis and diverticulitis. Considering
the rectum should prompt recall of hemorrhoids, fissures, and rectal
abscess. Finally, thinking of the spine should suggest rheumatoid
spondylitis, osteomyelitis, herniated disk, and other conditions.
Approach to the Diagnosis
A good pelvic and rectal examination is essential. These will often
disclose a mass or other pathology to explain the pain. If there is a
vaginal discharge, a smear and culture for gonococcus and Chlamydia need to be done.
A pregnancy test will help rule out an ectopic pregnancy, but
ultrasonography is most useful.
A gynecology consult should be obtained when there is any doubt. In acute
cases, the gynecologist may proceed with an exploratory laparotomy
immediately.
Other Useful Tests
-
CBC (PID, ruptured ectopic pregnancy)
-
Chemistry panel
-
Urinalysis (cystitis, pyelonephritis)
-
Urine culture (cystitis, urinary tract infection [UTI])
-
Pregnancy test (ectopic pregnancy)
-
CT scan of abdomen and pelvis (only if pregnancy has been ruled
out) (neoplasm, abscess)
-
Culdocentesis (PID, neoplasm, ectopic pregnancy)
-
Laparoscopy (PID, neoplasm, ectopic pregnancy)
-
Peritoneal tap (peritonitis, ruptured ectopic pregnancy)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Pelvic mass
Read excerpts from these other book chapters related to Pelvic mass:
Medical Books Excerpts
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Chronic Pelvic Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Pelvic mass
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PELVIC MASS (Differential Diagnosis in Primary Care)
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