Makindo Medical Notes.com |
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Cause | Clinical Features | Diagnostic Tests | Management |
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Ectopic Pregnancy |
- Acute pelvic pain
- Missed period - Vaginal bleeding - Shoulder pain (if rupture) - Hemodynamic instability in rupture |
- Pregnancy test (hCG): Elevated
- Transvaginal ultrasound: No intrauterine pregnancy seen, adnexal mass - Complete blood count (CBC): To assess for anaemia in case of rupture |
- Methotrexate: For stable, unruptured ectopic pregnancy
- Surgical intervention: Laparoscopic salpingectomy for ruptured ectopic pregnancy - Monitoring hCG levels: Until levels return to zero |
Pelvic Inflammatory Disease (PID) |
- Bilateral lower abdominal pain
- Fever - Abnormal vaginal discharge - Painful urination or intercourse - Cervical motion tenderness |
- Cervical swabs: For chlamydia and gonorrhoea
- CBC: Elevated WBCs - Pelvic ultrasound: May show thickened fallopian tubes or abscesses |
- Antibiotic therapy: Broad-spectrum antibiotics (e.g., ceftriaxone and doxycycline)
- Hospitalization: For severe cases or tubo-ovarian abscess - Partner treatment: To prevent reinfection |
Ovarian Torsion |
- Sudden, severe, unilateral pelvic pain
- Nausea and vomiting - Tenderness on pelvic examination |
- Pelvic ultrasound with Doppler: Decreased ovarian blood flow
- CBC: To assess for infection or haemorrhage |
- Surgical detorsion: Laparoscopy to untwist the ovary
- Oophorectomy: If the ovary is non-viable or necrotic |
Endometriosis |
- Chronic pelvic pain
- Dysmenorrhea - Dyspareunia (painful intercourse) - Infertility |
- Pelvic ultrasound: May show endometriomas ("chocolate cysts")
- Laparoscopy: Gold standard for diagnosis, confirms endometrial implants |
- Medical management: Hormonal therapy (e.g., OCPs, GnRH agonists)
- Surgical management: Laparoscopic excision of endometrial tissue - Fertility treatment: Assisted reproductive techniques for infertility |
Ovarian Cyst Rupture |
- Sudden-onset unilateral pelvic pain
- Pain may radiate to the back or thigh - Vaginal spotting - Symptoms may worsen with activity |
- Pelvic ultrasound: Fluid in the pelvis, possible cyst remnants
- CBC: To assess for anaemia from blood loss |
- Observation: For small, uncomplicated cyst rupture
- Surgical intervention: If hemodynamically unstable or large haemorrhage - Analgesics: Pain management for stable cases |
Appendicitis |
- Right lower quadrant pain
- Nausea, vomiting - Fever - Pain may migrate from the periumbilical area to the right lower quadrant |
- CBC: Elevated WBCs
- Abdominal ultrasound/CT: Enlarged appendix, surrounding inflammation |
- Surgical removal: Appendectomy (laparoscopic or open)
- Antibiotics: For infection or if surgery is delayed |
Urinary Tract Infection (UTI) |
- Suprapubic pain
- Dysuria (painful urination) - Urinary urgency and frequency - Haematuria (blood in urine) |
- Urinalysis: Pyuria, bacteriuria, haematuria
- Urine culture: To identify causative organism |
- Antibiotics: Oral antibiotics (e.g., nitrofurantoin, trimethoprim/sulfamethoxazole)
- Hydration: Encourage fluid intake |
Fibroids |
- Heavy menstrual bleeding
- Pelvic pressure or pain - Infertility - Urinary or bowel symptoms (if large) |
- Pelvic ultrasound: Solid mass within the uterus
- MRI: Further evaluation of large fibroids |
- Hormonal therapy: GnRH agonists to shrink fibroids
- Myomectomy: For symptom relief or fertility preservation - Hysterectomy: Definitive treatment for symptomatic fibroids |
Interstitial Cystitis |
- Chronic pelvic pain
- Bladder pain, urinary urgency/frequency - Pain worsens as bladder fills and is relieved after voiding |
- Urinalysis: Typically normal
- Cystoscopy: May show bladder inflammation or Hunner’s ulcers |
- Bladder training: Scheduled voiding and fluid management
- Medications: Pentosan polysulfate, tricyclic antidepressants - Intravesical therapy: Bladder instillations to relieve symptoms |