Lower Abdominal Pain in female

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍day history of pelvic pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Location is ‍diffuse

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent, worse during the ‍day

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍missed period, ‍one cycles missed, ‍possibility of pregnancynot sexually active

‍vaginal bleeding

‍vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍constipation

‍changes in bowel habits

‍diarrhea, ‍ episodes ‍per day, ‍

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍bloating

‍flatulence

‍dysuria

‍frequency

‍hematuria

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



Gynecological history:

Last menstrual period: ‍ ‍daysweeksmonths ago

Menstrual cycles: ‍ days, ‍regularirregular

Menarche: ‍ years old

G‍01234 P‍01234 A‍01234

Last Pap smear: ‍ ‍monthsyears ago

Coitarche: ‍ years old ‍never

Contraception: ‍yesno ‍oral contraceptives

Condom use: ‍alwayssometimesnever

STI risk factors: ‍



Contributing factors:

‍obesity

‍high stress

‍history of sexual abuse

no history of: ‍endometriosis, ‍uterine fibroids, ‍pelvic inflammatory disease, ‍ovarian cysts, ‍irritable bowel syndrome, ‍abdominal surgeries, ‍pelvic surgeries

no use of: ‍intrauterine device, ‍hormonal therapy





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, ‍blood, ‍mass, anus ‍

Pelvic:

- External genitalia: ‍normal, ‍rashlesions, ‍inguinal lymphadenopathy

- Vagina: ‍normal, ‍lesions, discharge ‍normal, ‍foul-smelling

- Cervix: ‍normal, ‍, ‍IUD strings visualized

- Bimanual exam: ‍normal, uterus ‍tendernessmass, adnexa ‍tendernessmass ‍on righton left, ‍cervical motion tenderness

- Tests performed: ‍Pap smearHPV test, ‍vaginal culturechlamydia/gonorrhea screeningHSV sample, pH ‍< 4.5 (normal)> 4.5, KOH sniff test ‍negative

- ‍Pelvic exam performed with chaperone 





ASSESSMENT:

‍Pelvic inflammatory disease ‍likelysuspectedpossible

DDx: pelvic inflammatory disease, ectopic pregnancy, ovarian cyst rupture, ovarian torsion, endometriosis, uterine fibroids, urinary tract infection, functional pelvic pain, miscarriage, irritable bowel syndrome, inflammatory bowel disease, diverticulitis, constipation, appendicitis, interstitial cystitis, kidney stones, prostatitis, testicular torsion, inguinal hernia, colorectal cancer, rectal prolapse, sexually transmitted infections, chronic pelvic pain syndrome





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍TSH, ‍prolactin, ‍FSH, ‍LH, ‍estradiol, ‍ß-hCG

- Urine: ‍urinalysis, ‍urine culture, ‍pregnancy test

- STI screening for chlamydia and gonorrhea

- Pelvic ultrasound

- CT scan of abdomen and pelvis

- Colonoscopy

Treatments:

- ‍Analgesics

- ‍Antibiotics

- ‍Oral contraceptives

Further care:

- Referral to gynecologist

- Referral to gastroenterologist

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as heavy bleeding or irregular periods, or if symptoms do not improve with treatment

- Referral to ER if severe abdominal pain, fever, or heavy bleeding occurs