Version May 2024
| Causative disorder or condition | Pain history | Associated symptoms | Supporting history | Physical examination | Useful tests | Atypical or additional aspects |
| Ectopic pregnancy (critical if ruptured) | Classically severe, sharp, lateral pelvic pain, but severity, location, and quality highly variable | Vaginal bleeding (often spotting or light, but can be absent) | Missed period History of previous ectopic pregnancy, infertility, pelvic surgery, PID, or IUD use | Classically, unilateral adnexal tenderness, adnexal mass, CMT |
| Cannot reliably exclude diagnosis based on history and physical examination Severe pain, hypotension, or peritonitis suggests rupture |
| Ruptured ovarian cyst (critical with significant hemorrhage; otherwise, emergency) | Abrupt moderate to severe lateral pain | Light-headedness if bleeding is severe Rectal pain arises from fluid in cul-de-sac Nausea and vomiting may occur | Pain may begin spontaneously or with intercourse Menstrual history may indicate LMP was two or more weeks ago | Hypotension and tachycardia if blood loss is significant Possible peritonitis |
| Physical examination findings often do not correlate with volume of blood in pelvis at US |
| Ovarian torsion (emergency) | Acute onset of moderate to severe lateral pain | Nausea and vomiting | History of ovarian mass or cyst | Adnexal mass and tenderness Possible peritonitis |
| Torsion can be intermittent, which causes symptoms to come and go |
| Appendicitis (emergency) | Duration often <48 hours, generalized followed by localized RLQ pain | Low-grade fever, nausea, vomiting, anorexia | Migration of pain to RLQ from center Abdominal pain before vomiting | RLQ tenderness Possible peritonitis |
| Early in course, tenderness may be minimal or poorly localized |
| PID (urgent-emergency), TOA (emergency) | Without TOA, pain is usually bilateral; may manifest acutely within 48 hours, but PID may also be chronic | Fever, vaginal discharge | Vaginal discharge History of PID History of a new sex partner, more than one partner, or a partner who has other sex partners or a sexually transmitted infection | Pus from cervical os, CMT, adnexal tenderness Peritonitis suggests TOA or severe PID |
| History and physical examination may be inaccurate for diagnosis, particularly in patients with subacute presentation |
| Complicated UTI (urgent) | Pain with urination Patient may have flank pain from associated pyelonephritis | Urinary urgency and frequency Fever and vomiting if patient has associated pyelonephritis | Recent urologic procedure Prior history of UTI | Suprapubic tenderness, flank tenderness, and fever with pyelonephritis |
| WBCs can be present in urine with PID and appendicitis RBCs present in urine with hemorrhagic cystitis |
| Ureteral obstruction (urgent) | Acute onset, manifests within hours Pain is lateral, usually moderate to severe Often radiates into the groin or costovertebral angle or flank | Nausea and vomiting | History of surgery that could cause ureteral obstruction or prior history of kidney stones | Patient often appears uncomfortable, but physical examination can be otherwise unremarkable |
| If obstruction or stone is at uretero-vesicle junction, patient can have localized pain that can mimic appendicitis or other acute pelvic pathology |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
