Pelvic inflammatory disease is life threatening, it is also associated with
PID systemic sepsis
PID could also present as a number of serious problems including
Ovarian torsion, rupture of cyst (adnexae), appendicitis, and complex renal tract infections
ectopic pregnancy survillence symptoms to look for
abdominal rebound and shoulder pain (phenric nerve C3-C5)
acute pelvic pain is variable. what is classed as acute pelvic pain
<3months
Acute Pelvic pain - Gynaecology issues
Ovarian torsion, ovarian cyst, pregnancy related - ectopic pregnancy, miscarriage variant, gynae infection, myoma generation
Acute pelvic pain - urological
Stone related, Lower urinary tract infection
Acute pelvic pain - gastroenterological
appendicitis, Other GI infections - diverticulitis, abscess, IBS, Hernia
History of acute pelvic pain assessment
duration, onset, location and radiation of pain, menstrual history, sexual health history.
What can occur when PID is not addressed properly
Life threatening issues if becomes a systemic infection + progression of local infection to tubo-ovarian abscess or generalised peritonitis.
Describing presenting
symptoms
Dysmennorrhea
Dyspareunia
Dyschesia
Dysuria
Non-menstrual
pelvic pain
Pain with menses
Pain with Intercourse
passing associated
with bowel motion
pain during micturition
pain not present
at time of menstruation. Cyclic manner.
dysuria is associated with?
Urinary tract infection (usually confirmed by leukocytes and nitrates in urine)
dysuria and dyspareunia without UTI
explore diagnoses of potential - urethral diverticulum (pockets or sacs form around urethra) or urethral pain syndrome (urethral irritation)
a women in shock may present with?
hypotension and tachycardia - dont ignore the signs
severe infections may cause metabolic acidosis. what is metabolic acidosis
build up of acid in the body due to kidney disease or renal failure. Resp system compensates by increasing RR to exhale more C02 to increase pH
what is metabolic alkalosis?
resp system compensates by reducing RR to increase C02 and reduce pH
Bicarbonate equation
metabolic acidosis vs metabolic alkalosis
C02 + H20 <> H2C03 <> HC03- + H+
(carbon dioxide + water <> carbonic acid <> bicarbonate +hydrogen ion)
shift to the left increased pH
shifts to the right decreased pH
is the presentation of a women with bradycardia, sweating and feeling faint an urgent transfer to the operating theatre?
No, a speculum examination would be best in order to be able to remove any products that may be retained around the cervix
does the presentation of a women with tachycardia, compensated respiratory rate, tachypnoea require emergency management?
Yes, volume expansion will be required.
what are the adnexal area to examine?
ovaries, fallopian tubes and uterus + ligaments
What should be included in a pelvic examination
swabs for PID, speculum examination to look for discharge or bleeding through the cervix
what does PUL stand for
Pregnancy of unknown location where a pregnancy is not confirmed intrauterine or extrauterine and monitored until located
how does a miscarriage present
usually with abnormal vaginal bleeding and or pain in the presence of a positive beta HCG test
threatened miscarriage
examination = cervix is closed, there is a viable pregnancy by transvaginal sonography
imminent miscarriage
examination = cervix is open, products are being expelled from the uterus, imaging shows live pregnancy, cervix is open = miscarriage will result
incomplete miscarriage
symptoms = cramping and discomfort, expelled some products, intervention may not be required but complete miscarriage is common
complete miscarriage
passed all products of conception, no further intervention required
silent miscarriage
missed or delayed. transvaginal sonography shows no viable/live pregnancy or non-progressive pregnancy (foetus has died). Intervention may be surgical or medical.
guidelines to consider with ovarian cysts as a cause of acute pelvic pain
1. association with ovarian torsion (adnexal)
2. signs of
haemorrhage into the peritoneal cavity with possibility of leading to
shock
3. physiological or pathological cyst
ovarian cysts can be physiological. Do these require surgical intervention
no, the occurrence of follicular cysts and corpora luteal cysts is normal.
reproductive physiology of follicular development
FSH will recruit follicles within the ovarian cortex to increase in size before cystic rupture of ovulation occurs. Rupture occurs and remaining structure fills with blood to become the corpus luteum.