Pelvic inflammatory disease differential diagnosis: Difference between revisions

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! style="background: #4479BA; width: 120px;" | {{fontcolor|#000|Disease}}
! style="background: #4479BA; width: 180px;" | {{fontcolor|#000|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#000|Findings}}
! style="background: #4479BA; width: 650px;" | {{fontcolor|#000|Findings}}
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ectopic pregnancy]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ectopic pregnancy]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.<ref name="pmid27720100">{{cite journal |vauthors=Morin L, Cargill YM, Glanc P |title=Ultrasound Evaluation of First Trimester Complications of Pregnancy |journal=J Obstet Gynaecol Can |volume=38 |issue=10 |pages=982–988 |year=2016 |pmid=27720100 |doi=10.1016/j.jogc.2016.06.001 |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" | History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.<ref name="pmid27720100">{{cite journal |vauthors=Morin L, Cargill YM, Glanc P |title=Ultrasound Evaluation of First Trimester Complications of Pregnancy |journal=J Obstet Gynaecol Can |volume=38 |issue=10 |pages=982–988 |year=2016 |pmid=27720100 |doi=10.1016/j.jogc.2016.06.001 |url=}}</ref>
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| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Appendicitis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Appendicitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.<ref name="pmid8259423">{{cite journal |vauthors=Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C |title=Acute appendicitis: CT and US correlation in 100 patients |journal=Radiology |volume=190 |issue=1 |pages=31–5 |year=1994 |pmid=8259423 |doi=10.1148/radiology.190.1.8259423 |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.<ref name="pmid8259423">{{cite journal |vauthors=Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C |title=Acute appendicitis: CT and US correlation in 100 patients |journal=Radiology |volume=190 |issue=1 |pages=31–5 |year=1994 |pmid=8259423 |doi=10.1148/radiology.190.1.8259423 |url=}}</ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ruptured ovarian cyst]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ruptured ovarian cyst]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |usually spontaneous, can follow history of trauma; mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.<ref name="pmid19299205">{{cite journal |vauthors=Bottomley C, Bourne T |title=Diagnosis and management of ovarian cyst accidents |journal=Best Pract Res Clin Obstet Gynaecol |volume=23 |issue=5 |pages=711–24 |year=2009 |pmid=19299205 |doi=10.1016/j.bpobgyn.2009.02.001 |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |usually spontaneous, can follow history of trauma; mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.<ref name="pmid19299205">{{cite journal |vauthors=Bottomley C, Bourne T |title=Diagnosis and management of ovarian cyst accidents |journal=Best Pract Res Clin Obstet Gynaecol |volume=23 |issue=5 |pages=711–24 |year=2009 |pmid=19299205 |doi=10.1016/j.bpobgyn.2009.02.001 |url=}}</ref>
|-
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ovarian cyst torsion]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Ovarian cyst torsion]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hemorrhagic ovarian cyst]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Hemorrhagic ovarian cyst]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with localized abdominal pain, nausea, and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Presents with localized abdominal pain, nausea, and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Endometriosis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Endometriosis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareuni, transvaginal ultrasound is suggestive, laparascopic exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
| style="padding: 7px 7px; background: #F5F5F5;" |Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareuni, transvaginal ultrasound is suggestive, laparascopic exploration is diagnostic.<ref name="pmid26760839">{{cite journal |vauthors=Bhavsar AK, Gelner EJ, Shorma T |title=Common Questions About the Evaluation of Acute Pelvic Pain |journal=Am Fam Physician |volume=93 |issue=1 |pages=41–8 |year=2016 |pmid=26760839 |doi= |url=}}</ref>
|-
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Diverticulitis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Diverticulitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Present with bowel symptoms in older women
| style="padding: 7px 7px; background: #F5F5F5;" |Present with bowel symptoms in older women
|-
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute cystitis]]'''
| style="padding: 7px 7px; background: #DCDCDC;" | '''[[Acute cystitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Features with increased frequency and urgency, [[dysuria]], and suprapubic pain.<ref>{{Cite journal
| style="padding: 7px 7px; background: #F5F5F5;" |Features with increased frequency and urgency, [[dysuria]], and suprapubic pain.<ref>{{Cite journal
  | author = [[W. E. Stamm]]
  | author = [[W. E. Stamm]]
  | title = Etiology and management of the acute urethral syndrome
  | title = Etiology and management of the acute urethral syndrome
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*[[]]
*[[Ectopic pregnancy]] - a sensitive serum pregnancy test should be obtained to rule out ectopic pregnancy.
*Hemorrhagic [[ovarian cyst]]
*Ruptured [[ovarian cysts]]
*[[Myoma]]
*[[Ovarian torsion]]
*[[Ovarian tumor]]
*[[Septic]] [[abortion]]
*[[Urinary Tract Infection]]
*Twisted [[ovarian cyst]]
*Degeneration of a [[myoma]]
*Acute [[enteritis]]
*[[Urinary Tract Infection]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
Culdocentesis will differentiate hemoperitoneum (ruptured [[ectopic pregnancy]] or hemorrhagic [[cyst]]) from pelvic sepsis ([[salpingitis]], ruptured [[pelvic abscess]], or ruptured [[appendix]]).


==References==
==References==

Revision as of 20:37, 17 October 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pelvic inflammatory disease must be differentiated from ectopic pregnancy, ovarian torsion, ovarian tumor, ruptured ovarian cysts, appendicitis, and urinary tract infection.

Differentiating Pelvic inflammatory disease from other Diseases

Disease Findings
Ectopic pregnancy History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[1]
Appendicitis Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.[2]
Ruptured ovarian cyst usually spontaneous, can follow history of trauma; mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[3]
Ovarian cyst torsion Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[4]
Hemorrhagic ovarian cyst Presents with localized abdominal pain, nausea, and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[4]
Endometriosis Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareuni, transvaginal ultrasound is suggestive, laparascopic exploration is diagnostic.[4]
Diverticulitis Present with bowel symptoms in older women
Acute cystitis Features with increased frequency and urgency, dysuria, and suprapubic pain.[5][6]

References

  1. ↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
  2. ↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
  3. ↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
  4. ↑ 4.0 4.1 4.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
  5. ↑ W. E. Stamm (1981). "Etiology and management of the acute urethral syndrome". Sexually transmitted diseases. 8 (3): 235–238. PMID 7292216. Unknown parameter |month= ignored (help)
  6. ↑ W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes (1980). "Causes of the acute urethral syndrome in women". The New England journal of medicine. 303 (8): 409–415. doi:10.1056/NEJM198008213030801. PMID 6993946. Unknown parameter |month= ignored (help)

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