Line 13:
Line 13: * [[Pyelonephritis]]
* [[Pyelonephritis]]
{| class="wikitable"
!
!Clinical Features
!Physical Examination
!Diagnostic Findings
|-
|[[Endometriosis]]
|
*[[Dysmenorrhea]]
*[[Dyspareunia]]
*[[Infertility]]
*Common in women between 25 to 35 years
|
*Nodules in the [[posterior fornix]]
*Adnexal masses
*Fixed retroverted [[uterus]]
*Lateral displacement of the [[cervix]]
|
*Increased [[CA-125|serum cancer antigen-125]]
*Nodules of the [[Rectovaginal fascia|recto vaginal]] septum and hypoechoic, vascular mass on [[MRI]]
*Laproscopic visualization confirms the diagnosis
|-
|[[Adenomyosis]]<ref name="pmid16782099">{{cite journal| author=Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P| title=Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. | journal=Fertil Steril | year= 2006 | volume= 86 | issue= 3 | pages= 711-5 | pmid=16782099 | doi=10.1016/j.fertnstert.2006.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16782099 }}</ref>
|
*[[Abnormal uterine bleeding]]
*[[Dysmenorrhea]]
*Common in women aged 40 and 50 years
|
* Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of [[gestation]]
|
*Asymmetric thickening of the [[myometrium]] on [[MRI]]
|-
|Submucous uterine [[Leiomyoma|leiomyomas]]<ref name="pmid26477496">{{cite journal| author=Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J et al.| title=Long-term medical management of uterine fibroids with ulipristal acetate. | journal=Fertil Steril | year= 2016 | volume= 105 | issue= 1 | pages= 165-173.e4 | pmid=26477496 | doi=10.1016/j.fertnstert.2015.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26477496 }}</ref>
|
*[[Menorrhagia]]
*Pelvic pressure and pain
*[[Infertility]]
*Peak age of onset 25 to 44 years of age
|
*Mobile [[uterus]] with an irregular contour
|
*[[Transvaginal ultrasound]] will demonstrate the presence of myomas
|-
|[[PID|Pelvic Inflammatory disease]]<ref name="pmid24216035">{{cite journal| author=Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections| title=2012 European guideline for the management of pelvic inflammatory disease. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 1 | pages= 1-7 | pmid=24216035 | doi=10.1177/0956462413498714 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24216035 }}</ref>
|
*Seen in patients with history of [[sexually transmitted disease]]
*History of multiple sexual partners
*Common in women younger than 25 years of age
|
*[[Abdominal tenderness]]
*Acute [[Cervical motion tenderness|cervical motion]], [[Uterus|uterine]], and adnexal tenderness
*Visualization of purulent endocervical discharge
|
*Positive [[Nucleic acid test|Nucleic acid amplification tests]] for [[Chlamydia trachomatis]] and [[Neisseria gonorrhoeae|N. gonorrhoeae]]
*Gram negative [[diplococci]] on [[gram stain]]
|-
|Pelvic congestion Syndrome<ref name="pmid11133549">{{cite journal| author=Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES| title=Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. | journal=AJR Am J Roentgenol | year= 2001 | volume= 176 | issue= 1 | pages= 119-22 | pmid=11133549 | doi=10.2214/ajr.176.1.1760119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11133549 }}</ref>
|
*Shifting lower abdominal pain
*Deep [[dyspareunia]]
*Post-coital pain
*Exacerbation of pain after prolonged standing
|
*Bimanual tenderness
*[[Cervical motion tenderness]]
|
*Pelvic [[varicosities]] on ultrasound with reduced blood flow
|}
Endometriosis should also be differentiated from conditions that present with [[lower abdominal pain]] in young women. The following is a list of diseases that present with acute onset severe lower abdominal pain:
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Differentiating an Ectopic Pregnancy from other Conditions
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]
Rupturedovarian cyst
Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[ 3]
Ovarian cyst torsion Presents 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 Presents with cyclic pain that is exacerbated by onset of menses, dyspareunia . laparoscopic exploration is diagnostic.[ 4]
Acute cystitis Presents with features of increased urinary frequency , urgency , dysuria , and suprapubic pain.[ 5] [ 6]
References
↑ 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 . ↑ 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 . ↑ 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 . ↑ 4.0 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 . ↑ {{Cite journal
| author = W. E. Stamm
| title = Etiology and management of the acute urethral syndrome
| journal = Sexually transmitted diseases
| volume = 8
| issue = 3
| pages = 235–238
| year = 1981
| month = July-September
| pmid = 7292216
↑ {{Cite journal
| author = W. E. Stamm , K. F. Wagner , R. Amsel , E. R. Alexander , M. Turck , G. W. Counts & K. K. Holmes
| title = Causes of the acute urethral syndrome in women
| journal = The New England journal of medicine
| volume = 303
| issue = 8
| pages = 409–415
| year = 1980
| month = August
| doi = 10.1056/NEJM198008213030801
| pmid = 6993946
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