Pelvic inflammatory disease differential diagnosis
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Differentiating Pelvic Inflammatory Disease from other Diseases |
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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] |
- [[]]
- 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 [7] [8]
Culdocentesis will differentiate hemoperitoneum (ruptured ectopic pregnancy or hemorrhagic cyst) from pelvic sepsis (salpingitis, ruptured pelvic abscess, or ruptured appendix).
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.
- ↑ 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) - ↑ 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) - ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X