骨盆腔疼痛. 急性骨盆腔疼痛 慢性骨盆腔疼痛 診斷. 急性骨盆腔疼痛 - 常見原因. 早期懷孕併發症 , 像 ectopic pregnancy & miscarriage PID Appendicitis Ovarian cyst ”accident” or Mittelschmerz. 急性骨盆腔疼痛 - 其它原因. OHSS Hematomatra or hematocolpos Necrosis of uterine fibroid 其他非婦產科的原因 , 像腸道或泌尿道疾病. Ovarian cyst accident.
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-sudden onset of coliky pelvic pain
-located to one or other of iliac fossa
-more constant after several hours or disappear
-initially apyrexial,later on necrosis can cause pyrexia
-可用膀胱鏡診斷(submucosal edema and petechiae)
-location of pain,mode of onset,constant or coliky in nature,radiaion,and relation to the menstrual cycle
-vaginal discharge or bleeding
-bowel or urinary symptoms?
-move or crouched up in bed?
-check vital sign
-abdominal examination:location of pain,rebounding tenderness or guarding,any mass or hernia
-pelvic examination:vaginal discharge or pelvic mass or assess the pelvic tenderness
-cervical lifting painblood in the peritoneal cavity(ectopic pregnancy) or inflammation in the peritoneal (PID)
-OHSSPV was not done (risk of rupture of ovarian cysts),but suspected ectopic pregnancy immediate laparotomy
-triple swabs(high vagina,cervix,endocervix)r/o STD as chlamydia or gonorrhea
-sent midstream uriner/o UTI
-check urine or serum HCGr/o ectopic pregnnacy
-pelvic ultrasoundr/o pelvic pathology
-laparoscopy-important place in management of chronic pelvic pain in women of reproductive age;”gold standard” for diagnosis of endometriosis,ectopic pregnnacy and PID