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Etiologies of Acute Lower Abdominal and Pelvic Pain

Perumbilical Appendicitis (early) Small bowel obstruction Gastroenteritis Mesenteric ischemia Abdominal aortic aneurysm rupture Abdominal aortic aneurysm dissection. Etiologies of Acute Lower Abdominal and Pelvic Pain. Right lower quadrant Appendicitis Inflammatory bowel disease

montana-wilkerson
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Etiologies of Acute Lower Abdominal and Pelvic Pain

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  1. Perumbilical Appendicitis (early) Small bowel obstruction Gastroenteritis Mesenteric ischemia Abdominal aortic aneurysm rupture Abdominal aortic aneurysm dissection Etiologies of Acute Lower Abdominal and Pelvic Pain

  2. Right lower quadrant Appendicitis Inflammatory bowel disease Ovarian tumor Ovarian torsion Ectopic pregnancy Pelvic inflammatory disease Tubo-ovarian abscess Pyelonephritis Perinephric abscess Urolithiasis Gastrointestinal malignancy Right-sided diverticulitis Ileocolitis Gastroenteritic; Hernia Etiologies of Acute Lower Abdominal and Pelvic Pain

  3. Suprapubic Irritable bowel disease Ovarian tumor Ovarian torsion Ectopic pregnancy Pelvic inflammatory disease Tubo-ovarian abscess Oysmenorrhed Colonic disease Diverticulitis Cystitis Nephrolithiasis Etiologies of Acute Lower Abdominal and Pelvic Pain

  4. left lower quadrant Irritable bowel disease Ovarian tumor Ovarian torsion Ectopic pregnancy Pelvic inflammatory disease Tubo-ovarian abscess Pyelonephritis Perinephric abscess Nephrolithiasis Sigmoid diverticulitis Ileocolitis Gastroenteritis Hernia Gastrointestinal malignancy Etiologies of Acute Lower Abdominal and Pelvic Pain

  5. Diffuse Gastroenteritis Bowel obstruction Peritonitis Mesenteric ischemia Irritable bowel disease Diabetic ketoacidosis Porphyria Uremia Hypercalcemia Sickle cell crisis Vasculitis Heavy metal intoxication Opiate withdrawal Familial Mediterranean fever Hereditary angioedema Etiologies of Acute Lower Abdominal and Pelvic Pain

  6. First-line medical treatment: Estrogen/progestin or progestin alone contraceptives/NSAIDS Not successful Successful Second-line treatment: GnRH agonists + Add back therapy where appropriate, danazol; Multidisciplinary, including psychological and/or acupuncture or TENS Operative diagnosis and treatment Laparoscopy Failure – consider alternative diagnosis and further workup Alternative second-line Medical Adjunctive Medical therapy and maintenance Recurrence – consider definitive surgical treatment therapy

  7. 8 9 LTB4 Leukoteriene LTB4 LTC4 7 10 5 Hydroxyeicosa tetraenoic acid (5-HETE) 6 5 Hydroxyeicosa eicosatetraenoic acid (5-HPETE) LTD4 5 11 Arachidonic Acid LTE4 Cellular phospholipids 1 2 10 Prostaglandin (PG) G2 LTF4 Cyclic endoperoxides PGH2 Prostacyclin (PGl2) PGF2α PGE2 PGD2 Thromboxane (TX) (A2) 6-oxa PGF1α TXB2

  8. Drawing displays anterior abdominal cutaneous nerve entrapment. (Redrawn from Greenbaum, 1994, with permission.)

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