Workup

1. History

2. Physical exam (cervical motion tenderness, adnexal tenderness, and abdominal tenderness are all signs of PID)

■ Pregnancy test (positive might indicate ectopic pregnancy or abortion)

■ CBC (PID or appendicitis might give elevated WBCs)

■ UA (leukocytes indicate possible UTI)

Pelvic sonogram (will show cysts and possibly torsion) Diagnostic laparoscopy

Ruptured cyst is the most common cause of acute pelvic pain.

TABLE 17-1. Differential Diagnosis of Acute GYN Pelvic Pain Clinical and Laboratory Findings

Pregnancy

Nausea and

Disease

CBC

UA

Test

Culdocentesis

Fever

Vomiting

Ruptured

Hematocrit

Red blood

Positive.

High

No

Unusual

ectopic

low after

cells rare

Beta-hCG

hematocrit

pregnancy

treatment of

low for

Defibrinated,

hypovolemia

gestational

nonclotting

age

sample with

no platelets

Crenated red

blood cells

Salpingitis/PID

Rising white

White blood

Generally

Yellow, turbid

Progressively

Gradual

blood cell

cells

negative

fluid with

worsening;

onset with

count

occasionally

many white

spiking

ileus

present

blood cells

and some

bacteria

Hemorrhagic

Hematocrit

Normal

Usually

Hematocrit

No

Rare

ovarian cyst

may be low

negative

generally

after

< 10%

treatment

of

hypovolemia

Torsion of

Normal

Normal

Generally

Minimal clear

No

Rare

adnexa

negative

fluid if

obtained

early

Degenerating

Normal or

Normal

Generally

Normal clear

Possibly

Rare

leiomyoma

elevated

negative

fluid

white blood

cell count

Reproduced, with permission, from Pearlman MD, Tintinalli JE, eds. Emergency Care of the Woman. New York: McGraw-Hill, 1998: 508.

NOTES

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