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- • Lower abdominal pain in women is a common presenting
complaint; pain characteristics (duration, location, quality, and
severity) may be helpful in determining the diagnosis.
- • Pain may be caused by gynecologic disorders, but
also by disorders of the gastrointestinal, urinary, and musculoskeletal
systems.
- • Pain on abdominal or pelvic examination may signal
peritoneal irritation.
- • History, physical examination, and laboratory
tests should be used to arrive at a diagnosis.
- • Ultrasound may aid in the diagnosis; diagnostic
laparoscopy can provide a definitive diagnosis and may be considered
when the diagnosis is uncertain.
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Lower abdominal pain is a common presenting complaint and one
of the most difficult problems to evaluate in women. Arriving at
the correct diagnosis when a woman of reproductive age presents
with acute pelvic pain remains a challenge in clinical medicine—a
fact that has been confirmed by numerous studies. A comprehensive
evaluation leading to a timely diagnosis will reduce the morbidity
associated with delayed diagnosis.
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Pelvic pain is a common presenting symptom of many gynecologic
disorders. However, it also may occur with disorders of the gastrointestinal,
urinary, and musculoskeletal systems. To determine the etiology
of the pain, the clinician must use the history, physical examination,
and diagnostic tests as tools.
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Characteristics of the pain may aid in determining the diagnosis.
Important characteristics include timing of onset, location, quality,
and severity.
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Pain of sudden onset suggests an acute event such as hemorrhage,
rupture, or torsion of an ovarian cyst, whereas pain that is more
gradual may be present in subacute or progressive conditions. The differential
diagnosis of lower abdominal pain grouped by time of onset is presented
in Table 5–1.
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The location of the pain may also be helpful, although different
disease processes can lead to pain in the same region. The uterus,
cervix, and adnexae share visceral innervation with the lower ileum,
sigmoid, and rectum (T10–L1), and pain from any of these
structures may be felt in the same place. This is one of the dilemmas
when trying to distinguish acute appendicitis ...