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 • 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
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
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
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
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-lineMedical
Adjunctive Medical therapy and maintenance
Recurrence – consider definitive surgical treatment therapy
LTB4
8Leukoteriene LTB4
9LTC4
5 Hydroxyeicosa tetraenoic acid (5-HETE)
7
5 Hydroxyeicosa eicosatetraenoic acid (5-HPETE)
10
LTD4
11
LTE4
10
LTF4
6
5
1Cellular phospholipidsArachidonic Acid
2
Prostaglandin (PG) G2
Cyclic endoperoxides
PGH2
Prostacyclin (PGl2) PGF2α PGE2 PGD2 Thromboxane (TX) (A2)
6-oxa PGF1α TXB2
Drawing displays anterior abdominal cutaneous nerve entrapment. (Redrawn from Greenbaum,
1994, with permission.)
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