Makindo Medical Notes

1. Clinical History

1. Location: Ask the patient to specify the site of pain. Is it generalized or localized (e.g., left or right lower quadrant)?
2. Onset and Duration: When did the pain begin? Is it acute or chronic? Duration and pattern (continuous or intermittent).
3. Character: Describe the pain: sharp, dull, cramping, or burning.
4. Associated Symptoms:
   • Menstrual irregularities
   • Urinary symptoms: urgency, dysuria, or hematuria
   • Gastrointestinal symptoms: constipation, diarrhoea, or nausea
   • Vaginal discharge or bleeding
5. Aggravating/Relieving Factors: Does anything worsen or alleviate the pain (e.g., physical activity, rest, medications)?
6. Medical and Surgical History:
   • Past gynecological issues: endometriosis, fibroids, PID
   • History of abdominal or pelvic surgeries
   • Sexual history and possible infections
7. Family History: History of gynecologic cancers or other relevant conditions.

2. Physical Examination

1. General Inspection: Observe for signs of discomfort, pallor, or jaundice.
2. Abdominal Examination:
   • Inspection: Look for distension, visible masses, or scars.
   • Palpation: Check for tenderness, guarding, and rigidity.
   • Rebound tenderness: Indicates peritoneal irritation.
3. Pelvic Examination:
   • Speculum examination: Assess for discharge, cervical abnormalities.
   • Bimanual examination: Evaluate uterine size, adnexal tenderness, or mass.

3. Investigations

1. Urinalysis: To check for urinary infections or hematuria.
2. Pregnancy Test: Rule out ectopic pregnancy.
3. STI Screening: If there is a possibility of a sexually transmitted infection.
4. Blood Tests:
   • Complete Blood Count (CBC) for infection or anaemia
   • C-reactive protein (CRP) or ESR for inflammation
5. Imaging:
   • Ultrasound (first-line) for evaluation of pelvic organs.
   • CT or MRI: For complex cases or to assess further if ultrasound findings are inconclusive.

4. Possible Causes of Pelvic Pain

• Gynecologic Causes:
  • Ovarian cysts
  • Endometriosis
  • Pelvic Inflammatory Disease (PID)
  • Ectopic pregnancy
  • Fibroids
• Non-Gynecologic Causes:
  • Urinary: UTI, interstitial cystitis, kidney stones
  • Gastrointestinal: Appendicitis, diverticulitis, irritable bowel syndrome (IBS)
  • Musculoskeletal: Pelvic floor dysfunction
  • Neurological: Nerve entrapment or neuropathy

5. Management

1. Address underlying cause once identified.
2. Analgesia: NSAIDs or other pain relief as needed.
3. Referral to gynecology, urology, or GI specialists if indicated.
4. Consider surgical intervention if there is an acute or serious pathology.