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.)