scholarly journals Validation of the Diagnostic Score for Acute Lower Abdominal Pain in Women of Reproductive Age

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Kijja Jearwattanakanok ◽  
Sirikan Yamada ◽  
Watcharin Suntornlimsiri ◽  
Waratsuda Smuthtai ◽  
Jayanton Patumanond
Keyword(s):  
Abdominal Pain ◽  
Likelihood Ratio ◽  
Lower Abdominal Pain ◽  
Positive Likelihood Ratio ◽  
Clinical Score ◽  
Reproductive Age ◽  
Differential Diagnoses ◽  
Validation Data ◽  
Diagnostic Score ◽  
Development Data

Background. The differential diagnoses of acute appendicitis obstetrics, and gynecological conditions (OB-GYNc) or nonspecific abdominal pain in young adult females with lower abdominal pain are clinically challenging. The present study aimed to validate the recently developed clinical score for the diagnosis of acute lower abdominal pain in female of reproductive age.Method. Medical records of reproductive age women (15–50 years) who were admitted for acute lower abdominal pain were collected. Validation data were obtained from patients admitted during a different period from the development data.Result. There were 302 patients in the validation cohort. For appendicitis, the score had a sensitivity of 91.9%, a specificity of 79.0%, and a positive likelihood ratio of 4.39. The sensitivity, specificity, and positive likelihood ratio in diagnosis of OB-GYNc were 73.0%, 91.6%, and 8.73, respectively. The areas under the receiver operating curves (ROC), the positive likelihood ratios, for appendicitis and OB-GYNc in the validation data were not significantly different from the development data, implying similar performances.Conclusion. The clinical score developed for the diagnosis of acute lower abdominal pain in female of reproductive age may be applied to guide differential diagnoses in these patients.

scholarly journals Clinical Scoring for Diagnosis of Acute Lower Abdominal Pain in Female of Reproductive Age

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Kijja Jearwattanakanok ◽  
Sirikan Yamada ◽  
Watcharin Suntornlimsiri ◽  
Waratsuda Smuthtai ◽  
Jayanton Patumanond
Keyword(s):  
Abdominal Pain ◽  
Young Adult ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
Lower Abdominal Pain ◽  
Clinical Score ◽  
Reproductive Age ◽  
Care Hospital ◽  
Adult Females ◽  
Clinical Scoring

Background. Obstetrics and gynecological conditions (OB-GYNc) are difficult to be differentiated from appendicitis in young adult females presenting with acute lower abdominal pain. Timely and correct diagnosis is clinically challenging.Method. A retrospective data analysis was performed on 542 female patients who were admitted to a tertiary care hospital with a chief complaint of acute lower abdominal pain. Diagnostic indicators of appendicitis and OB-GYNc were identified by stepwise multivariable polytomous logistic regression. Diagnostic performances of the scores were tested.Result. The developed clinical score is comprised of (1) guarding or rebound tenderness, (2) pregnancy, (3) sites of abdominal tenderness, (4) leukocytosis, (5) peripheral neutrophils ≥75%, and (6) presence of diarrhea. For diagnosis of appendicitis, the area under the ROC curve was 0.8696, and the sensitivity and specificity were 89.25% and 70.00%. For OB-GYNc, the corresponding values were 0.8450, 66.67%, and 94.85%, respectively.Conclusion. The clinical scoring system can differentiate the diagnosis of acute lower abdominal pain in young adult females. Time spent for diagnosis at the emergency room may be shortened, and the patients would be admitted to the appropriate departments in less time.

scholarly journals Development of Diagnostic Score for Acute Pericarditis in Patients Admitted for Chest Pain

2020 ◽  
Author(s):  
Andre Costa Meireles ◽  
Joao Vitor Miranda Porto Oliveira ◽  
Bruna de Sa Barreto Pontes ◽  
Alexandre Costa Souza ◽  
Laila Caroline Oliveira Souza Barbo Gomes ◽  
...  
Keyword(s):  
Chest Pain ◽  
Likelihood Ratio ◽  
Clinical Laboratory ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Acute Chest Pain ◽  
Clinical Score ◽  
Acute Pericarditis ◽  
St Segment Elevation ◽  
Diagnostic Score

Background: Despite the presence of clinical, laboratory and electrocardiographic characteristics suggestive of acute pericarditis, there is no multivariate diagnostic score developed for this condition. Objective: To develop a clinical score for diagnosis of pericarditis as the cause of acute chest pain, using data from admission. Methods: In a diagnostic case-control study, we compared consecutive 45 patients of the Chest Pain Registry diagnosed of pericarditis (confirmed by magnetic resonance imaging or the presence of pleural effusion in echocardiography) versus 90 patients with an alternative confirmed diagnosis, randomly selected from our registry. Six clinical characteristics, 16 chest pain characteristics and 4 additional tests were candidates as predictors. Logistic regression was used to derivate a model composed by independent predictors of pericarditis. Results: Among 17 variables associated with pericarditis, 5 remained independent predictors: age; pain aggravation with thorax movement; positive troponin; diffuse ST-segment elevation and C-reactive protein. Each independent predictor was attributed points proportional to its regression coefficient. The final score presented discriminatory capacity represented by C-statistic of 0.97 (95% CI = 0.93 to 1.0). The best cutoff point was defined as > 6 points, with sensitivity of 96% (95% CI = 85 to 100), specificity of 87% (95% CI = 78 to 93), positive likelihood ratio of 7.2 (95% CI = 4.2 to 12) and negative likelihood ratio of 0.05 (95% CI = 0.01 to 0.2). Conclusion: The proposed multivariate score seems to be accurate for the diagnosis of pericarditis and require further validation in an independent sample.

scholarly journals Management of hemoperitoneum due to rupture of the ovarian cyst

2021 ◽  
Vol 6 (1) ◽  
pp. 6-10
Author(s):  
Oana Denisa Balalau ◽  
Ileana Maria Conea ◽  
Nicolae Bacalbasa ◽  
Anca Silvia Dumitriu ◽  
Stana Paunica ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Ovarian Cyst ◽  
Lower Abdominal Pain ◽  
Physical Exertion ◽  
Sudden Onset ◽  
Reproductive Age ◽  
Adnexal Torsion ◽  
Ultrasound Monitoring ◽  
Chemical Peritonitis ◽  
Rule Out

Ovarian cyst is the most common female gynecological pathology and it is characteristic of reproductive age. Its rupture causes the sudden onset of pelvic-abdominal pain, often associated with physical exertion or sexual contact. The differential diagnosis is made with other causes of lower abdominal pain: ectopic pregnancy, adnexal torsion, pelvic inflammatory disease or acute appendicitis. The clinical picture may vary depending on the type of ruptured cyst. Dermoid cyst causes severe symptoms due to chemical peritonitis that occurs in response to extravasation of sebaceous contents in the peritoneal cavity. Surgical treatment is indicated for complicated forms of cystic rupture. Most cases have self-limiting, quantitatively reduced bleeding and spontaneous resorption within a few days. Patients diagnosed with ovarian cyst are recommended for regular ultrasound monitoring to prevent complications such as cystic rupture or adnexal torsion. The identification of any ovarian tumor mass in the woman at menopause requires further investigation to rule out the causes of malignancy.

scholarly journals Dysgerminoma: diagnostic impasse

2020 ◽  
Vol 7 (11) ◽  
pp. 3811
Author(s):  
Indrajit Anandakannan ◽  
Shanthi Ponnandai Swaminathan ◽  
Vikas Kawarat ◽  
Rajeshwari Mani ◽  
Kannan R.
Keyword(s):  
Abdominal Pain ◽  
Abdominal Mass ◽  
Germ Cell Tumour ◽  
Lower Abdominal Pain ◽  
Gastrointestinal Stromal Tumour ◽  
Reproductive Age ◽  
Ca 125 ◽  
Abdominal Radiograph ◽  
Bowel Loop ◽  
Plain Abdominal Radiograph

Dysgerminoma is a rare malignant ovarian tumour in women of reproductive age group, featuring lower abdominal pain and abdominal mass with elevated tumour markers. The tumour grows rapidly and diagnosed at an earlier stage. We present a short-statured 20 years girl with intermittent abdominal pain and distention for 4 months, on examination huge abdominal mass of size 20x15 cm, firm in consistency was palpable, lower limit not ascertained. Routine blood investigations normal, thyroid function test showed hypothyroidism. A plain abdominal radiograph shows a large homogenous mass fitting mid part of abdomen with displaced bowel loop. Contrast-enhanced computed tomography abdomen and pelvis show up 20x18.5x9.5 cm well defined heterogeneous mass, with areas of necrosis suggesting mesenchymal tumour or germ cell tumour. CA 125, alpha-fetoprotein, lactate dehydrogenase, beta human chorionic gonadotropin were raised. Magnetic resonance imaging abdomen and pelvis show 10x16x17cm hetero intense lesion, bilateral ovary normal. After tumour board discussion image-guided biopsy was done, suggestive of epithelioid gastrointestinal stromal tumour. Laparotomy displayed a large mass 22x16x10 cm arising from left ovary, no enlarged lymph node, completed with left salpingo-oophorectomy. Histopathology examination and immunohistochemistry definitive of dysgerminoma. In this clinical scenario, we narrate the importance of clinical examination and increased dependence on imaging modalities in diagnosing the patient. The treatment is based on the international federation of gynaecology and obstetrics staging with surgical treatment, adjuvant chemotherapy and radiotherapy.

scholarly journals Epidemiology and Risk Factors of Pelvic Inflammatory Disease.

2015 ◽  
Vol 13 (1) ◽  
pp. 4-8
Author(s):  
Bandana Pandey
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Rural Areas ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Modern Contraceptive ◽  
Age Group ◽  
Increased Risk ◽  
Reproductive Age Group

Introduction: Knowledge of pelvic inflammatory disease and its epidemiology is essential to understand reproductive morbidity in women. This paper estimates the level of association between demographic factors and pelvic inflammatory disease in women in their reproductive age. Methods: A descriptive study done in Humla, Kritipur and Baudha by organizing a health camp. Women of reproductive age group and who have lower abdominal pain, pervaginal discharge, fever, and dysparunia were included in the study after taking informed verbal consent from the patient. Patients who have lower abdominal pain and pervaginal discharge were diagnosed as pelvic inflammatory disease. Results: Diagnoses of pelvic inflammatory disease were made in 30% of attendances amongst women aged between 16 to 48. Increased risk of pelvic inflammatory disease was associated with smoking (P<0.0001), age groups 31 – 40 yrs (44.6%),in rural areas(45%) and people who are illiterate (P<0.0001). Among 400, 383(95%) were reported ever using a modern contraceptive. Conclusion: The prevalence of pelvic inflammatory disease was 30% in reproductive age group and was significantly associated with smoking.doi: http://dx.doi.org/10.3126/mjsbh.v13i1.12992 

scholarly journals Herniation of Small Bowel Loop through a Broad Ligament Defect Masquerading as Torsion of Ovarian Cyst

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Babatola Bakare ◽  
Olumide Akadiri ◽  
Akinyemi Akinsoji Akintayo
Keyword(s):  
Abdominal Pain ◽  
Abdominal Surgery ◽  
Acute Abdomen ◽  
Ovarian Cyst ◽  
Broad Ligament ◽  
Previous History ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Essentially Normal ◽  
Broad Ligament Defect

Torsion of ovarian cyst is a common cause of acute abdomen especially in women of reproductive age-group. It commonly presents with colicky abdominal pain associated with nausea and vomiting. It could however mimic acute intestinal obstruction. The patient was a 32-year-old multipara with no previous history of pelvic or abdominal surgery. She was admitted with colicky lower abdominal pain associated with repeated episodes of vomiting and nausea. Laboratory investigations were essentially normal. Abdominopelvic USS showed a hypoechoic mass lesion in the left adnexium measuring 7.1 × 5.5 cm; surrounding bowel loops were hypoactive, dilated, and fluid filled. Diagnosis of acute abdomen secondary to suspected torsion of ovarian cyst was made. Management began for acute abdomen with intravenous hydration, prophylactic antibiotics, and analgesics. An emergency laparotomy revealed about 6 cm defect in the left broad ligament in which a 20 cm segment of terminal ileum was encased. Liberation of the ileal segment was done and the broad ligament defect closed. Bowel obstruction requires high index of suspicion in a patient with acute abdomen due to suspected torsion ovarian cyst most especially in the absence of previous pelvic or abdominal surgery.

scholarly journals Experience with Ectopic Pregnancy in a Tertiary Care Teaching Hospital

2018 ◽  
Vol 27 (2) ◽  
pp. 22-26
Author(s):  
NA Parveen ◽  
MM Sarker ◽  
MK Sarker
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Tertiary Care ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Age Group ◽  
Treatment Morbidity ◽  
Incidence Risk ◽  
Abnormal Vaginal Bleeding

Ectopic pregnancy is a common life-threating condition. Diagnosis is frequently missed and should be considered in any women in the reproductive age group presenting with abdominal pain or vaginal bleeding. This prospective observational study was conducted in RMCH to determine the incidence, risk factors, clinical presentation, treatment, morbidity and mortality associated with ectopic pregnancy. A total of 50 cases of ectopic pregnancy were operated during the study period giving the incidence of ectopic pregnancy of 8.02/1000 pregnancies. The age of the patient ranged from 18-37 years, with maximum (40%) between 26-30 years age group. 36% patients had delivered one child and 24% were nulliparous. 30% patients had pelvic inflammatory disease and 22% had history of previous abortion/ MR. All patients presented with lower abdominal pain, 68% presented with abnormal vaginal bleeding and 60% had amenorrhoea. Most of the patients were diagnosed by high clinical suspicion and confirmed by USG. 96% cases ectopic pregnancy occurred in the fallopian tube and ampullary part was mainly affected. Laparotomy followed by unilateral salphingectomy was performed in majority (60%) of cases. 22% cases ipsilateral salpingectomy with tubectomy other side and 12% cases salpingostomy were performed. The recovery of majority of patients was smooth and uneventful. There was no death in this study.TAJ 2014; 27(2): 22-26

Lipoleiomyoma Causing Adnexal Torsion

2016 ◽  
Vol 33 (1) ◽  
pp. 47-49 ◽  
Author(s):  
Christopher Kiefer ◽  
Joseph Minardi ◽  
Debra Williams ◽  
Shelley M. Layman
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Fibrous Tissue ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Emergency Physicians ◽  
Adnexal Torsion ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Patient At Risk

Abdominal pain in women of reproductive age is a frequently encountered chief complaint in the emergency department. Adnexal torsion is a time-sensitive diagnosis that is essential for emergency physicians to consider in the initial differential diagnosis. Bedside sonography can be used to assist the clinician in the detection of adnexal masses placing the patient at risk for torsion. Lipoleiomyomas are uncommon, benign neoplasms consisting of variable portions of mature lipocytes, smooth muscle, or fibrous tissue. Very few cases have been reported, with no cases previously reported by emergency physicians using bedside ultrasound. A case is presented of a middle-aged woman who presented to the emergency department with acute lower abdominal pain. At the time of the initial history and physical examination, bedside screening sonogram was performed, which allowed rapid diagnosis of a large, heterogeneous, relatively avascular adnexal mass that was later identified as a lipoleiomyoma, a rare adnexal neoplasm, that resulted in adnexal torsion.

scholarly journals Clinicomicrobiological spectrum of abnormal discharge from vagina in women in costal Andhra Pradesh

2020 ◽  
Vol 10 (1) ◽  
pp. 150
Author(s):  
Jyothi Singamsetty ◽  
G. Sravani
Keyword(s):  
Abdominal Pain ◽  
Bacterial Vaginosis ◽  
Vaginal Discharge ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Exclusion Criteria ◽  
History Of ◽  
Abnormal Vaginal Discharge ◽  
Trichomonas Vaginitis ◽  
Reproductive Age Group

Background: When there is change in colour, consistency, order and volume of discharge then it is called abnormal vaginal discharge and associated with vulvar pruritus, dyspareunia, dysuria and lower abdominal pain. There is variability in organism isolated and treatment used.Methods: Sexually active women in reproductive age group with complain of abnormal vaginal discharge were included in this study based in following inclusion and exclusion criteria. . A detailed history of patient was taken regarding nature of discharge, colour, smell along with dysuria, dyspareunia, itching of vulva and lower abdominal pain.Results: Out of 160 patients 88 patients have bacterial vaginosis. Trichomonas vaginitis was present in 7.5% patients. Candidiasis was present in 6.25% patients. Some patients were having more than one infection like Bacterial vaginosis and Trichomonas vaginitis was coexisting in 13.75%, Bacterial vaginosis + Candidiasis were present in 8.75% patients. Mixed infection was present in 8.75%.Conclusions: From present study we can conclude that vaginal discharge is more common in married women in young age. Patients commonly presented with curdy white discharge, pruritus vulva and lower abdominal pain. Erythema and excoriation in vulva were common presentation, followed by erythema of vagina. Nature of discharge was mucopurulent in most patients. Bacterial vaginosis was most common followed by Trichomonas vaginitis.

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