3. Es una causa frecuente de consulta El ginecólogo es consultado para saber si el cuadro es de etiología ginecológica o no. Se deben identificar rápidamente las condiciones potencialmente mortales y que demandan cirugía inmediata Los elementos más importantes para elaborar una correcta hipótesis diagnóstica inicial de trabajo son la anamnesis y el examen físico Conceptos clave
8. Dolor Localización Instalación y duración Carácter2 Intensidad Historia previa Historia ginecobstétrica Historia Clínica 2. Fauconnier, A, Dallongeville, E, Huchon, C, et al. Measurement of AcutePelvicPainIntensity in Gynecology: A Comparison of FiveMethods. ObstetGynecol 2009; 113:260.
47. Test de embarazo β-hCG De acuerdo a sospecha: Hemograma con fórmula de Schilling Orina completa y urocultivo Laboratorio
48. Ecografía5 TAC abdomen y pelvis En embarazo Ecografía RNM Imagenología 5.- Harris, RD, Holtzman, SR, Poppe, AM. Clinical outcome in female patients with pelvic pain and normal pelvic US findings. Radiology 2000; 216:440.
49. Laparoscopía Eventualmente también terapéutica Sin embargo, la mayoría de pacientes con algia pélvica aguda, examen físico normal y exámenes de lab. normales mejorará sin necesidad de intervención.6 6.- Barloon, TJ, Brown, BP, Abu-Yousef, MM, Warnock, N. Predictivevalue of normal endovaginalsonography in excludingdisease of thefemale genital organs and adnexa. J UltrasoundMed 1994; 13:395.
50. The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain. METHODS: Diagnostic laparoscopy was carried out in 736 patients (31.1%) with APP and in 1629 (68.9%) with CPP. In 315 patients (13.3%) the diagnostic procedure was extended to operative laparoscopy. RESULTS: The most frequent laparoscopic findings in patients with APP were acute salpingitis and pelvic adhesions (22.8%) and ectopic pregnancy (19%), while in patients with CPP the most frequent findings were pelvic adhesions (35.4%) and endometriosis (24.6%). In 7.5% of patients with APP and 24% with CPP, laparoscopy did not reveal any pathological finding in the pelvis. Among the 315 patients in whom operative laparoscopy was carried out, 40% suffered from APP and 60% from CPP. In the 446 patients (18.9%) without laparoscopic findings no treatment was given, while of the remaining 905 patients 40% were subjected to laparotomy and 60% received conservative treatment. The total incidence of side effects reached 4.7% and serious side effects resulting from emergency laparotomy occurred in 0.15% of patients with pelvic pain. Laparoscopía
51. CONCLUSION: Our results in a large group of patients with pelvic pain show that there are discrepancies in the incidence of laparoscopic findings between patients with APP and CPP. Discrepancies between the two groups of patients were also found during operative laparoscopy, the treatment administered after laparoscopic diagnosis and the complications encountered. Laparoscopía Int J Gynaecol Obstet. 1996 Mar;52(3):243-8.
52. El origen del dolor en una paciente con dolor pélvico agudo puede ser metabólico, vascular, gastrointestinal, urológico, musculoesquelético o ginecobstétrico. La historia y el examen físico deben ser acuciosos, pero relacionados con la presentación clínica de la paciente. Las mujeres con shock o signos de peritonitis pueden requerir cirugía inmediata Un test de embarazo debe obtenerse en todas estas pacientes. Otros exámenes de laboratorio o imagenológicos deberían estar basados en la anamnesis o hallazgos clínicos. Conclusiones