Mittelschmerz: Difference between revisions
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==Background== | ==Background== | ||
Lower abdominal or pelvic pain during ovulation | *Lower [[abdominal pain|abdominal]] or [[pelvic pain]] during ovulation | ||
*From German for "middle pain." | |||
==Clinical Features== | ==Clinical Features== | ||
occurs roughly halfway of menstrual cycle | *Pain occurs roughly halfway of menstrual cycle | ||
*Should ''not'' have any additional symptoms | |||
*Abdominal/pelvic exam benign | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pelvic pain DDX}} | |||
{{Abd DDX RLQ}} | {{Abd DDX RLQ}} | ||
{{LLQ DDX}} | |||
==Evaluation== | |||
== | [[File:PMC4603210 usg-15013-f1.png|thumb|A gray-scale sonogram shows a dominant follicle with a much smaller, cystic-appearing structure at the periphery of the follicle, the cumulus oophorus (arrow). This is indicative of imminent ovulation.]] | ||
*Frequently a diagnosis of exclusion | |||
==Management== | ==Management== | ||
*Benign | *Benign, [[analgesia]] as needed | ||
==Disposition== | ==Disposition== | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:OBGYN]] | ||
Latest revision as of 17:01, 3 May 2023
Background
- Lower abdominal or pelvic pain during ovulation
- From German for "middle pain."
Clinical Features
- Pain occurs roughly halfway of menstrual cycle
- Should not have any additional symptoms
- Abdominal/pelvic exam benign
Differential Diagnosis
Acute Pelvic Pain
Gynecologic/Obstetric
- Normal variants may be noted on exam but generally do not cause pain or other symptoms
- Nabothian cysts: Epithelial cells within mucous glans that appear as yellow inclusions on the cervix
- Cervical Ectropion: Edothelial cells on the exterior of the cervix
- Parous cervix: The is no longer round but may have multiple shapes after birth
- Pregnancy-related
- Ectopic pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Pelvic organ prolapse
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Evaluation
- Frequently a diagnosis of exclusion
Management
- Benign, analgesia as needed
Disposition
- Outpatient
See Also
External Links
References
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.