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NRP 563 DQ 7

Overview of GI, GU, MSK and gynecologic pelvic pain diagnosis: appendicitis, UTIs, muscle sprains, abortion, ectopic pregnancy, IBS, Crohn’s – clinical tests and criteria.

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    Gastrointestinal conditions, such as appendicitis, genitourinary issues like urinary tract infections (UTIs), and musculoskeletal problems, including muscle sprains, can result in various distressing symptoms that require careful evaluation (Schuiling & Likis, 2022). A range of targeted tests can be used to diagnose these conditions effectively. For appendicitis, we can assess tenderness at McBurney's point and conduct a CT scan of the abdomen for confirmation. In the case of UTIs, a urinalysis revealing the presence of nitrates can help establish the diagnosis. For muscle sprains, particularly those resulting from pelvic trauma, gathering a detailed patient history along with a comprehensive physical examination is crucial (Schuiling & Likis, 2022). Causes of gynecologic acute pelvic pain include abortion, ectopic pregnancy, and uterine fibroids. To diagnose these conditions, a positive pregnancy test usually indicates an abortion. At the same time, vaginal bleeding may be present in case of infection, along with elevated white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) (Schuiling & Likis, 2022). Chronic pelvic pain can be caused by several conditions, including irritable bowel syndrome (IBS). To be diagnosed with IBS, a person must experience abdominal pain at least once a week for three months, along with two of the following symptoms: pain related to bowel movements, changes in the frequency of bowel movements (more than three times a day or fewer than three times a week), and changes in stool appearance (harder, softer, or more liquid). These criteria must be met for at least three months, with symptoms beginning at least six months before diagnosis (Rome Foundation, 2024). For Crohn's disease, an accurate diagnosis typically involves endoscopy, which allows doctors to examine the digestive tract directly. This is often combined with lab tests, physical exams, and a review of medical history (NTH: National

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    Institute of Diabetes and Digestive and Kidney Diseases, 2024). Celiac disease is confirmed through an intestinal biopsy, which examines the small intestine for damage caused by gluten. Proper diagnosis is essential for effective treatment of both conditions Celiac Disease Foundation, 2025). Common non-gynecologic causes of pelvic pain in adolescents include genitourinary, gastrointestinal, musculoskeletal, and psychological disorders. A prospective observational study was conducted to investigate the potential role of endometriosis as an etiological factor associated with unexplained infertility and chronic pelvic pain (CPP) in a cohort of 100 women of reproductive age. Following laparoscopic examination, it was determined that 33% of these participants were diagnosed with endometriosis. Among those diagnosed, significant associations were identified with several factors, including the experience of dysmenorrhea, a history of prior pelvic surgery, and elevated levels of CA-125. This biomarker is correlated with the severity of endometriosis. For perimenopausal women, pelvic pain considerations are low back pain, sleep disorders, and chronic fatigue. Older women are undergoing considerable changes. The researchers found that women with CPP experienced significantly more depression, infertility, miscarriages, and terminated pregnancies, cesarean births, multiple somatic symptoms, fatigue, and decreased quality of life, compared to women without CPP (Schuiling & Likis, 2022).

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    References: Celiac Disease Foundation. (2025). Diagnosis, https://celiac.org/about-celiac-disease/screening- and-diagnosis/diagnosis/ NIH: National Institute of Diabetes and Digestive and Kidney Diseases (2024). Diagnosis of Crohn's Disease, https://www.niddk.nih.gov/health-information/digestive-diseases/crohns- disease/diagnosis Rome Foundation. (2024). ROME IV diagnostic criteria. For disorders of gut-brain interaction (DGBI). https://theromefoundation.org/wp-content/uploads/Rome-Foundation-Diagnostic- Criteria-Booklet-2019.pdf Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care: With an introduction to prenatal and postpartum care (4th ed.). Jones & Bartlett Learning. How would you diagnose ectopic pregnancy? According to Tulandi (2024), the majority of ectopic pregnancies occur in the fallopian tube; nontubal sites include cervical, interstitial, ovarian, and abdominal pregnancy. Other abnormally implanted pregnancies, including hysterotomy, cesarean, myomectomy, scar pregnancies, can also occur. In rare cases, a multiple gestation may be heterotopic (include both an intrauterine and extrauterine pregnancy). Rupture of an ectopic pregnancy can result in life-threatening hemorrhage. Clinical presentation of ectopic pregnancy is first-trimester vaginal bleeding and/or abdominal pain and may also be asymptomatic. In addition, Tulandi (2024) wrote that clinicians should consider ectopic pregnancy as a diagnosis in any patient of reproductive age with vaginal bleeding and/or abdominal pain who has the following characteristics: pregnant but does not have a confirmed intrauterine pregnancy, pregnant and

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    conceived with in vitro fertilization, pregnancy status uncertain, particularly if amenorrhea of >4 weeks preceded the current vaginal bleeding, and in patient who presents with hemodynamic instability and an acute abdomen that is not explained by another diagnosis in rare cases. Ectopic pregnancy typically appears six to eight weeks after the last normal menstrual period. However, it may occur later, especially if the pregnancy is at an extrauterine site other than the fallopian tube. Normal pregnancy discomforts such as breast tenderness, frequent urination, and nausea are sometimes present. Early pregnancy symptoms may be less common in patients with ectopic pregnancy because progesterone, estradiol, and human chorionic gonadotropin levels may be lower than in normal pregnancy. The diagnosis of ectopic pregnancy can be confirmed by visualization of an extrauterine gestational sac with a yolk sac or embryo (with or without a heartbeat) on TVUS, a positive serum hCG, and no products of conception on uterine aspiration with subsequent rising or plateauing hCG levels, and visualization at surgery with histologic confirmation following resection of ectopic pregnancy tissue. According to Tulandi (2024), most ectopic pregnancies occur in the fallopian tubes, but they can also happen in places like the cervix, ovaries, or abdomen. Occasionally, a woman may have both an intrauterine and an extrauterine pregnancy, known as a heterotopic pregnancy. A rupture can lead to serious bleeding. Signs of ectopic pregnancy typically include vaginal bleeding and/or abdominal pain during the first trimester, although some may have no symptoms. Doctors should consider this diagnosis if a patient is bleeding, is pregnant without a confirmed normal pregnancy, conceived through in vitro fertilization, or is uncertain about their pregnancy status, especially if they've missed their period for over four weeks. Ectopic pregnancies are usually noticeable about six to eight weeks after the last normal menstrual period, but they can appear later. Normal pregnancy symptoms like breast tenderness, frequent urination, and nausea might be less common due to lower hormone levels. Diagnosis involves checking for an extrauterine gestational sac through transvaginal ultrasound, a positive blood test for hCG, and ensuring no

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