Assessing Acute Pelvic Pain

Mrs. A, a 32-year-old G2, P2 arrives at the office for a focus visit complaining of right lower quadrant pain for two days that is increasing in intensity. Her height is 5’2”; weight is 110 lbs;  BP is 130/80.

HISTORY
The pain began approximately 72 hours ago and has steadily increased.  Mrs. A notes no fever, change in bowel habits, or nausea.  Her last menstrual period was “normal.”  Her menses are “sort of” regular with her last period being “sometime last month.” She and her husband use condoms for contraception. 

EXAMINATION
Mrs. A is well dressed and well groomed. She states that she is in mild to moderate pain and rates the pain as a 4 out of 10. Upon physical examination:

   Vulva: Normal
   Vagina: Small amount of white discharge; no “heat” appreciated in pelvis
   Cervix: Clear, no discharge
   Uterus: Anteverted, non-tender
   Adnexa: Left ovary palpable. Right ovary not palpated secondary to guarding.

ASSESSMENT AND TREATMENT PLAN
Mrs. A’s pelvic pain may be due to a possible ectopic pregnancy or appendicitis. A transvaginal ultrasound is scheduled to rule out ectopic pregnancy, and a CBC and quantitative BHCG (stat) are ordered.