醫學筆記匯整 ED Notes

• Vital signs unstable : ABC, Resucitation, FAST 
• Stable Vital signs : beta HCG 所有育齡女性都應驗孕 
      - Pregnant : Ultrasound for IUP (Early pregancy), abortion, Ectopic 
• Not pregnant : 
      - Infection (U/A) : UTI, Pyelonephritis, PID, TOA
      - Torsion, rupture, ovulation pain, dysmenorhea, endometriosis  
      - Stone 
      - Appen, diverticulitis, aneurysm 

 Torsion 
 - Ovarian cyst or tumor > 5cm (6-8cm) 容易發生
 - Sudden lower abd pain 隨著 torsion 越來越痛
   N/V, adnexal mass 
   Can present as intermitten torsion with intermitten symptoms 
   Tenderness absent in 30% cases 
 - Urine hCG, U/S Doppler : flow, ovarian edema, whirlpool sign     

 Rupture 
 - Sudden unilateral sharp pelvic pain 破掉的當下最痛
   Mild vaginal bleeding
   Adnexal tenderness/mass
   can present as peritoneal signs (Rupture 釋出內含物, 較有刺激)
 - After sexual intercourse, can be spontaneous  
 - 最重要 : D/D ectopic (Urine hCG)
 - Hemodynamic unstable : FAST 
   U/S : Mass, free fluid ( hemoperitoneum)

 PID / TOA 
 - 上生殖道感染 ( Endometritis, salphitis, oophoritis, peritonitis, perihepatitis, TOA )
 -  STD, IUD, Procedure 
 -  披衣菌 Chlamydia trachomatis, 淋病雙球菌 Neisseria gonorrhoeae 
    Strept, GNB, Anaerobes
 - Lower abd pain, vaginal discharge, vaginal bleeding, fever, UTI symptoms 
    Cervical motion tenderness, adnexal tenderness 
 - 80% can be OPD f/u 
    except : 無法配合口服藥物, 臨床嚴重症狀, 無法排除其他問題, TOA, Pregnancy 

Fitz-Hugh-Curtis Syndrome : PID + Perihepatitis 
 - C. trachomatis as a more common etiologic agent. 
 - May be suspected in sexually active young women who visit the ER with severe RUQ pain,
   when emergency sonography reveals an intact gallbladder
   and no demonstrable abnormal lesion in the abdomen.
 - Very sharp RUQ pain aggravated with deep respiration or coughing along the right costal margin
   常被誤診為膽囊炎或肋膜炎
 - Dynamic CT : Arterial-phase reveals characteristic hepatic capsular enhancement