Incidence
Age
Sex
Geography
Aetiology	Ectopic pregnancy Septic/incomplete miscarriage Ovarian cyst accident PID, endometriosis Renal tract infection/calculus Appendicitis Ovarian malignancy (older patients)
Presentation	History: review of gynae Hx; timing, nature, site of pain, menstrual Hx, dyspareunia, sexual/contraceptive Hx, GI symptoms/anorexia Examination: General: appearance, temperature, BP, pulse, anaemia, shock Abdomen: site and degree of tenderness, bowel sounds Pelvis: masses, cervical excitation, adnexal tenderness, discharge
Investigations	Bloods for FBC Pregnancy test Swabs for culture if negative USS Culture urine   Initial pain Bleeding Discharge Fever Peritonism Pregnancy test USS Ovarian cyst accident Unilateral Occasional Occasional Low grade Often usually -ve Usually shows cyst Ectopic Unilateral Usual Bloody Normal Often Positive Empty uterus PID Bilateral Often Usual Often Often Negative Normal Appendicitis Right Unusual No Low grade Usual Negative Normal
Macro
Micro
Staging
Serum markers
Management	Analgesia, admit, nil by mouth If probable ectopic or ovarian cyst: laparoscopy ± laparotomy If PID: doxycycline+metronidazole+penicillin If unsure (pregnancy test -ve) admit, observe, give antibiotics empirically, do laparoscopy if no improvement
Prognosis
Complications

Gynaecology

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