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
(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
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).
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).
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
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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