ED Pathway for Evaluation of Post-Pubertal Girls with Lower Abdominal Pain and No Vaginal Bleeding
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Initial FLOC, RN Team Assessment
  • Assess
    • Pain, hydration, peritoneal sign
  • Obtain Urine
    • Clean: HCG, POC
    • Dirty: STI testing, as clinically indicated
  • Consider
    • NPO, need for IV, labs
    • IVF to fill bladder
    • Serum HCG (promote bladder filling)
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Positive Pregnancy
  • Determine need for transfer to HUP
  • STI screening, treatment as clinically indicated
  • SW consult, counseling
  • Safe discharge plan
Indications for Pelvic US
  • Severe pain
  • Significant focality to pain
  • Palpable mass on PE
  • Uncertain diagnosis
  • Elevated inflammatory markers

  • Consider retrograde bladder filling if high concern for ovarian torsion
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Possible Surgical Disease
  • Ovarian Torsion
  • Appendicitis
Possible Medical Disease
  • Pyelonephritis
  • Urolithiasis
  • Gastroenteritis
  • Constipation
  • Ovarian cyst
  • Mittelschmerz
  • IBS
  • Functional
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Social Work Consult
Health Educator
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Indications for Admission
  • Inpatient Treatment
  • Age < 15 years
  • Immunodeficiency
  • TOA
  • Severe disease
  • Vomiting, significant dehydration
  • Concern for follow-up, compliance
  • Pregnancy
  • Uncertain Diagnosis
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  • Reassuring H&P
  • Able to tolerate PO
  • Follow-up care available
  • Discharge
Posted: April 2006
Revised: September 2011, April 2015, October 2017, December 2017
Authors: C. Mollen, MD, J. Lavelle, MD, M. Zucker, MD