Abdominal Pain, Lower, Post-Pubertal Girls Clinical Pathway — Emergency

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Information

Related Pathways

Post-Pubertal Girls with
Lower Abdominal Pain

Triage

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)

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

Confidentiality, Consent

History & Physical

GU Exam with Attending/Fellow

Diagnostic Testing

Consent for HIV Testing, Guidance for
Delivering Test Results to Patients

See Indications for Pelvic Ultrasound

Criteria for PID Diagnosis

Possible Surgical Disease

Ovarian Torsion
Appendicitis

Possible Medical Disease

Pyelonephritis
Urolithiasis
Gastroenteritis
Constipation
Ovarian cyst
Mittelschmerz
IBS
Functional

Social Work Consult
Health Educator

Indications for Admission

Inpatient Treatment
Age < 15 years
Immunodeficiency
TOA
Severe disease
Vomiting, significant dehydration
Concern for follow-up, compliance
Pregnancy
Uncertain Diagnosis

Outpatient Treatment

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

Related Links

For Providers:
Sexually Transmitted Diseases Treatment Guidelines

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.