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dx.
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Suprapubic Pain
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Suprapubic Pain
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
HPI overview
Symptom context
▶
Suprapubic location
Acute vs subacute vs chronic
Baseline urinary and gynecologic status
Onset
Onset
▶
Sudden onset
Gradual onset
Time since onset
Provocation/Palliation
Provocation and palliation
▶
Worse with urination
Worse with movement
Worse with sexual activity
Better with voiding
Better with NSAID
Quality
Quality
▶
Cramping
Pressure
Sharp
Burning
Region/Radiation
Region and radiation
▶
Midline only
Groin radiation
Flank radiation
Rectal radiation
Severity
Severity
▶
Peak severity
Functional limitation
Analgesic response
Timing
Timing
▶
Constant
Intermittent
Episodic with voiding
Cyclic with menses
Associated symptoms
Associated symptoms
▶
Fever
Nausea
Vomiting
Anorexia
Dysuria
Urinary frequency
Urgency
Hematuria
Urinary retention
Vaginal bleeding
Vaginal discharge
Dyspareunia
Pelvic pain
Testicular pain
Penile discharge
Constipation
Diarrhea
Hematochezia
Gynecologic and obstetric history
Pregnancy and gynecologic context
▶
LMP timing
Pregnancy possibility
Contraception
Prior ectopic pregnancy
Prior PID
IUD in situ
Urologic history
Urologic context
▶
Prior UTI and pyelonephritis
Prior nephrolithiasis
BPH symptoms
Prior urinary retention
Sexual history and STI exposure
STI exposure context
▶
New partners
Barrier use
Prior STI
Partner symptoms
Alarm Features
Immediate threats
Immediate escalation triggers
▶
Hemodynamic instability
Syncope
Altered mental status
Peritonitis
Severe pain out of proportion
Vital sign danger thresholds
High risk vitals
▶
SBP < 90 mmHg
HR > 120
RR > 24
SpO2 < 92%
Temp >= 38.5 C
High risk history patterns
High risk patterns
▶
Pregnant with abdominal pain or bleeding
Postpartum within 6 weeks
Recent pelvic instrumentation
Anticoagulated with abdominal pain
Immunocompromised with fever or severe pain
High risk exam findings
High risk exam
▶
Guarding
Rebound
Cervical motion tenderness with systemic features
Testicular high riding or absent cremasteric reflex
Distended bladder with inability to void
Medications
Medication reconciliation
Current medications
▶
Antibiotics within 30 days
NSAID and acetaminophen use
Opioids
Anticholinergics
Alpha blockers
Diuretics
SGLT2 inhibitors
High risk medication exposures
Medication risks
▶
Anticoagulants
Antiplatelets
Chronic steroids
Immunosuppressants
Medication contraindication context
Contraindication flags
▶
NSAID contraindications
Contrast allergy history
Metformin use with renal impairment concern
Diet
Recent intake and hydration
Intake pattern
▶
Poor oral intake
Reduced fluids
Vomiting limiting intake
Exposures
Potential dietary triggers
▶
High oxalate intake pattern
High sodium intake pattern
Caffeine and energy drinks
Review of Systems
System screen
Constitutional and infectious
▶
Fever
Chills
Night sweats
Weight loss
GI
▶
Nausea
Vomiting
Diarrhea
Constipation
Hematochezia
GU
▶
Dysuria
Frequency
Urgency
Hematuria
Flank pain
Urinary retention
Gynecologic
▶
Vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia
Male genital
▶
Testicular pain
Scrotal swelling
Penile discharge
Collateral History and Family History
Collateral sources
Collateral
▶
Partner or family report
Paramedic report
Prior records and recent labs
Family history
Family risk
▶
Early cardiovascular disease
Nephrolithiasis
Inflammatory bowel disease
Endometriosis
Risk Factors
Patient and exposure risks
Infection and sepsis risks
▶
Diabetes mellitus (E11.9)
CKD (N18.9)
Pregnancy
Immunosuppression
STI and PID risks
▶
Age < 25
New sexual partner
Multiple partners
Prior PID
IUD placement within 3 weeks
Procedure and device related risks
Procedure and device
▶
Recent urinary catheterization
Recent cystoscopy
Recent pelvic procedure
Thrombosis and bleeding risks
Bleeding and vascular
▶
Anticoagulation
Known aneurysm
Connective tissue disorder
Differential Diagnosis
Life threatening
Life threatening
▶
Ectopic pregnancy (O00.9)
▶
Pregnancy positive
Pain with vaginal bleeding
Hemodynamic instability
Ovarian torsion (N83.5)
▶
Sudden severe unilateral pelvic pain
Nausea or vomiting
Adnexal mass risk
Testicular torsion (N44)
▶
Acute scrotal pain
High riding testis
Absent cremasteric reflex
Sepsis from urinary source (A41.9)
▶
Fever with tachycardia
Hypotension
Altered mental status
Perforated viscus (K63.1)
▶
Peritonitis
Free air on imaging
Ruptured or leaking abdominal aortic aneurysm (I71.4)
▶
Older age
Hypotension
Syncope
Back pain
Common
Common
▶
Acute cystitis (N30.0)
▶
Dysuria
Frequency
Positive urine nitrites or leukocyte esterase
Acute pyelonephritis (N10)
▶
Fever
Flank pain
CVA tenderness
Ureteral stone (N20.1)
▶
Colicky pain
Hematuria
Radiation to groin
Urinary retention (R33)
▶
Inability to void
Suprapubic fullness
Pelvic inflammatory disease (N73.9)
▶
Pelvic pain
Cervical motion tenderness
Purulent discharge
Constipation (K59.00)
▶
Reduced stool frequency
Hard stools
Less common
Less common
▶
Endometriosis (N80.9)
▶
Cyclic pain
Dyspareunia
Interstitial cystitis or bladder pain syndrome (N30.10)
▶
Pain with bladder filling
Relief with voiding
Recurrent sterile pyuria
Diverticulitis (K57.32)
▶
LLQ pain overlap
Fever
Appendicitis atypical location (K35.80)
▶
Migratory pain
Anorexia
Prostatitis (N41.0)
▶
Perineal pain
Fever
Dysuria
Incarcerated hernia (K40.30)
▶
Groin mass
Obstructive symptoms
Key distinguishing clues
Distinguishing features
▶
Pregnancy status drives imaging and urgency
Urinary retention with large bladder volume supports outlet obstruction
Cervical motion tenderness supports PID
Hematuria with colic supports stone
Peritonitis supports surgical abdomen
Past Medical History
Relevant prior conditions
Relevant conditions
▶
Recurrent UTI
Nephrolithiasis
BPH (N40.0)
Endometriosis (N80.9)
IBD (K50.90, K51.90)
Prior ectopic pregnancy (O00.9)
Prior procedures and devices
Procedures and devices
▶
Prior pelvic surgery
Prior C section
IUD
Urinary catheter history
Physical Exam
Initial appearance and perfusion
General and perfusion
▶
Toxic appearance
Hydration status
Capillary refill delay
Peripheral mottling
Abdomen
Abdominal exam
▶
Suprapubic tenderness
Guarding
Rebound
Distension
Palpable bladder
Pelvic and genital
Pelvic exam findings
▶
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
Discharge
Male genital exam findings
▶
Testicular tenderness
Testicular lie
Cremasteric reflex
Scrotal edema
Back and CVA
Flank and CVA
▶
CVA tenderness
Back tenderness
Cardiorespiratory and neuro
System screen for instability
▶
Murmur
Pulmonary crackles
Focal neurologic deficits
Lab Studies
Core tests
Core labs
▶
Urine pregnancy test
Urinalysis with microscopy
Urine culture
CBC
CMP
Targeted tests by phenotype
Targeted labs
▶
Lactate if sepsis concern
Blood cultures if febrile or septic
STI NAAT
Vaginal wet mount testing if discharge
Interpretation pearls
Interpretation limits
▶
Negative nitrites does not exclude UTI
Hematuria absence does not exclude stone
Pregnancy positive requires ectopic exclusion until proven otherwise
Imaging
Scoring Systems
Risk stratification tools
▶
STONE score for ureteral stone likelihood
Alvarado score if appendicitis concern
qSOFA elements for sepsis risk
MRI
MRI use cases
▶
Pregnancy with suspected appendicitis and nondiagnostic ultrasound
Pelvic pathology characterization when ultrasound equivocal
CT
CT use cases
▶
CT abdomen pelvis with IV contrast for complicated infection or surgical abdomen concern
CT KUB noncontrast for stone pathway when not pregnant
CTA abdomen pelvis if aneurysm concern with instability or high risk features
Ultrasound
Ultrasound use cases
▶
Transvaginal pelvic ultrasound for ectopic pregnancy and torsion evaluation
Renal ultrasound for hydronephrosis screening
Bladder ultrasound for post void residual and retention
Aortic ultrasound for aneurysm screening when appropriate
Special Tests
Bedside maneuvers and procedures
Bedside tests
▶
Bladder scan post void residual
Straight catheter trial if urinary retention with severe discomfort
Pelvic speculum exam when discharge or bleeding
Cervical motion tenderness assessment
Procedural diagnostics
Procedures
▶
Foley catheter placement if retention with high residual
Paracentesis only if ascites and peritonitis concern
ECG
When relevant
ECG indications
▶
Older patient with unexplained abdominal pain
Hypotension or syncope
Significant tachycardia
High risk patterns
High risk findings
▶
STEMI equivalents
New ischemic changes
Ventricular arrhythmia
Assessment
Working problem list
Problem framing
▶
Suprapubic pain phenotype
Pregnancy status known vs unknown
Infection vs obstruction vs gynecologic source
Severity and risk stratification
Risk stratification
▶
Sepsis risk based on vitals and lactate
Surgical abdomen risk based on peritonitis
Ectopic risk based on pregnancy test and ultrasound findings
Diagnostic uncertainty
Alternative diagnoses
▶
Mixed pathology
Early disease with nondiagnostic labs and imaging
Plan
First 5 minutes
Time critical stabilization
▶
If SBP < 90 mmHg, resuscitation bay
If severe pain with peritonitis, surgical consult activation
If pregnant with pain and bleeding, urgent pelvic ultrasound pathway
Analgesia and symptom control
Symptom control
▶
Acetaminophen PO 1000 mg once
Ketorolac IV 15 mg once
Ondansetron ODT 4 mg once
Diagnostic sequencing
Sequencing
▶
Pregnancy test before ionizing imaging in reproductive potential
Urinalysis early in all urinary phenotypes
Pelvic ultrasound early in pregnancy or torsion concern
Condition specific pathways
Cystitis pathway
▶
Nitrofurantoin PO 100 mg twice daily
Duration 5 days
Avoid if suspected pyelonephritis
Pyelonephritis pathway
▶
Ceftriaxone IV 1 g once
Oral step down per local resistance patterns
Blood cultures if septic physiology
Ureteral stone pathway
▶
NSAID first line if no contraindications
Tamsulosin PO 0.4 mg daily if distal stone suspected
Urology consult if infected obstruction concern
PID pathway
▶
Ceftriaxone IM 500 mg once
Doxycycline PO 100 mg twice daily
Metronidazole PO 500 mg twice daily
Duration 14 days
Reassessment loop
Reassessment
▶
Pain score trend every 30 to 60 minutes until controlled
Repeat vitals after analgesia and fluids
Escalate if new peritonitis or worsening instability
Disposition
Admission and escalation criteria
ICU or resuscitation criteria
▶
Persistent hypotension after fluids
Rising lactate or lactate >= 4 mmol/L
Altered mental status
Inpatient admission criteria
▶
Pyelonephritis with vomiting or dehydration
Infected obstructing stone concern
Pregnant with abdominal pain and nondiagnostic ultrasound
PID with severe pain or tubo ovarian abscess concern
Observation and discharge criteria
Copy
Observation criteria
▶
Pain requiring repeat parenteral analgesia
Diagnostic uncertainty requiring serial exams
Discharge criteria
▶
Stable vitals
Tolerating oral intake
Pain controlled with oral regimen
Reliable follow up within 24 to 72 hours when indicated
Discharge Instructions
Copy discharge instructions
Copy
Patient instructions
▶
Pain control plan using acetaminophen and ibuprofen if safe
Hydration goals unless restricted
Complete prescribed antibiotics if given
Avoid sexual activity until STI and PID treatment complete when applicable
Return to ED now
▶
Fainting
Worsening pain
New fever
Repeated vomiting
Inability to urinate
Heavy vaginal bleeding
New shortness of breath or chest pain
Follow up
▶
Primary care within 2 to 3 days
Urology follow up if stone suspected
OB GYN follow up if pelvic pathology suspected
References
Guidelines and core sources
References
▶
CDC Sexually Transmitted Infections Treatment Guidelines 2021
IDSA Acute Uncomplicated Cystitis and Pyelonephritis Guideline 2010
AUA Kidney Stones Medical Management Guideline 2019
ACOG Practice Bulletin Ectopic Pregnancy 2018
ACEP Clinical Policy on Suspected Acute Venous Thromboembolic Disease 2018 local protocol dependent for imaging pathways
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Suprapubic Pain