A 29 year old patient, with a known ovarian cyst presents to ED complaining of worsening pelvic pain and pain in the medial thigh region. Irritation of which of the following structures is responsible for the pain in the medial thigh region:
Ovaries are the site of egg production, which are ovulated into the peritoneal cavity and normally directed into the adjacent openings of the uterine tube by fimbriae on the ends of the uterine tubes.
The ovaries lies adjacent to the lateral pelvic wall just inferior to the pelvic inlet. Each of the two ovaries is about 3 cm long and is suspended by a mesentery (the mesovarium) that is a posterior extension of the broad ligament. Its medial end is attached to the uterus by the ligament of the ovary and its lateral end is related to the fimbriae of the uterine tube.
Ovary (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
The arterial supply to the ovaries is from the ovarian arteries, direct branches from the anterolateral surfaces of the abdominal aorta.
There are three main pathways for lymphatic flow from the ovaries: superiorly to the para-aortic lymph nodes adjacent to the ovarian artery, inferiorly to the medial group of superficial inguinal lymph nodes through the inguinal canal alongside the round ligament, and horizontally to the opposite ovary across the uterine fundus.
Visceral afferent fibres usual follow the sympathetic fibres of the ovarian plexus and lumbar splanchnic nerves to cell bodies in the T10 - T12 and L1 spinal sensory ganglia; pain is thus referred to the periumbilical region, suprapubic region and groin. Additionally ovarian pain can also be referred to the medial aspect of the thigh by route of the adjacent obturator nerve.
Is there something wrong with this question? Let us know and we’ll fix it as soon as possible.
Biochemistry | Normal Value |
---|---|
Sodium | 135 – 145 mmol/l |
Potassium | 3.0 – 4.5 mmol/l |
Urea | 2.5 – 7.5 mmol/l |
Glucose | 3.5 – 5.0 mmol/l |
Creatinine | 35 – 135 μmol/l |
Alanine Aminotransferase (ALT) | 5 – 35 U/l |
Gamma-glutamyl Transferase (GGT) | < 65 U/l |
Alkaline Phosphatase (ALP) | 30 – 135 U/l |
Aspartate Aminotransferase (AST) | < 40 U/l |
Total Protein | 60 – 80 g/l |
Albumin | 35 – 50 g/l |
Globulin | 2.4 – 3.5 g/dl |
Amylase | < 70 U/l |
Total Bilirubin | 3 – 17 μmol/l |
Calcium | 2.1 – 2.5 mmol/l |
Chloride | 95 – 105 mmol/l |
Phosphate | 0.8 – 1.4 mmol/l |
Haematology | Normal Value |
---|---|
Haemoglobin | 11.5 – 16.6 g/dl |
White Blood Cells | 4.0 – 11.0 x 109/l |
Platelets | 150 – 450 x 109/l |
MCV | 80 – 96 fl |
MCHC | 32 – 36 g/dl |
Neutrophils | 2.0 – 7.5 x 109/l |
Lymphocytes | 1.5 – 4.0 x 109/l |
Monocytes | 0.3 – 1.0 x 109/l |
Eosinophils | 0.1 – 0.5 x 109/l |
Basophils | < 0.2 x 109/l |
Reticulocytes | < 2% |
Haematocrit | 0.35 – 0.49 |
Red Cell Distribution Width | 11 – 15% |
Blood Gases | Normal Value |
---|---|
pH | 7.35 – 7.45 |
pO2 | 11 – 14 kPa |
pCO2 | 4.5 – 6.0 kPa |
Base Excess | -2 – +2 mmol/l |
Bicarbonate | 24 – 30 mmol/l |
Lactate | < 2 mmol/l |