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Gynaecology > 1: Pelvic Pain, Dyspareunia, Endometriosis > Flashcards

1: Pelvic Pain, Dyspareunia, Endometriosis Flashcards

1
Q

What are 6 acute gynaecological causes of pelvic pain

A
  • Ectopic
  • Miscarriage
  • Ovarian torsion
  • Fibroid torsion or red degeneration
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2
Q

How will ectopic pregnancy present clinically

A
  • 6-8W amenorrhoea
  • Unilateral iliac fossa pain
  • Bleeding
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3
Q

How will miscarriage present clinically

A
  • Amenorrhoea
  • Crampy abdominal pain
  • PV bleeding
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4
Q

How will PID present clinically

A
  • Pelvic pain
  • Discharge
  • Dysuria
  • Pyrexia
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5
Q

How will PID present on examination

A

Cervical excitation

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6
Q

How will ovarian cyst torsion present clinically

A

Sudden-onset unilateral abdominal pain

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7
Q

How will torsion/ruptured ovarian cyst present OE

A

Unilateral tender adenoxa

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8
Q

how does torsion of a fibroids present

A

Acute pelvic pain

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9
Q

what is mittelschmerz

A

Mid-cycle pain

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10
Q

how long does mittelschmerz last

A

48-72h

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11
Q

what are the two urinary causes of pelvic pain

A

UTI

Renal calculi

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12
Q

how will UTI present

A

frequency
urgency
haematuria

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13
Q

how will renal calculi present

A

loin to groin pain
haematuria
fever
N+V

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14
Q

what are 3 GI causes of pelvic pain

A

IBD
Appendicitis
Diverticulitis

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15
Q

how will appendicitis present

A
  • T10 then radiates to RIF

- N+V

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16
Q

how will IBD present

A
  • Abdominal pain
  • Bloating
  • Change in bowel habit
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17
Q

how will diverticulitis present as a cause of abdominal pain

A
  • Severe abdominal pain in left quadrant
  • N+V
  • Change in bowel habit
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18
Q

define chronic pelvic pain

A

persistent or intermittent pelvic pain lasting >6-months

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19
Q

what are 5 categories of causes of chronic pelvic pain

A
  1. Gynaecological
  2. Urological
  3. GI
  4. Neuropathic
  5. MSK
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20
Q

what are 7 gynaecological causes of pelvic pain

A 
Endometriosis 
Adenomyosis 
Adhesions 
Ovarian cysts 
Urogenital prolapse 
Fibroids 
Chronic PID
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21
Q

what are 4 features of endometriosis

A
  • Dysmenorrhoea
  • Dyspareunia
  • Pelvic pain = 1 day before period
  • Subfertility
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22
Q

in endometriosis when is the pain

A

One day before period onset

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23
Q

how will adenomyosis present clinically

A

Dysmenorrhoea

Menorrhagia

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24
Q

what are the examination features in adenomyosis

A

Symmetrical enlarged tender uterus

‘Boggy uterus’

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25
Q

what is a feature of adhesions as a cause of pelvic pain

A

Previous surgery

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26
Q

how will ovarian cysts present

A

Dull unilateral ache

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27
Q

how can torsion or rupture of an ovarian cysts present

A

Sudden-onset pelvic pain

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28
Q

what may large ovarian cysts cause

A

Compress on bladder to cause frequency and urgency

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29
Q

in which patients is urogenital prolapse more common

A

Older patients

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30
Q

how does urogenital prolapse present clinically

A

Dragging sensation

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31
Q

how do fibroids present

A

Crampy abdominal pain

Menorrhagia

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32
Q

how will chronic PID present

A

Deep dyspareunia

Change in discharge

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33
Q

what are the GI causes of chronic pain

A

IBD

Hernia

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34
Q

how will IBS present

A

Bloating
Abdominal pain
Change in bowel habit

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35
Q

how will hernia present

A

Dragging sensation

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36
Q

what are urological causes of chronic pain

A

Urethral syndrome

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37
Q

what are MSK causes of abdominal pain

A

Fibromyalgia

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38
Q

in which population is fibromyalgia more common

A

Females

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39
Q

how does fibromyalgia present

A

Chronic pain at several sites

40
Q

what are two neurological causes of chronic pelvic pain

A

Entrapped nerve

41
Q

what is a risk factor for nerve entrapment

A

Previous surgery

42
Q

what is the psychological association of pelvic pain

A

women with pelvic pain have increase history of abuse and depression

43
Q

in RCOG guidelines on chronic pain what is first method to investigate

A

History

  • Ask about symptoms
  • Ensure to exclude red flags
44
Q

what can be excluded solely based on history

A

IBS

45
Q

what are 8 red flags of chronic pelvic pain

A
  • New-onset Bowel symptoms >50
  • PR Bleeding
  • Post-menopausal bleeding
  • Post-coital bleeding
  • Irregular PV bleeding
  • Pelvic mass
  • Suicidal Ideation
  • Excessive weight loss
46
Q

what other ‘bedside’ measures are used in work-up of chronic pelvic pain

A

STI Check
Exam
Symptom diary - complete for at least two cycles to check for any patterns to pain

47
Q

what imaging is used to for pelvic pain

A

TVUS

MRI

48
Q

why is MRI ordered

A

Endometriosis

Adenomyosis

49
Q

what is seen on adenomyosis

A

Thickening of myometrial-endometrial junction

50
Q

what is gold-standard investigation in examination of chronic pelvic pain

A

Diagnostic laparoscopy

51
Q

what is diagnostic laparoscopy reserved for

A

Usually after women have tried treatment - as otherwise it reinforces women’s beliefs about pain being debilitating

52
Q

what is diagnostic laparoscopy looking for

A

Peritoneal endometriosis

53
Q

what tumour marker may be looked for in chronic pelvic pain

A

CA125

54
Q

when may CA-125 be looked for

A

if frequent symptoms (more than 12-times a year)

55
Q

what is the ultimate management of chronic pelvic pain

A

treat underlying cause

56
Q

what is used short-term from chronic pelvic pain

A

analgesia - NSAIDs

57
Q

what do RCOG recommend about treatment for chronic pelvic pain

A

individuals should trial hormonal treatment of at least 6m prior to diagnostic laparoscopy

58
Q

what hormonal treatments do RCOG recommend

A
  • COCP

- GnRH analogue

59
Q

how long can GnRH analogues be given

A
  • 6m alone

- 2y with HRT

60
Q

if GnRH is effective at controlling pain what does this indicate

A

That a hysterectomy and bilateral saplingo-oopherectomy will likely be effective in controlling pain

61
Q

if GnRH is ineffective at controlling pain what does this indicate

A

hysterectomy will not relieve persons pain

62
Q

what does RCOG state should be offered to those with IBS

A

antispasmodics

63
Q

define dyspareunia

A

pain during sex

64
Q

what is the problem with dyspareunia

A

leads to a viscous cycle where women anticipates pain causing her to tense and dry

65
Q

what are the two types of dyspareunia

A

superficial dyspareunia

deep dyspareunia

66
Q

what is superficial dyspareunia

A

pain on entry

67
Q

what are 5 causes of superficial dyspareunia

A
  1. Tears/trauma
  2. Vaginitis
  3. Atrophic vaginitis
  4. Vaginismus
  5. Inadequate lubrication - psychosocial problems
68
Q

in what population does atrophic vaginitis occur

A

Post-menopausal women

69
Q

what is deep dyspareunia

A

Abdominal or pelvic pain

70
Q

what are 7 causes of deep dyspareunia

A
  1. IBD
  2. IBS
  3. Adenomyosis
  4. Endometriosis
  5. PID
  6. IUD/IUS malposition
  7. Vaginitis
  8. Cystitis
71
Q

Define endometriosis

A

presence of endometrial tissue outside endometrial cavity

72
Q

Define adenomyosis

A

presence of endometrial tissue in myometrium

73
Q

what age is the peak incidence of endometriosis

A

20-40years

74
Q

what are 6 RF of endometriosis

A
  1. FH
  2. Early menarche
  3. Short cycle
  4. Long duration bleeding
  5. Menorrhagia
  6. Defect in Fallopian tube
75
Q

how does endometriosis present clinically

A
  • Dysmenorrhoea. Pain starts one day before menses
  • Deep dyspareunia
  • Dyschezia (pain on defecation)
  • Dysuria
  • Sub-fertility
76
Q

explain pain in endometriosis

A

pain happens one day before menses

77
Q

if endometrial tissue is at a distant site what can it cause

A

haemothorax (lung)

78
Q

what is a classical sign of endometriosis O/E

A

fixed retroverted uterus

79
Q

why are symptoms cycle-dependent

A

as endometrial tissue responds to oestrogen

80
Q

what can endometriosis lead to and why

A

repeated inflammation with menstrual cycles can lead to scarring and adhesions

81
Q

what is gold-standard diagnostic test for endometriosis

A

diagnostic laparoscopy

82
Q

explain timing of laparoscopy in endometriosis

A

diagnostic laparoscopy should not be performed in 6-months of hormonal treatment as this causes false negative

83
Q

what are 3 features of endometriosis on laparoscopy

A

chocolate cysts
adhesions
peritoneal deposites

84
Q

what are chocolate cysts

A

deep brown-colour cysts in ovary

85
Q

what other investigation is ordered in endometriosis

A

pelvic US

86
Q

what may be seen on pelvic US in endometriosis

A

kissing ovaries

87
Q

what are kissing ovaries

A

endometriosis have adhered together

88
Q

what is first-line for pain in endometriosis

A

analgesia - escalate up WHO analgesia ladder as required

89
Q

what can reduce symptoms in endometriosis

A

hormonal treatments to suppress ovulation

90
Q

what may be used to suppress ovulation in endometriosis

A
  1. COCP
  2. IUS
  3. Low-dose progesterone
91
Q

what is second-line hormonal treatment in endometriosis

A

GnRH analogue (Gosrelin)

92
Q

what is the maximum duration GnRH analogue should be used for and what should it be used for

A

6-months

Use with HRT (Tibolone)

93
Q

when is surgery for endometriosis indicated

A

If symptoms are not managed by medical treatment and impacting women life

94
Q

what surgery is indicated for endometriosis

A

endometrial ablation

95
Q

what is ultimate treatment for endometriosis

A

hysterectomy and bilateral salpingoopherectomy

Gynaecology (22 decks)

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