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
2
Q
How will ectopic pregnancy present clinically
A
- 6-8W amenorrhoea
- Unilateral iliac fossa pain
- Bleeding
3
Q
How will miscarriage present clinically
A
- Amenorrhoea
- Crampy abdominal pain
- PV bleeding
4
Q
How will PID present clinically
A
- Pelvic pain
- Discharge
- Dysuria
- Pyrexia
5
Q
How will PID present on examination
A
Cervical excitation
6
Q
How will ovarian cyst torsion present clinically
A
Sudden-onset unilateral abdominal pain
7
Q
How will torsion/ruptured ovarian cyst present OE
A
Unilateral tender adenoxa
8
Q
how does torsion of a fibroids present
A
Acute pelvic pain
9
Q
what is mittelschmerz
A
Mid-cycle pain
10
Q
how long does mittelschmerz last
A
48-72h
11
Q
what are the two urinary causes of pelvic pain
A
UTI
Renal calculi
12
Q
how will UTI present
A
frequency
urgency
haematuria
13
Q
how will renal calculi present
A
loin to groin pain
haematuria
fever
N+V
14
Q
what are 3 GI causes of pelvic pain
A
IBD
Appendicitis
Diverticulitis
15
Q
how will appendicitis present
A
- T10 then radiates to RIF
- N+V
16
Q
how will IBD present
A
- Abdominal pain
- Bloating
- Change in bowel habit
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
18
Q
define chronic pelvic pain
A
persistent or intermittent pelvic pain lasting >6-months
19
Q
what are 5 categories of causes of chronic pelvic pain
A
- Gynaecological
- Urological
- GI
- Neuropathic
- MSK
20
Q
what are 7 gynaecological causes of pelvic pain
A
Endometriosis Adenomyosis Adhesions Ovarian cysts Urogenital prolapse Fibroids Chronic PID
21
Q
what are 4 features of endometriosis
A
- Dysmenorrhoea
- Dyspareunia
- Pelvic pain = 1 day before period
- Subfertility
22
Q
in endometriosis when is the pain
A
One day before period onset
23
Q
how will adenomyosis present clinically
A
Dysmenorrhoea
Menorrhagia
24
Q
what are the examination features in adenomyosis
A
Symmetrical enlarged tender uterus
‘Boggy uterus’
25
what is a feature of adhesions as a cause of pelvic pain
Previous surgery
26
how will ovarian cysts present
Dull unilateral ache
27
how can torsion or rupture of an ovarian cysts present
Sudden-onset pelvic pain
28
what may large ovarian cysts cause
Compress on bladder to cause frequency and urgency
29
in which patients is urogenital prolapse more common
Older patients
30
how does urogenital prolapse present clinically
Dragging sensation
31
how do fibroids present
Crampy abdominal pain
| Menorrhagia
32
how will chronic PID present
Deep dyspareunia
| Change in discharge
33
what are the GI causes of chronic pain
IBD
| Hernia
34
how will IBS present
Bloating
Abdominal pain
Change in bowel habit
35
how will hernia present
Dragging sensation
36
what are urological causes of chronic pain
Urethral syndrome
37
what are MSK causes of abdominal pain
Fibromyalgia
38
in which population is fibromyalgia more common
Females
39
how does fibromyalgia present
Chronic pain at several sites
40
what are two neurological causes of chronic pelvic pain
Entrapped nerve
41
what is a risk factor for nerve entrapment
Previous surgery
42
what is the psychological association of pelvic pain
women with pelvic pain have increase history of abuse and depression
43
in RCOG guidelines on chronic pain what is first method to investigate
History
- Ask about symptoms
- Ensure to exclude red flags
44
what can be excluded solely based on history
IBS
45
what are 8 red flags of chronic pelvic pain
- New-onset Bowel symptoms >50
- PR Bleeding
- Post-menopausal bleeding
- Post-coital bleeding
- Irregular PV bleeding
- Pelvic mass
- Suicidal Ideation
- Excessive weight loss
46
what other 'bedside' measures are used in work-up of chronic pelvic pain
STI Check
Exam
Symptom diary - complete for at least two cycles to check for any patterns to pain
47
what imaging is used to for pelvic pain
TVUS
| MRI
48
why is MRI ordered
Endometriosis
| Adenomyosis
49
what is seen on adenomyosis
Thickening of myometrial-endometrial junction
50
what is gold-standard investigation in examination of chronic pelvic pain
Diagnostic laparoscopy
51
what is diagnostic laparoscopy reserved for
Usually after women have tried treatment - as otherwise it reinforces women's beliefs about pain being debilitating
52
what is diagnostic laparoscopy looking for
Peritoneal endometriosis
53
what tumour marker may be looked for in chronic pelvic pain
CA125
54
when may CA-125 be looked for
if frequent symptoms (more than 12-times a year)
55
what is the ultimate management of chronic pelvic pain
treat underlying cause
56
what is used short-term from chronic pelvic pain
analgesia - NSAIDs
57
what do RCOG recommend about treatment for chronic pelvic pain
individuals should trial hormonal treatment of at least 6m prior to diagnostic laparoscopy
58
what hormonal treatments do RCOG recommend
- COCP
| - GnRH analogue
59
how long can GnRH analogues be given
- 6m alone
| - 2y with HRT
60
if GnRH is effective at controlling pain what does this indicate
That a hysterectomy and bilateral saplingo-oopherectomy will likely be effective in controlling pain
61
if GnRH is ineffective at controlling pain what does this indicate
hysterectomy will not relieve persons pain
62
what does RCOG state should be offered to those with IBS
antispasmodics
63
define dyspareunia
pain during sex
64
what is the problem with dyspareunia
leads to a viscous cycle where women anticipates pain causing her to tense and dry
65
what are the two types of dyspareunia
superficial dyspareunia
| deep dyspareunia
66
what is superficial dyspareunia
pain on entry
67
what are 5 causes of superficial dyspareunia
1. Tears/trauma
2. Vaginitis
3. Atrophic vaginitis
4. Vaginismus
5. Inadequate lubrication - psychosocial problems
68
in what population does atrophic vaginitis occur
Post-menopausal women
69
what is deep dyspareunia
Abdominal or pelvic pain
70
what are 7 causes of deep dyspareunia
1. IBD
2. IBS
3. Adenomyosis
4. Endometriosis
5. PID
6. IUD/IUS malposition
7. Vaginitis
8. Cystitis
71
Define endometriosis
presence of endometrial tissue outside endometrial cavity
72
Define adenomyosis
presence of endometrial tissue in myometrium
73
what age is the peak incidence of endometriosis
20-40years
74
what are 6 RF of endometriosis
1. FH
2. Early menarche
3. Short cycle
4. Long duration bleeding
5. Menorrhagia
6. Defect in Fallopian tube
75
how does endometriosis present clinically
- Dysmenorrhoea. Pain starts one day before menses
- Deep dyspareunia
- Dyschezia (pain on defecation)
- Dysuria
- Sub-fertility
76
explain pain in endometriosis
pain happens one day before menses
77
if endometrial tissue is at a distant site what can it cause
haemothorax (lung)
78
what is a classical sign of endometriosis O/E
fixed retroverted uterus
79
why are symptoms cycle-dependent
as endometrial tissue responds to oestrogen
80
what can endometriosis lead to and why
repeated inflammation with menstrual cycles can lead to scarring and adhesions
81
what is gold-standard diagnostic test for endometriosis
diagnostic laparoscopy
82
explain timing of laparoscopy in endometriosis
diagnostic laparoscopy should not be performed in 6-months of hormonal treatment as this causes false negative
83
what are 3 features of endometriosis on laparoscopy
chocolate cysts
adhesions
peritoneal deposites
84
what are chocolate cysts
deep brown-colour cysts in ovary
85
what other investigation is ordered in endometriosis
pelvic US
86
what may be seen on pelvic US in endometriosis
kissing ovaries
87
what are kissing ovaries
endometriosis have adhered together
88
what is first-line for pain in endometriosis
analgesia - escalate up WHO analgesia ladder as required
89
what can reduce symptoms in endometriosis
hormonal treatments to suppress ovulation
90
what may be used to suppress ovulation in endometriosis
1. COCP
2. IUS
3. Low-dose progesterone
91
what is second-line hormonal treatment in endometriosis
GnRH analogue (Gosrelin)
92
what is the maximum duration GnRH analogue should be used for and what should it be used for
6-months
| Use with HRT (Tibolone)
93
when is surgery for endometriosis indicated
If symptoms are not managed by medical treatment and impacting women life
94
what surgery is indicated for endometriosis
endometrial ablation
95
what is ultimate treatment for endometriosis
hysterectomy and bilateral salpingoopherectomy
