10 - Pelvic Pain and Other Gynae Presentations Flashcards
What are some gynaecological differentials for pelvic pain?
- UTI
- Dysmenorrhoea
- Irritable bowel syndrome (IBS)
- Ovarian cysts
- Endometriosis
- PID
- Ectopic pregnancy
- Appendicitis
- Mittelschmerz
- Pelvic adhesions
- Ovarian torsion
- Inflammatory bowel disease (IBD)
What are some differentials for excessive foul smelling PV discharge?
- BV
- Candidiasis (thrush)
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis
- Foreign body
- Cervical ectropion
- Polyps
- Malignancy
- Pregnancy
- Ovulation (cyclical)
- Hormonal contraception
What are some differentials for Pruritus Vulvae?
- Irritants e.g soap, detergents
- Atrophic vaginitis
- Thrush
- Pubic lice
- Eczema
- Vulval malignancy
- Pregnancy-related vaginal discharge
- Urinary or faecal incontinence
- Stress
What are some causes of RIF pain?
- GI: appendicitis, mesenteric adenitis, inflamed Meckel’s diverticulum, diverticulitis, Crohn’s
- Gynae: ectopic pregnancy, ovarian torsion of cyst, PID
- Male: testicular torsion
- Urological causes: pyelonephritis, ureteric colic.
How do you take a history from a woman with pelvic pain?
PC: SOCRATES
Systems Review: Fever, Weight Loss, PV bleeding, Pain, Any chance could be pregnant, Urinary Symptoms, Bowel Symptoms
PMHx inc Surgical
DHx and Allergies
Gynae: Any gynaecological issues, Last smear?
Obs: Mentruation regularity/flow/duration, LMP, Any children, Any abortions, Any miscarriages?
Sexual: How many partners last year, Any previous STIs, Last STI screening
FHx: Mother or Siblings gynaecological issues?
SHx: Occupation, Smoker, Alcohol
ICE!!
What are some causes of acute and chronic pelvic pain in women?
Acute
- Ectopic
- Ovarian Torsion
- PID
- UTI
- Appendicitis
- Ovarian Cyst
Chronic
- Endometriosis
- Adhesions
- Ovarian Cyst
- IBS
- Fibroids
- Adenomyosis
- Stress/Depression
- MSK pain
- Nerve entrapment
What are some causes of pelvic pain in pregnant women?
- Misscarriage
- Ectopic
- Pelvic girdle pain
- Appendicitis
- UTI
- IBD
- Round ligament pain
- Ovarian torsion
- PID
What investigations should you do for a woman with acute pelvic pain?
- Pregnancy Test (Serum hCG)
- If above positive do TVUS for ectopic
- Pelvic US
- Urine Dipstick
- STI screening
- Bloods: FBC, CRP
What examinations and investigations should you do for chronic pelvic pain?
Examinations
- Abdominal
- Bimanual
Investigations
- STI screen
- TVUS
- MRI
- Diagnostic Laparoscopy (Gold but last line)
- CA125
How can women with chronic pelvic pain be managed?
Cyclical pain: therapeutic trial of hormonal treatment (COCP, IUS, GnRH analogues) for 3–6 months before a diagnostic laparoscopy
IBS: antispasmodics, amend diet
Give all women analgesia, if not controlled refer to pain management team or pelvic pain clinic.
Also consider CBT - BIG PSYCHOSOCIAL IMPACT
How is an unruptured ectopic pregnancy managed?
Methotrexate
What are some non-gynaecological causes of chronic pelvic pain (over 6 months)?
- IBS
- Interstitial cystitis
- MSK pain
- Nerve entrapment
- Psychological (Childhood sexual abuse)
What are some of the side effects of HRT?
- Risk of stroke with oral but can be reduced if transdermal!!!!!
- Risk of VTE with oral but nil if transdermal
- Risk of breast cancer if combined HRT used, if oestrogen only then reduced risk
What is conscientious objection?
Refusing to provide a service within their competence due to their own conscience/morals
e.g use of animal parts, genetic modification, withdrawing life sustaining machinery
What healthcare scenarios is there legal grounds for conscientious objection?
- TOP
- Fertility treatment
However if there is an emergency you are not allowed to object e.g TOP needs pain relief or fluids you have to prescribe
What are the pros and cons of medical and surgical management of a TOP?
What steps need to be taken before a TOP can take place?
- Counselling
- TWO INDEPENDENT DOCTORS MUST AGREE
What are some initial lifestyle questions to ask when a couple present with infertility
- Alcohol
- Smoking
- Previous STIs
- Tight underwear
- Stress
