acute and chronic pelvic pain

Question 1

2 pain types

Answer 1

1. nociceptive - somatic or visceral

2. neuropathic - distrurbed or altered pathways

Question 2

5 mech. or pain

Answer 2

1. inflammation
2. iscemia/infarct
3. obstruction
4. distension of capsule
5. direct nerve stim

Question 3

mech of dysmenhorea

Answer 3

1. increase prostaglandins
2. vasoconstriciton
3. ischemia
4. stim. or nerve endings
5. altered uterine contractions

Question 4

what is pattern of somatic pain

Answer 4

• from parietal perioneum

- follows dermatomes

Question 5

what is pattern of visceral pain

Answer 5

• sensory impulses from the distal fallopian tubes

- mixed via many nerve plexuses and thus complicated

Question 6

4 constiderations in DDx

Answer 6

1. context pt is seen in
2. age
3. durations
4. serious and common conditions first

Question 7

what is systems based approach

Answer 7

consider various systems

- GI, GU, MSK, vascular, reproductive

Question 8

2 main GI concerns

Answer 8

1. appendicitis

2. obstruction

Question 9

GU concernes

Answer 9

• interstitial cystitis
• stones
• UTI or pyelo

Question 10

MSK concerns

Answer 10

• hernia
• fibromyaligia
• myofascial
• arthritis

Question 11

vascular concerns

Answer 11

• throbosis

- bowel infarct

Question 12

4 parts of reproductive to consider

Answer 12

1. uterine
2. ovarian
3. fallopian
4. peritoneal

Question 13

uterine concerns (2)

Answer 13

• endomet.

- miscarriage

Question 14

ovarian concerns 3

Answer 14

• cysts
• torsion
• TOabscess

Question 15

2 fallopian concerns

Answer 15

• salpingitis

- ectopic preg

Question 16

2 peritoneal concerns

Answer 16

1. endomet

2. PID

Question 17

DDx for adolescents

Answer 17

• PID
• obstructed flow if first time
• appedicitis
• preg

Question 18

DDx for reproductive age

Answer 18

• preg
• PID
• endo
• torsion
• cysts

Question 19

DDx for menopause

Answer 19

• torsion
• endo less likely
• tumors
• not reproductive causes

Question 20

3 of only acute durations

Answer 20

1. appendicitis
2. ectopic preg
3. torsion

Question 21

3 acute on chronic

Answer 21

1. PID - recurrent
2. ruptured cysts
3. torsion

Question 22

DDx for chronic (4)

Answer 22

1. endo
2. adenomyosis
3. fibroids
4. adhesions

Question 23

DDx for chronic and non-reproductive

Answer 23

1. IBS
2. IC
3. fibromyalgia

Question 24

things to ask about that might help (pearls)

Answer 24

sexual activity - PID, preg
bilateral pain - PID
episodic - torsion
cyclic - endo, adenomyosis
migratory - appendicicits
flank/colicky - stones
left sides - cysts, divertivulitis
dyspaerunia - PID, endo, fibroids

Question 25

pearls to ask about bleeds

Answer 25

irregular - PID, endo
menorrhagia - adeno, fibroids
rectal bleed - IBD, tumors
uria - stones, cystitits, tumors

Question 26

invesitgations to order

Answer 26

1. HCG
2. CBC
3. ESR, CRP
4. cultures
5. urinalysis
6. stool

Question 27

imaging to order

Answer 27

1. US
2. CT abdo
3. MRI

Question 28

what are adhesion

Answer 28

common complications of abdo surgery

- typically visceral pain

Question 29

medical treatment of adhesions

Answer 29

NSAIDS

• tylenol
• gabapentin
• avoid narcotics

Question 30

2 behaviors mods for adhesions

Answer 30

1. timed voiding to avoid overfill

2. alternate positions for intercourse

Question 31

surgical treatment for adhesions

Answer 31

removal of scar tissue only found to be helpful for severe adhesions
- prevention of new adhesions is neccesary

Question 32

check out cases

Answer 32

in online notes