Adnexal masses And Pelvic Pain Flashcards
What are the gynecologic causes of acute onset pelvic pain?
Infectious causes, Ovarian torsion, Follicular cysts/Mittleschmerz
Infectious causes include Pelvic Inflammatory Disease (PID), which is associated with fever, nausea, and vomiting.
What are the non-gynecologic causes of acute onset pelvic pain?
Urolithiasis, Constipation
Urolithiasis is associated with symptoms such as gross hematuria and back pain.
What is Pelvic Inflammatory Disease (PID)?
An infectious cause of acute pelvic pain associated with fever, nausea, and vomiting
PID can be diagnosed with peritoneal signs and mucopurulent discharge.
What are the historical factors associated with PID and tubo-ovarian abscess (TOA)?
- Multiple sex partners
- STIs, especially Gonorrhea/Chlamydia
- Immunocompromised patients
- Previous episodes of PID
What is the treatment protocol for PID if the patient is stable?
- Outpatient treatment with antibiotics
- Culture for GC/CT
- Empirical treatment with Azithromycin and Ceftriaxone
- 2 weeks of oral antibiotics: Levofloxacin and Metronidazole
How is ovarian torsion diagnosed?
Ultrasound and Doppler of ovarian blood supply
It is almost always associated with an adnexal mass or cyst.
What is the primary treatment for ovarian torsion?
Surgery
The goal is to conserve the ovary if possible.
What characterizes Follicular cysts/Mittleschmerz?
Simple cysts less than 4 cm are normal, may cause intermittent pain, worse with ovulation
Treatment includes managing pain and suppressing ovulation.
What is the treatment for urolithiasis?
- Hydration
- Pain management
- Surgery depending on obstruction and recurrences
What are the treatment options for constipation?
- Laxatives
- Stool softeners
- Dietary modifications (increase fiber and hydration)
- Evaluate for irritable bowel syndrome
- Acupuncture and herbal medicine
What is a teratoma, also known as a dermoid?
A tumor made of all three germ layers, potentially containing sebaceous fluid, calcifications, hair, and other tissues
Thyroid tissue is found in about 12% of dermoids and can lead to Struma Ovarii.
What are the classic symptoms of endometriosis?
- Cyclic pain
- Dysmenorrhea
- Fixed pelvis
- Nodular uterosacral ligaments
What are the three theories of endometriosis pathophysiology?
- Retrograde menstruation
- Hematogenous/Lymphatic spread
- Coelomic metaplasia
What is the treatment approach for endometriosis?
- Surgical for endometriomas > 3 cm
- Medical to suppress menstruation (e.g., CHC, Depo Provera, Mirena IUS)
- GnRH agonist - Depo Lupron
What is Interstitial Cystitis?
A chronic inflammatory condition of the bladder associated with a breakdown of the glycosaminoglycan layer
It can lead to irritation of the mucosa and sensitization of nerves.
What are the treatment options for Interstitial Cystitis?
- Bladder diet (avoid caffeine, aged cheese, preserved meats, spicy foods)
- Elmiron (pentosan sulfate)
- Amitriptyline
- NSAIDs
- Bladder instillation/double distention cystoscopy
What is Crohn’s Disease?
A chronic inflammation of the GI tract characterized by ‘skip lesions’ from mouth to anus
It differs from ulcerative colitis, which has continuous lesions.
What are the key associated symptoms to consider in chronic pelvic pain diagnosis?
- GI symptoms
- GU symptoms
- Musculoskeletal symptoms
- Systemic symptoms (weight loss, gain, heat/cold intolerance)
