B. Pelvic Pain Flashcards
Intermittent pelvic pain points towards?
Obstruction
Constant pelvic pain points towards?
Perotinits/inflam
Pelvic pain with nausea/vomiting is _________?
Bowel obstruction
Pelvic pain with vaginal bleeding is _________?
Ectopic pregnancy
Causes of acute pelvic pain?
Appendicitis (RLQ) Inflammatory bowel disease (Chrons & ulcerative colitis) Diverticulitis (which can rupture & lead to peritonitis, tend to be older & LLQ) Cystitis or pylonephritis Renal/ureteral stone PID Ectopic Pregnancy Adnexal Torsion Ruptured Ovarian Cyst
What causes a patient to never be able to get comfortable due to pelvic pain?
Stone
Pelvic Pain with fever is _________?
Infection
Pelvic pain with hypotension is _________?
Bleeding –> ruptured cyst or ectopic
Pelvic pain with absent bowel sounds is ________?
Ileus
Pelvic Pain with racing bowel sounds (rushes) is ______?
Bowel obstruction
Pelvic pain with flank tenderness is _________?
Pyelonephritis
Pelvic pain with distended abdomen is ___________?
Mass, intraperotineal bleeding or ileus
Pelvic pain where the patient lies with legs drawn up is ____________?
Peritonitis
Pelvic pain with rebound tenderness is ___________?
Peritonitis
Pelvic pain with + cough test, heel percussion test, Psoas sign or obturator sign is ___________?
Peritonitis
Pelvic pain with mucopurulent discharge is ____________?
Infection (Gonorrhea or chlamydia)
Pelvic pain with uterine or adnexal tenderness is ____________?
PID
Diagnostic test for appendicitis?
[On test]
CT
WBC can also be helpful as is elevated & has left shift
Treatment for appendicitis?
Surgery
Diagnostic test for inflammatory bowel disease?
CT
Endoscopy
Treatment for Inflammatory bowel disease?
Anti-inflammatory (NSAIDS) or immune modulating agents
Surgery for perforations or intractable pain
Diagnostic test for Diverticulitis?
WBC
CT
Treatment for diverticulitis?
Antibiotics
Surgery for perforation
Diagnostic test for cystitis or pyelonephritis?
Urine culture
WBC also helpful
Treatment for cystitis or pyelonephritis?
Antibiotics
Diagnostic test for stones?
[On test]
Best is Ultrasound (for calcified)
CT if ultrasound is not diagnostic
Will also have gross or microscopic blood in urine
Treatment for stones?
Observation
Lithotripsy
Surgery
Diagnostic test for ectopic preg?
[On test]
Urine hcg
Ultrasound
CBC/Hematocrit (blod loss)
Treatment for ectopic preg?
Methotrexate for non-ruptured
Surgery for ruptured
Diagnostic test for PID?
[On test]
PCR/Nucleic Acid Amplification Test (NAAT) for gonorrhea & chlamydia
WBC
Ultrasound for cysts
Treatment for PID?
Antibiotics
Surgery for ruptured Tubo-ovarian abscess (TOA)
Diagnostic test for Ovarian cyst?
ultrasound
Treatment for ovarian cyst?
Observation
Surgery
Diagnostic test for adnexal torsion?
Ultrasound
Treatment for adnexal torsion?
Surgery
Which is more of an emergency, acute or chronic pelvic pain?
Acute
Causes of Chronic pelvic pain?
Infection --> adhesions Endometriosis Mass Leiomyoma (Fibroid tumor) Psychogenic (wants attention, depression, abuse, sexual dysfunction)
Chronic pelvic pain & midline mass is ________?
Fibroid tumor of uterus
Chronic pelvic pain & unilat mass is ___________?
Ovarian mass
Diagnostic test for psychogenic?
Endoscopy diagnosis of exclusion
Treatment for psychogenic pelvic pain?
Counseling, treat depression/sexual dysfunction
Diagnostic test for chronic infection/adhesions?
Laparoscopy
Treatment for chronic infection/adhesion?
Surgery
Diagnostic test for Ovarian Tumor?
Ultrasound
Tumor markers
Treatment for ovarian tumor?
surgery
Diagnostic test for ovarian cyst?
Ultrasound
Treatment for ovarian cyst?
Surgery
Diagnostic test for Leiomyoma?
Ultrasound
Treatment for Leiomyoma?
GnRH agonist
Surgery (myomectomy/hysterectomy)
Diagnostic test for endometriosis?
Endoscopy
Biopsy
Treatment of endometriosis?
Oral concraceptive (hormonal suppression)
GnRH agonist
Surgery
If have chornic pelvic pain but can’t figure out the cause, the best test is ________?
[On test]
Laproscopy
