Chronic Pelvic Pain

Question 1

What is the next step in diagnosing a pt with suspected endometriosis if pelvic ultrasound is normal?

Answer 1

diagnostic laparoscopy

Question 2

What is interstitial cystitis?

Answer 2

chronic inflammatory condition of the bladder characterized by recurrent irritative voiding symptoms of urgency and frequency; can also experience dyspareunia; have an autoimmune and even hereditary component and may be more common in women who also have endometriosis

Question 3

What is irritable bowel syndrome?

Answer 3

common functional bowel disorder characterized by chronic, relapsing pattern of abdominal and pelvic pain and bowel dysfunction with constipation or diarrhea; one of most common disorders associated with chronic pelvic pain

Question 4

What are the Rome II Criteria for IBS?

Answer 4

includes at least 12 weeks(need not be consecutive) in preceding 12 months of abdominal discomfort or pain that has two of three features: 1)relief with defecation 2)onset associated with change in frequency of stool 3)onset associated with change of stool form or appearance

Question 5

Studies have found that 40-50% of women with chronic pelvic pain have history of __.

Answer 5

abuse

Question 6

What is ovarian remnant syndrome?

Answer 6

occurs following surgical removal of ovaries, with subsequent development of cyclical pain due to ovarian tissue that was left behind inadvertently

Question 7

Chronic pelvic pain after prior hysterectomy and subsequent infection that is now resolved could be caused by?

Answer 7

pelvic adhesive disease

Question 8

What is pelvic congestion syndrome?

Answer 8

pelvic varicosities that can cause chronic pelvic pain; pelvic veins are vulnerable to chronic dilation with stasis leading to vascular congestion; worse premenstrually and during pregnancy and aggravated by standing, fatigue and coitus; often described as pelvic fullness or heaviness; associated symptoms include vaginal discharge, backache, and urinary frequency with menstrual cycle defects and dysmenorrhea being common

Question 9

What nerves are at risk during pelvic surgery with low transverse incision?

Answer 9

iliohypogastric(T12-L1) and ilioinguinal(T12, L1); these nerves pass laterally through psoas muscle before piercing transversus abdominus to anterior abdominal wall and courses medially between internal and external oblique and provides cutaneous sensation to groin and skin overlying pubis;;; ilioinguinal provides sensation to groin, symphysis, labium and upper inner thigh

Question 10

When are iliohypogastric and ilioinguinal nerves more susceptible to injury?

Answer 10

low transverse incision is extended beyond lateral border of rectus abdominus muscle into internal oblique

Question 11

What nerve can be damaged during lymph node dissection and what would this result in?

Answer 11

obturator nerve; inability to adduct thigh

Question 12

What is the best predictor of successful elimination of pain by hysterectomy?

Answer 12

tenderness confined to uterus

Question 13

What is Carnet’s sign?

Answer 13

tenderness on flexion of abdominal muscles; suggestive of abdominal wall pain as opposed to visceral pain

Question 14

Pain that is constant, refractory to hormonal manipulation and reproducible with palpation of somatic structures is suggestive of?

Answer 14

neuromuscular pain or fibromyalgia

Question 15

How do you manage neuromuscular pain or fibromyalgia?

Answer 15

physical therapy and exercise; GABAergic medication such as gabapentin or pregabalin may be helpful adjuncts