Office, Abdominal pain, IC, Endometriosis Flashcards
What is the definition of chronic lower abdominal pain?
Vague nonspecific pain that is present for > 6 months
What is the most common diagnoses of chronic lower abdominal pain?
Endometriosis
Adhesions
Irritable bowel syndrome
Interstitial cystitis
How do you separate the differential diagnosis for chronic lower abdominal pain?
GYN related
(vagina, cervix, uterus, tubes, ovaries)
Non GYN related
(Urological, GI, musculoskeletal, psych)
What are GYN related causes for chronic lower abdominal pain?
Vagina= vaginitis
Cervix= cervicitis
Uterus= fibroids, adenomyosis
Tubes= salpingitis, hydrosalphinx, PID
Ovaries= cyst, tumors, torsion
Endometriosis, adhesions
What are non GYN related causes for chronic lower abdominal pain?
Urological= stones, cystitis, interstitial cystitis, pyelonephritis, detrusor instability
GI= Irritable bowel syndrome, appendicitis, diverticulosis, inflammatory bowel disease, mocked diverticulum, mesenteric adenines
Musculoskeletal= pelvic floor dysfunction, trigger points, fibromyalgia, myofascial syndrome, arthritis, spondylolisthesis
Psych= Dépression, somatization disorder, PTSD
CNS= neuropathic pain
What is the workup for GYN related chronic lower abdominal pain?
Physical exam
Cultures
hcg test
Ultrasound
Diagnostic laparoscopyy
What is the workup for non GYN related chronic lower abdominal pain?
GI= abdominal X-ray, stool for occult blood, barium enema , colonoscopy
Urinary tract= Urine culture, IVP, CMG
Musculoskeletal= X-ray pelvis and spine
What is the overall guiding principal for describing how to evaluate chronic lower abdominal pain?
- Extensive history
- Physical exam based on history
- Lab work up based on history and physical exam
What is another name for interstitial cystitis?
Painful bladder syndrome
What is interstitial cystitis?
Chronic pain condition of the bladder
What are the symptoms of interstitial cystitis?
Urgency
Frequency
Pain
How do you diagnosis interstitial cystitis?
Clinical diagnosis
Based on H&P and r/o other etiologies
Can do cystoscopy looking for petechiae or hunter ulcer
What is the treatment for interstitial cystitis?
Dietary modifications
Pentosan polysulfate
Intravesical instillations
TCA
Antihistamines
What is the definition of vulvodynia?
Vulvar pain not attributed to an identifiable cause or due to specific lesions
How do you diagnosis vulvodynia?
Diagnosis of exclusion
Rule out infection
Assess for pelvic floor dysfunction
