Pelvic Pain Flashcards
What are the causes of acute pelvic pain (non-pregnant)
Gynae:
Uterus: fibroid, endometriosis, adenomyosis, congenital anomaly, dysmenorrhoea, PID, STI
Ovary: tubo-ovarian abscess, ovarian torsion, ovarian cyst, endometriosis, ovulation pain
Fallopian tube: tubo-ovarian abscess, PID, torsion, hydrosalpinx
Non-gynae:
Genitourinary: infection, stone
Gastrointestinal: appendicitis, gastroenteritis, diverticulitis, IBD
Musculoskeletal
What are the causes of acute pelvic pain in pregnant women
Intra-uterine: placental abruption, spontaneous abortion, labour, molar pregnancy
Extra-uterine: ectopic pregnancy
What are the causes of chronic pelvic pain
Gynaecological: endometriosis, chronic PID, dysmenorrhoea, adenomyosis, ovarian cyst, adhesions
Non-gynae:
- GI: IBS, IBD, constipation, neoplasm
- Genitourinary: interstitial cystitis, urinary retention, neoplasm
- Musculoskeletal: pelvic floor myalgia, myofascial pain, injury
Other: somatisation, abuse, depression
Which cysts are most and least likely to undergo torsion
Most likely: dermoid cysts
Least likely: endometriomas
What are the risk factors for ovarian torsion
Ovarian cysts or tumours (especially >5cm)
Long ovarian ligaments
Pregnancy
Tubal ligation
What are the signs and symptoms of ovarian torsion
Intermittent severe colicky pain (May be more predisposed to having cysts mid cycle so may get pain mid cycle)
Severe right or left iliac fossa pain*
Vomiting
May feel a palpable mass
Consider bimanual → adnexal mass felt
*Unlikely to have shoulder-tip pain (differentiate from ectopic)
What investigations should be done for ovarian torsion
Bedside: PREGNANCY TEST, urinalysis (ureteric colic) ± speculum and swabs
Bloods: FBC, CRP (exclude PID), blood gas (lactate high due to necrosis)
Imaging: if UNSTABLE → urgent laparoscopy
- US with dopplers (TA in children, TVUSS in adults)
- → whirlpool sign
- Doppler may give a false negative due to the dual blood supply fo the ovary (ovarian and uterine artery)
What is the management for ovarian torsion
1st line: laparoscopic detorsion ± cystectomy (if required)
2nd line: salpingo-oophorectomy
If surgery is not prompt enough, removal of a necrotic ovary may be necessary
What is ovarian hyperstimulation syndrome
A complication of infertility treatment in which there are multiple luteinised cysts in the ovaries → high oestrogen and progesterone + high vasoactive substances → increased vascular permeability → fluid loss
→ Intravascularly deplete and third space fluid
What are the risk factors for ovarian hyperstimulation syndrome
Gonadotrophin or HCG treatment
Young age
PCOS
Low BMI
What are the signs and symptoms of ovarian hyperstimulation syndrome
Pain
Nausea and vomiting
Bloating
Loss of appetite
SOB (Pleural effusion)
Abdominal distention (ascites)
Reduced urinary frequency/volume
Referred pain to the shoulder tip
What investigations should be done for ovarian hyperstimulation syndrome
Bedside: Urine pregnancy, ECG, urine dipstick
Bloods: Hormone profile, U&Es, LFTs (albumin, good prognostic marker), Coagulation, FBC (Look for haemoconcentration, raised WCC)
Imaging: US, CXR
What is the management for ovarian hyperstimulation syndrome
Expectant - keep patient stable and not intravascularly deplete
Consider clexane for increased VTE risk
