Pelvic Pain

Question 1

acute pelvic pain is defined as discomfort for what duration?

Answer 1

less than 7 days

Question 2

First line imaging study of choice for pelvic pain? What can be seen on this imaging?

Answer 2

ultrasound. can show fibroids, infected/dilated tubues, adnexal masses, blood in abdomen

Question 3

When is a CT abd/pelvis indicated for pelvic pain?

Answer 3

if suspect GI etiology (diverticulitis, appendicits)

Question 4

Indications for ordering an MRI for pelvic pain?

Answer 4

• if sonography inconclusive or equivocal
• distorted pelvic anatomy
• Mullerian anomaly eval
• Large poorly delineated masses
• Endometrial disordres in poor surgical candidates

Question 5

When is a laparoscopy indicated for pelvic pain?

Answer 5

• definitive dx of endometriosis unresponsive to hormonal therapy
• PID with unclear dx (appendicits vs PID)
• ovarian torsion
• ruptured ectopic pregnancy
• persistant adnexal masses

Question 6

vulvar etiologies of acute pelvic pain

Answer 6

• infection (HSV, candida, syphillis)
• trauma (straddle injury, hematoma)
• bartholin’s gland cyst/abscess

Question 7

vaginal etiologies of acute pelvic pain

Answer 7

• trauma (penetrating is MC, pelvic frx, hydraulic skiing injury)
• infection (candida)

Question 8

What is Pelvic Inflammatory Disease?
How is it diagnosed?

Answer 8

• infection of upper female reproductive tract; ascending infection from cervix/vagina
• diagnosed based on PE (cervical motion/uterine/adnexal tenderness)

Question 9

which findings enhance specificity of PID dx?

Answer 9

One or more of:
- temp >101.6
- mucopurulent discharge
- abundant WBCs on saline microscopy
- elevated ESR/CRP
- N. gonorrhea or C. trachomatis

Question 10

PID management?

Answer 10

Outpatient abx, antiemetics, pain control. If no improvement, then inpatient for abx.

Question 11

Define ectopic pregnancy and list possible locations

Answer 11

-extrauterine pregnancy, implantation outside of the normal endometrium
- cervical, cornual, fallopian tube, ovary

Question 12

management for ectopic pregnancy

Answer 12

medical vs surgical mgt depends on stability of pt, size, location, pt preference, and rupture status.
if ruptured, immediate surgery.

Question 13

what is adnexal torsion? Which side is more common?

Answer 13

• twisting of the adnexa on a vascular pedicle resulting in cessation of blood flow to the adnexa and cessation of venous drainage
• more common on right side (due to limited mobility of the left ovary by the sigmoid colon)

Question 14

diagnosis of adnexal torsion?

Answer 14

• sharp lower pelvic pain
• adnexal pain/tenderness on exam
• adnexal mass on US

Question 15

trx for adnexal torsion?

Answer 15

SURGICAL EMERGENCY. laparoscopy preferred over laparotomy

Question 16

General non-gynecological differential diagnoses for chronic pelvic pain?

Answer 16

(acronym GUMP)
Gastrointestinal
Urologic
Musculoskeletal
Psych

Question 17

what is adenomyosis and associated sx? what is seen on exam?

Answer 17

• extension of the endometrial glands and stroma INTO the UTERINE MUSCULATURE
• Sx: heavy and painful periods
• PE: uterus symmetrically enlarged, tender, boggy

Question 18

Diagnostic for definitive diagnosis of adenomyosis?

Answer 18

Definitive dx (and trx) - Surgically with hysterectomy.

(Plus, TVUS can show heterogenous appearance of the myometrium. Can also order MRI).

Question 19

What are uterine leiomyomas?

Answer 19

benign smooth muscle neoplasms of uterine musculature.

Question 20

Uterine leiomyomas are the most common _______ _________.

Answer 20

uterine neoplasm. (though are benign)

Question 21

Sx of uterine leiomyoma?

Answer 21

type and degree of sx depend on size and location.
- most are asymptomatic**
- pelvic pain/bulk sx (pressure)
- urinary sx
- back pain
- heavy or prolonged menstrual bleeding

Question 22

trx for uterine leiomyoma?

Answer 22

• ## hormones (OCP or progesterone)