Pelvic pain

Question 1

Acute pelvic pain:

• Definition + timeframe
• Causes
• Assessment - hx, ex, ix
• Management
• Red flags

Answer 1

Acute pelvic pain:

• Definition + timeframe: <3 months
• Causes : ectopic, miscarriage, ovarian torsion, ruptured ovarian cyst, pid, degenerating fibroid, endometriosis, adhesions, appendicitis, uti
• Assessment - hx, ex, ix
  ex: vitals, abdo, pelvic
  ix: preg, urine dip, fbc/crp/g&s, transvag uss
• Management
• Red flags: shock, peritonism, severe pain, post menop bleed

Question 2

Chronic pelvic pain:

• Definition + symptoms
• Causes
• Assessment: hx, ex, ix
• Management

Answer 2

Chronic pelvic pain:

• Definition + symptoms: >3 months
• Causes : endometriosis, fibroids, ovarian cyst, malig, adhesions, dysmenn, haemorrhoids, contip, ibs/ibd, msk pain, nerve entrapment, prolapse
• Assessment: hx, ex, ix: pain diary
• Management :
  treat cause, lubricants, avoid constip, empty bladder. Give gnrh agonists and if resolves issue means ovary problem so then oophorectomy.

Question 3

PID:

• Definition
• Causes (4)
• Risk factors (5)
• Symptoms + signs
• DD (4)
• Investigations
• Management
• Complications

Answer 3

PID:

• Definition : ascending infection from endocervix
• Causes (4): chla, gonn, bv, appendicitis
• Risk factors (5): young, multiple partners, no protection, previous, coil
• Symptoms + signs: pelvic pain, discharge, dysuria, irregular bleeding, deep dyspareunia, cervical excitation
• DD (4)
• Investigations: naat swabs (chla, gonn), charcoal (bv, tv, candida), urine dip, preg test, transvag uss
• Management : im ceft, 2 weeks deoxy + metron, screen partners within 6 months
• Complications: fitz hugh curtis (perihepatitis), infertility, chronic pain, ectopic preg

Question 4

Ovarian cysts:

• Definition
• Symptoms
• Investigations
• Management
• Types: benign neoplastic and non neoplastic
• When is ca125 raised
• What is risk of malignancy index RMI

Answer 4

Ovarian cysts:

• Definition
• Symptoms: assymp, chronic pain, abdo bloat + satiety, urin + bowel symp, palp mass
• Investigations :
• Management
  premenop: if small cyst <5cm then just repeat uss in 8-12 weeks then refer if persists
  Post: refer to gynae
• Types: benign neoplastic and non neoplastic
  physiological (functional): follicular most common + regresses after cycles, corpus luteum in luteal phase
  benign gc tumours: dermoid cyst (teratoma): esp if <30
  benign epithelial tumours : serous (mimics adenoc), mucinous (multinuc + large) = BIOPSY
  sex cord: fibrome (meigs syndrome - ovarian mass, ascites, pleural effusion)
• When is ca125 raised
• What is risk of malignancy index RMI: if <25 uss 1 yr + ca125. If 25-250 bilat oophorectomy. if high laprotomy

Question 5

Ruptured ovarian cyst:

• Causes (2)
• Symptoms + signs
• Assessment - ex, ix
• Management

Answer 5

Ruptured ovarian cyst:

• Causes (2): spont, trauma
• Symptoms + signs : n+v, acute unilat pain, fever, guarding, tachyc
• Assessment - ex, ix : pelvic uss shows free fluid
• Management : conservative, if unstable lapro oophorectomy

Question 6

Ovarian torsion:

• Definition + complication
• Cause
• Risk factors
• Symptoms and signs
• Investigations
• Management

Answer 6

Ovarian torsion:

• Definition + complication
• Cause
• Risk factors : ovarian mass, ovarian hyperstim syndrome, preg, reproductive age
• Symptoms and signs: sudden colicky rif/lif pain, n+v, fever if necrosis, cervical tenderness, adnexal tenderness, guarding
• Investigations: preg test, pelvic uss w doppler (free fluid + oedema, whirlpool), lapro diagnostic
• Management : lapro surgery, if necrotic oophorectomy