Pelvic Pain Flashcards
dysmenorrhea
painful menses
dyspareunia
pain with intercourse
dyschezia
pain with bowel movements
vulvodynia
pain of the vulva
allodynia
pain with non-noxious stimuli
hyperalgesia
increased response to noxious stimuli
how long is acute pain?
chronic pain?
< 3 months
> 6 months
what 3 labs should be done with patients presenting with pelvic pain?
pregnancy test
UA/urine culture
STI screening
what is the first line imaging study for pelvic pain?
what imaging can be used if a non-gyn etiology is suspected?
abdominal US
CT abdomen/pelvis
what can be used as a diagnostic in acute pain that would suggest PID, ovarian torsion, ruptured ectopic pregnancy, or persistent adnexal masses?
laparoscopy
what is the most common type of trauma that causes acute pain?
penetrating injury
infection of the upper female reproductive tract that includes the uterus
pelvic inflammatory disease
a patient presents with cervical motion tenderness, uterine tenderness, adnexal tenderness, and macropurulent discharge. Dx? treatment? (3)
PID
antibiotics
antiemetics
pain control
the presence of what in a culture would indicate PID? (2)
gonorrhea
trachomatis
what imaging would diagnose PID?
pelvic ultrasound
twisting of the adnexa on a vascular pedicle resulting in cessation of blood flow to the adnexa and cessation of venous drainage
adnexal torsion
what side does an adnexal torsion typically occur? why?
right side
limited mobility of left ovary by the sigmoid colon
patient presents with sharp lower pelvic pain, adnexal pain/tenderness, and adnexal mass on US. Dx? treatment?
adnexal torsion
emergency surgical laparoscopy
extension of the endometrial glands and stroma into the uterine musculature
adenomyosis
a patient presents with heavy and painful periods. On exam, the uterus is symmetrically enlarged, tender, and boggy. transvaginal US shows a heterogenous appearance of the myometrium. Dx?
adenomyosis
how is adenomyosis definitively diagnosed?
with hysterectomy
what is the most common uterine neoplasm?
uterine leiomyoma (benign)
a patient presents with pelvic pain/pressure, feels pressure on the bladder, back pain, and heavy/prolonged menstrual bleeding. Dx?
uterine leiomyoma (benign)
what are 5 treatment options for uterine leiomyomas?
hormones
GNRH agonists
myomectomy
uterine fibroid embolization
radiofrequency fibroid ablation
what is the most definitive treatment option for a uterine leiomyoma?
hysterectomy
what diameter is a functional ovarian cyst?
3 cm or more
what is the treatment for functional ovarian cyst?
observation
+/- surgery if symptomatic / persistent
what can prevent further cyst formation?
oral contraceptives
most common ovarian neoplasm that is a germ cell tumor, containing sweat and sebaceous glands, hair follicles, and teeth
mature cystic teratoma (dermoid cyst)
what is the treatment for a mature cystic teratoma (dermoid cyst)?
surgery (cystectomy vs oophectomy)
presence of endometrial glands and stroma outside of the endometrial cavity or uterine musculature
endometriosis
patient presents with dysmenorrhea, dyspareuna, dyschezia, and pelvic pain. Dx? treatment?
endometriosis
hormonal management
+/- excision/ablation
what is the only way to definitively diagnose endometriosis?
laparoscopy
what does a black, blue, red, or clear appearance indicate?
superficial powder burn lesions
what does a chocolate cyst appearance indicate?
endometriomas
what is the definitive treatment for endometriosis?
hysterectomy
42 yr old G2P2002 with 2 years of heavy painful periods and pelvic pressure. She
has tried birth control pills with mild improvement of bleeding but still has
pressure symptoms. On exam her uterus is at the level of the umbilicus
with irregular shape. What is the most likely diagnosis?
leiomyoma
A 23 y/o G1P1 presents to the clinic with a new crampy pain in her right
lower quadrant over the last 3 days. Her last menstrual period was 3 weeks
ago and was normal. She uses condoms for contraception and her urine
pregnancy test is negative. On pelvic examination a 3-4 cm tender cystic
mass is palpated in the right adnexa. The remainder of her examination
is negative. What is the appropriate next step in her evaluation?
transvaginal ultrasound
A 25 y/o G0 complains of a painful full sensation in her right lower
quadrant. She has had regular periods since menarche. She has no
history of STDs. On physical examination you find a mobile mass in
her right adnexa about 8 cm x 8 cm. This mass is mobile. Her urine
pregnancy test is negative. You order a transvaginal ultrasound. What is the diagnosis?
teratoma (dermaoid cyst)
Patient is a 45 yr old G2P2002 with a history of progressively worsening
painful and heavy periods. She has tried birth control pills
without improvement. She is examined and has a boggy tender
uterus. You repeat the exam two weeks later and find the uterus to be
smaller and not as tender. What is the likely diagnosis?
adenomyosis
