Pelvic pain Flashcards
How do you evaluate patient with pelvic pain?
H&P (symptom onset/severity, association w/ menses, sexually active, other medical comorbidities, pelvic surgeries, meds). Physical exam: abdominal exam, pelvic exam (uterine, adnexal tenderness, pelvic floor muscles to see if pain is reproducible
- Pelvic US, GC/CT
What is differential for pelvic pain?
Gyn causes (infection like PID, endometriosis, leiomyomas, adenomyosis, adnexal mass, ectopic pregnancy) and non-Gyn (musculoskeletal pain, pain from adhesive disease w/ prior surgery, gastritis, IBS, chronic constipation, diverticulosis), urinary (painful bladder syndrome), prior sexual assault
If GI sx: fecal calprotectin to eval for IBD. serologic testing for celiac.
What is the rome IV criteria for IBS? How do you treat IBS
Recurrent abdominal pain at least 1 day per week associated with 2 or more: related to defecation, associated w/ changes in stool frequency, associated w/ changes in stool form/appearance.
Low FODMAP diet (fermentable oligo ??). Lifestyle changes (find triggers), treat constipation (miralax) or diarrhea (immodium). Linzess is another medication, tricyclic antidepressants (slow intestinal transit time).
