Pelvic Pain

Question 0

What are the differentials for acute pain.

Answer 0

In pregnancy- rupture of ectopic pregnancy, miscarriage, degeneration of fibroid.
Infections- endometritis, PID, tubo-ovarian abscess.

Question 1

What can different types of pain indicate

Answer 1

Rapid onset: perforation of hollow organ, ischemia
Colic/cramping pain- muscular contraction/obstruction of hollow viscus eg uterus, intestine.
Generalised pain: pain over entire abdomen due to reaction to irritating fluid in peritoneal cavity.

Question 2

List the four adnexal disorders

Answer 2

Hemorrhagic functional ovarian cyst
Torsion
Twisted para ovarian cyst
Rupture of neoplastic cyst.

Question 3

How is ectopic pregnancy managed

Answer 3

With methotrexate

Surgically - laparotomy

Question 4

What are the features of endometriosis?

Answer 4

Dysmenorrhea, dyspareunia, dyschezia, infertility
On PV: fixated retro vertex uterus, painful nodules, painful mass
Dx: surgical biopsy.
Mx: laparoscopy

Question 5

What are the causes of chronic pelvic pain

Answer 5

Endometriosis, adenomyosis, adhesions, pelvic congestion (bulky uterus, enlarged ovaries), salpingo- oopheritis, fibroids, IBS

Question 6

What are the symptoms of pelvic congestion

Answer 6

LAP and lower back pain (starting with ovulation), secondary dysmenorrhea, dyspareunia, chronic fatigue, IBS.

Question 7

What is ovarian remnant syndrome

Answer 7

Residual ovarian cortical tissue left in pelvis after difficult surgery (removal of endometriosis). Symptoms seen after 2.5 years after surgery.