pelvic pain Flashcards
dermatomal distribution of pelvic pain
T10-L1
3 serious and life threatening conditions (reproductive)
1- torsion
2- TOA
3- Ectopic pregnancy
Common reproductive conditions leadin to pain
1- endometriosis 2- PID 3- miscarriage 4- salpinigitis 5- cycsts
chronic pelvic pain durtation
> 6 months
More common causes of chronic pevlic pain
Endometriosis
adenomyosis
fibroids
adhesions
Patterns - bilateral pain Episodic pain Cyclical pain Flank/colicky pain left sided pain dyspareunia
PID torsion endometriosis, adenomyosis ureteric stone ovarian cyst/diverticulitis PID, ENdometriosis, fibroids
irregular bleeding menorrhagia Hypotension perionteal signs palpable mass fixed uterus trigger points
endometriosis, PID, tumors adenomyosis, fibrosis ruptured ectopic, cyst, TOA appendix, PID, diverticulitis fibroid, cyst, TOA adhesions or endometriosis fibromyalgia
Classic triad of endometriosis
Dysmenorrhea
Deep dyspareunia
Infertility
Other symptoms of endometriosis
1- irregular menstruation 2- dyschezia - pain with defecation 3- dysuria - pain with urination 4- hematochezia 5- hematuria
Physical findings of endometriosis
1- FOCAL tenderness
2- uterosacral nodularity
3- fixed retroversion of uterus
4- adnexal mass with tenderness -
Endometriomas (endometriosis within the ovary)
Chocolate cysts -
Does the number of lesions in endometriosis correlate with pain?
NO, the depth of infiltration does
Definitive diagnosis for endometriosis is
SURGICAL- confirm histologically
1st line treatment for endometriosis
1- NSAIDs
2- OCPs
3- Progestin - Depo
2nd line treatment for endometriosis
1 - Dienogest - new progestin analog
2 - anti-estrogen agents - Danazol
3- GnRH agonists - long term anti estrogenic effects
