Pelvic pain Flashcards
Acute Defined as pain that starts ___ and persists less than __
Chronic defined as pain longer than
Acute etiologies E, O, A, C, P, O, D, R
Chronic etiologies E, M, A
suddenly, 6m
6m
ectopic preg, ovarian torsion, appendicits, constipation, PID, ovarian cyst, diverticular dz, renal stones
endometriosis, msk pain, adenomyosis
Adnexal torsion is twisting of ___ and sometimes ___
cuts of ___ to the organs
presentation
often ___
quick confident dx required to
Causes
O
P__ due to presence of
Abnormal __ such as __ and ___ (more common in __)
ovary, FT, blood supply
sudden, severe pain, V
nonspecific
save adnexal tissues from infarct
ovarian cyst
preg, corpus luteum cyst
adnexal structures, long FT/mesosalpinx, children
Ovarian torsion occurs ___ and in typically __ ovary
irregularity of ___ creates fulcrum around which ___ revolves
can involve ___ but moe commonly affects ___ and ___ (adnexal torsion)
often ___ sided
TX is to
unilaterally, enlarged
ovary, oviduct
ovary alone, ovary/FT
right
untorse the ovary/adnexa
PID is inflam disorder of ___ including E, S, P, T
__ ascending from genitals
pathogens usually
__ and __ prevent PID
New onset
usually ___ tenderness
___ inflammation know as
violin string between __ and ___
upper genital tract
endometritis, salpingitis, pelvic peritonitis, tubo-ovarian abscess
polymicrobial
chlamydia, gonorrhea
barrier contraception, BTL
lower ab pain
bilateral lower ab
peri-hepatic, Fitz-High-Curtis
diaphragm/liver capsule
PID dx w __ or __ pain
___ or ___ or ___
Additional criteria
Oral temp >
Mucopurulent ___
Lab findings of __ or ___
Most specific criteria
Endometrial biopsy w evidence of ___
TVUS or MRI showing __
Dx w ____ showing abnormalities consistent w PID
Mx- start __ in sexually active women w PID suspected
If IUD present, device can either be
mild PID- manage as __
ab such as
pelvic/lower ab pain
cervical motion/uterine/adnexal tenderness
101
cervical discharge
gonorrhea/chlamydia
endometritis
fluid filled tubes
laparoscopy
empiric therapy
removed/kept
outpt
Rocephin/Doxy and Flagyl
PID criteria for hospitalization S P Pt does not respond Unable to follow T F/S/N/V
Tx w
surgical emergency pregnant oral therapy outpt therapy TOA Fever, severe illess, NV
Cefotitan, Cefoxitin, Doxy
Tubo-ovarian abscess
Late comp of
consist of a pocket of __ that involves ___
Pt often presents w
Dx made w
Tx w
IV
transition to __ for 14 days
unteated PID
purulent material, tube and ovary
acute ab pain
US, CT, direct visualization
ab
Clindamycin/Ceftriaxone
Augmentin/Flagyl PO
TOA needs drainage if
N
greater than
Method of drainage- ___ w ___ guidance
sex partners need ___ and ___ if unprotected interocuse w/in ___ of PID
not responding to tx
10cm
drain placement, CT/US
eval, tx, 60d
Endometriosis- presence of ___ outside uterus
most common location
possible path- __ causes endometrial implants
Sx C and s D D D D
___ imaging/labs to confirm
__ may be elevated
visualization of ___ via ___ is gold standard dx
endometrial tissue
pelvic peritoneum
retrograde menstruation
chronic pelvic pain, subfertility dysmenorrhea dyschezia dysuria dyspareunia
no
Ca125
endometrial lesions, dx laparoscopy
Endometriosis tx is for
__ first line
start on __ or __ to menses start
___ using either __ or __ regimens
\_\_\_ therapy provides similar relief to GnRH agonists M D P M
GnRH agonst put pt in \_\_ state SE Dec \_\_ w greater than \_\_ use Liit tx to \_\_\_\_ Can do \_\_\_\_ w progestin/OCP to \_\_\_
No use for
pelvic pain
NSAIDs
first day/day prior
COCs, cyclic/continuous
Progestin only Mirena Depo POPs Megace
medical menopasual hot flashes, vaginal dryness bone density, 6m 6-12m add back regimen, minimize SE
Aromatase inhibitor
Surgery for endometriosis
__ and __ of implants, may improve
__ w ___ for women who are ___ is best option for pain relief
___ and ___ is controversial
excision/ablation, fertility
hysterectomy w BSO, done child bearing
Presacral neurectomy, lap uterosacral nerve ablation
Adenomyosis usually in women in
coexists w __ and __
significant risk factor
Sx D D D A
uterus is ___ and __, especially around __
MRI shows enlarged ___ and ___
US shows heterogenous abnormal ___
in 40s
endometriosis, fibroids
prior uterine surgery
dysmenorrhea
dyspareunia
dyschezia
AUB
soft/tender, menstruation
jxnal zone, myometrial cysts
myometrial echogenicity
Adenomyosis pathophys
growth of __ and __ inside myometrium
Dx made by __ after __
Tx
endometrial glands/stroma
patho, hysterectomy
hysterectomy
