Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics & Gynecology > Pelvic Pain > Flashcards

Pelvic Pain Flashcards

1
Q

Describe acute pelvic pain

A 
Well- defined onset 
Short duration 
Rest is helpful
Variable intensity 
Anxiety is common
Symptom is usually associated with a disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe chronic pelvic pain

A 
Ill-defined onset 
Unpredictable duration 
Rest not helpful
Persistent 
Depression is common 
May not be able to identify underlying disease process
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the benign causes of pelvic pain

A 
Uterine
- fibroid degeneration/torsion 
- dysmenorrhoea and adenomyosis
- extrusion of foreign body e.g. IUD, endometrial cast and prolapsed polyp
Ovarian
- cyst rupture
- cyst haemorrhage 
- adnexal torsion
Tubal
- abscess/PID
- hydrosalpinx 
Vulvovaginal
- infection e.g. herpes or thrush
- bartholin's cyst/abscess
- vulvodynia/vaginismus
- skin disease e.g. lichen sclerosis and lichen planus
Other
- endometriosis 
- psychological 
- PID
- pelvic adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epidemiology of ovarian cysts

A

In pre-menopausal women - normal part of ovulation

4% of women by 65 admitted due to ovarian cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What cyst events can cause acute pelvic pain

A

Cyst rupture
Cyst haemorrhage
Adnexal torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the risk of malignancy in ovarian cysts

A

Increases with age (0.4-0.4 up to 60/100,000 between premenopausal and women aged 60-80)
Around 90% of all cysts are benign
Risk of Malignancy index (seen in benign condition notes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe cyst rupture/haemorrhage

A

Can commonly occur in functional cysts
- between days 20 and 28 of the menstruation cycle
Bleeding can be severe and cause hypovolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe ovarian torsion

A

Often ovary and tube together - more common on the right
Risk factors
- type of cyst
- size of cyst
- weight
May result in loss of ovary if blood supply is compromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What could you expect on history and examination in an ovarian rupture/haemorrhage

A

Sudden lower abdominal pain
+/- nausea/vomiting
Pain maximum at onset
Normally well on examination - unless large bleed causing shock (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What could you expect on history and examination in an ovarian torsion

A

Pain is acute/intermittent, builds over time, and increases in severity as ovary becomes ischaemia
Anorexia
Nausea and vomiting
Pyrexia
Tachycardia
Peritonism
Cervical excitation on vaginal examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations are required in ?ovarian torsion/rupture/haemorrhage

A 
Urine
- pregnancy test
- dipstick and MSU for urinary tract infection 
Bloods
- WCC and CRP increase during torsion 
Vaginal/cervical swabs 
- ?PID
USS pelvic 
- ?hemoperitoneum
- torsed ovary (increased in size and oedema) 
- other cause e.g. appendix mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of ovarian torsion/rupture/haemorrhage

A 
Expectant 
- analgesia and observe 
- repeat scan 6 weeks to confirm resolution 
Laparoscopy IF
- haemodynamic compromise 
- uncertain compromise 
- torsion suspected 
- no symptom relief if 48 hours or more since presentation 
- blood supply to ovary/tube compromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is pelvic inflammatory disease

A

Caused by ascending infection from cervix/vagina into upper genital tract
- most commonly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What nomenclatures are associated with pelvic inflammatory disease

A

Endometriosis
Salpingitis
Tubo-ovarian abscess
Pelvic peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of pelvic inflammatory disease

A

Infertility 20%
Ectopic pregnancy 10%
Chronic pelvic pain 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the most common causative organisms involved in pelvic inflammatory disease

A 
Chlamydia trachomatis 
Neisseria gonorrhoea
Mycoplasma hominis
Anaerobic 
Bacterial vaginosis 
The causative organism is not always found
17
Q

Clinical features of pelvic inflammatory disease

A 
Asymptomatic (around 2/3rds of women)
PCB or IMB
Vaginal purulent discharge 
Anorexia 
Deep dyspareunia 
General malaise 
Fever >38 
Lowe abdominal pain - acute abdomen (abscess)
18
Q

Investigations for ?pelvic inflammatory disease

A 
Examination
- increases heart rate, increased temperature and decreased blood pressure
- abdo distension and tenderness
- rebound and guarding 
- RUQ tenderness 
Speculum - mucopurulent cervicitis 
Bimanual exam 
- cervical excitation
- adnexal tenderness and fullness 
Pregnancy test
Bloods - FBC, CRP
- raised in severe disease
Swabs
TVUSS - tubo-ovarian abscess
19
Q

Management of pelvic inflammatory disease

A

Early antibiotics treatment improves the outcome
- follow local protocols
Partner testing with treatment +/- contact tracing
- abstain until until treatment is complete
Surgery if no improvement

20
Q

What is endometriosis and adenomyosis

A

Presence of endometrial tissue outside of the uterus

Adenomyosis if endometrial tissue specifically within the myometrium

21
Q

Aetiology of endometriosis

A 
Theories - exact cause is uncertain 
Seeding of endometrial cells form
- retrograde menstruation 
- during surgery  e.g. endometriosis in C-section scars
Peritoneal metaplasia
22
Q

Where is endometriosis commonly found?

A

Bowel - sigmoid colon, caecum and appendix
Peritoneum - pouch of douglas, perineal body, pelvic peritoneum and bladder/uterovesical peritoneum
Ligaments - round ligament and uterosacral ligament
Genital tract - ovary, myometrium, vulva, bartholin’s gland, cervix, vagina and uterine tubes

23
Q

What are the clinical features of endometriosis

A 
Severe dysmenorrhoea
Heavy menstrual bleeding
Chronic fatigue 
Infertility 
Asymptomatic 
Dyspareunia 
Ovulation pain 
Cyclical symptoms of bladder/bowel
Pain on defecation
24
Q

What investigations are required in ?endometriosis

A 
Examination
- fixed, immobile retroverted uterus 
- thickened uterosacral ligaments +/- nodules
- adnexal masses (endometrioma)
- enlarged and boggy uterus (adenomyosis)
TV USS
- identified endometrioma 
MRI
- identifies tissue infiltration 
Laparoscopy 
- gold standard 
- also allows treatment and assessment of tubal patency
25
Q

How is endometriosis managed?

A

Same as heavy menstrual bleeding (suppression of endometrial activity)

  • medical = mirena, COCP, POP, GnRH analogues, depo-provera
  • surgical = diathermy, remove endometrioma, assess tubal patency, hysterectomy and/or oophorectomy
26
Q

What is chronic pelvic pain syndrome

A

Chronic/constant lower abdominal pain for 6 months or more
- unrelated to menstrual cycle
No discernible cause
Allow time to get better

27
Q

How is chronic pelvic pain syndrome managed

A 
Investigation and treatment of any non-gynaecological causes when appropriate 
- e.g. IBS, interstitial cystitis and neuropathies 
MDT team 
- chronic pain services 
- psychology 
- physiotherapy 
- psychosexual therapy 
- self-help groups

Obstetrics & Gynecology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions