Pelvic pain Flashcards
history
• Keep in mind: Onset, Inciting events, Duration, Character, Radiation,
Provocation/Palliation, Correlation with changes in
habits/meds/exposures.
• Prior diagnosis, Prior procedures, Prior family medical diagnosis
• Correlating symptoms of bowel, bladder, or menstrual changes
• For premenopausal women, a menstrual history & menstrual profile
whats included in the menstrual profile?
• Consider menarche, Cycle length, Variability, Menstrual flow,
Dysmenorrhea, Cramping, Pain patterns, Radiation,
Concomitant changes in bowel or bladder
physical exam
• Look at the patient, get an overall assessment.
• Head to toe, skin, back, spine, abdomen, pelvic exam- look and feel,
urine and bowel evaluation as appropriate.
• Abdomen- overall, then by quadrant, think of ‘what lies beneath’ ..
• Pelvic exam- try to follow a consistent pattern- begin externally,
look carefully at the tissues, evaluate for infectious processes, feel
the cervix, the cul de sac, the uterus, the ovaries.
what are examples of cyclic pain?
Mittelschmerz , Endometriosis, Dysmenorrhea
what are examples of noncyclic pain?
• Interstitial cystitis, Diverticulosis, or a Hernia
• Endometriosis:
Ectopic endometrial glands and stroma.
Adenomyosis:
Glands and stroma, invading into the walls of the uterus.
Post Ablation Syndrome:
Collection of menstrual fluid behind scar in the
uterine cavity
Leiomyoma:
A cloning phenomena, where proliferation of cells can enlarge
the uterus, the adnexa, or the supporting ligaments of the uterus. These
may be intramural, pedunculated, subserosal, ligamentous, cervical, or
intracavitary.
Catamenial-
Menstrual related, linked to endometriosis.
Theories regarding endometriosis:
- Coelomic metaplasia- Metaplasia of cells has been
- demonstrated from ovarian and peritoneal surfaces.
- (Matsuura, et al 1999) Pluripotential cells are present on
- peritoneal or pleural surfaces.
- Retrograde menstruation-Retrograde flow of endometrial cells
- through the tubes, onto pelvic surfaces.
Ovarian cysts-
a dynamic and elastic occurrence in the
functioning ovary. Cysts may be physiologic, endometriotic,
teratoma, benign, borderline, or cancerous (serous, mucinous,
germ cell). Painful with rupture, bleeding, leaking of fluid, or
ovulation. (Mittelschmerz)
ovarian torsion
Rotation of the ovary on its suspensory
ligaments. Usually precipitated by a cyst or mass, frequently
greater than 5 cm.
Ovarian Remnant-
this occurs when ovarian tissue regenerates or
grows in response to gonadotropins. May be seen as a cyst or mass,
increased estradiol levels in bilateral ovarian removal. More frequent
on the left side.
what are the most common reason for cyclic pain
complaints.
ovarian cysts
what decreases risk of ovarian cysts, ovarian and uterine cancer?
OCP
Fallopian tube issues
• Torsion or ischemia of the tube is rare. Tubal cysts or paratubal
cysts do occur, and may be hard to distinguish on imaging.
what are most tubal issues due to?
obstruction of flow or infection –
hematosalpinx (blood), pyosalpinx (pus), hydrosalpinx (fluid).
These cause pain by distension. Like any irritated hollow
viscous, stimulation of the lumen an cause
contraction/cramping.
Pelvic Inflammatory Disease (PID)
Salpingitis due to infection.
This can lead to peritonitis, abscess, or sepsis. Pain, fever,
elevated WBC, ESR, peritoneal symptoms. STI or ascending
infections can occur.
ectopic pregnancy
Pain is usually caused by distension or rupture.
what level of hCG should transvaginal sonography show sign of IUP?
hCG of >1200 mIU/mL,
what level of hCG should transabdominal sonography show sign of IUP?
2000 mIU/mL
Endometritis
is an infection of the uterine cavity. Multiple agents can cause
this. Ascending infection with Strep, Mycoplasma, Ureaplasma,
Haemophilus, anaerobes, or STI can be cause.
Cervicitis
related to STI
