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Maddy - PCM III EXAM II > Pelvic Pain > Flashcards

Pelvic Pain Flashcards

1
Q

things to keep in mind when evaluating pelvic pain

A
  • OLDCAARTS (duh)
  • provocation/palliation
  • correlation w/ habits/meds/exposures
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2
Q

what correlating sx should you ask about with a pt w/ pelvic pain

A

bowl sx, bladder sx, or menstrual changers

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3
Q

things to consider in premenopausal patients presenting with pelvic pain

A
  • menarche
  • cycle length and variability
  • menstrual flow
  • dysmenorrhea
  • cramping
  • pain patterns
  • radiation
  • simultaneous changes in bowel or bladder
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4
Q

define mittelschmerz

A

pain with oculation

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5
Q

mittelschmerz, endometriosis, and dysmenorrhea are all examples of what type of pelvic pain

A

cyclic

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6
Q

interstitial cystitis, diverticulosis, and hernias are all examples of what type of pelvic pain

A

non-cyclic

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7
Q

what is it called when there are glands and stroma invading into the walls of the uterus

A

adenomyosis

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8
Q

what is it called when there is ectopic endometrial glands and stroma

A

endometriosis

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9
Q

define post-ablation syndrome

A

a collection of menstrual fluid behind the scar in the uterine cavity after an ablation

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10
Q

define leiomyoma (fibroids)

A

a cloning phenomena where proliferation of cells can enlarge the uterus, adnexa, or supporting ligaments

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11
Q

how do leiomyomas (fibroids) present

A

rapidly enlarging mass

- “fulness” and/or “heaviness”

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12
Q

define catamenial

A

menstrual related, “cyclic”, linked to endometriosis

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13
Q

define the coelomic metaplasia theory of endometriosis

A

endometriosis originates from the metaplasia of pluripotential cells from ovarian and peritoneal surfaces

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14
Q

define the retrograde menstruation theory of endometriosis

A

endometriosis caused from retrograde flow of endometrial cells through the tubes onto pelvic surfaces

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15
Q

clinical presentation of ovarian torsion

A

rapid onset of pain, nausea, and vomiting

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16
Q

what normally precipitates ovarian torsion

A

a cyst or a mass, frequently greater than 5cm

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17
Q

what events can cause an ovarian cyst to elicit pain

A
  • rupture
  • bleeding
  • leaking of fluid
  • ovulation (mittelschmerz)
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18
Q

define ovarian remnant

A

small pieces of ovarian tissue are inadvertently left in the pelvic cavity following the surgical removal of one or both ovaries –> ovarian tissue regenerates or grows in response to gonadotropins
- may be seen as a cyst or mass

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19
Q

describe the lab values in a pt with ovarian remnant

A
  • normal FSH and LH

- increased estradiol

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20
Q

what is the most common reason for cyclic pain complaints

A

ovarian cysts

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21
Q

effect of oral contraceptives on risk of ovarian cysts and ovarian and uterine cancer

A

decreases risk for all

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22
Q

most tubal issues causing pelvic pain are due to ___

A

obstruction or flow or infection

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23
Q

define hematosalpinx, pyosalpinx, and hydrosalpinx

A
  • hematosalpinx: bleeding in the fallopian tube
  • pyosalpinx: pus in the fallopian tube
  • hydrosalpinx: water in the fallopian tube
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24
Q

how do hematosalpinx, pyosalpinx, and hydrosalpinx cause pain

A

by distension of the fallopian tube

- can cause contraction/cramping

25
Q

sx and lab values of pelvic inflammatory disease in the fallopian tubes (salpingitis)

A

sx: pelvic pain and fever
labs: elevated WBC and ESR

26
Q

PID of the fallopian tubes (salpingitis) puts pts at risk for developing what other conditions

A

peritonitis, abscess, or sepsis

27
Q

a transVAGINAL ultrasound will detect an intrauterine pregnancy at what HCG level

A

> 1200 mIU/mL

28
Q

a transABDOMINAL ultrasound will detect an intrauterine pregnancy at what HCG level

A

2000 mIU/mL

29
Q

if a patient comes in with an HCG level of over 2000, but there is no visible gestational sac on transvaginal or transabdominal US, what can be suspected

A

ectopic pregnancy

30
Q

what organisms commonly cause ascending infection leading to endometritis

A
  • strep
  • mycoplasma
  • ureaplasma
  • haemophilus
  • anaerobes
  • STIs
31
Q

what event commonly causes endometritis

A

childbirth

occurs postpartum

32
Q

common cause of cervicitis

A

STI (trichomonas vaginalis)

33
Q

negative effects of IUD

A
  • cyclic pain
  • perforation
  • concomitant infection
  • inflammatory reaction
  • stimulation of a hollow organ
34
Q

what are the pregnancy related causes of pelvic pain

A

threatened abortion, septic abortion, post-termination pain

35
Q

define pelvic congestion

A

presence of dilated veins in the pelvis causing pain and congestion after vigorous activity, standing, intercourse, or menses
- seen in the broad ligament, paratubular/ovarian supporting structures, paravaginally, or vulvar

36
Q

define interstitial cystitis

A

defect in the protective layer of the bladder
- related to frequency, burning pain, decreased bladder compliance (“stiff bladder”), UTI-like sx, and flares of increased sx

37
Q

what is hunner’s ulcer

A

not a true ulcer - areas are red, frequently w/ prominent or radial vessels
- may be seen in interstitial cystitis

38
Q

list the bladder related causes of pelvic pain (6)

A
  1. UTI
  2. urinary retention
  3. bladder prolapse
  4. interstitial cystitis
  5. hunner’s ulcer
  6. bladder cancer
39
Q

what ureter related causes of pelvic pain cause anterior pain, flank pain, and renal colic

A

anterior pain: stone moving towards the bladder

flank: obstruction of ureter

renal colic: intense contracture of ureter to move stone through

40
Q

causes of ureteral obstruction or stenosis

A

fibrosis, injury, or endometriosis

41
Q

list the bowel related causes of pelvic pain (5)

A
  1. chronic constipation
  2. IBD (crohn’s, UC)
  3. diverticular dz
  4. dietary intolerance
  5. appendicitis
42
Q

why can IBS be effected by the menstrual cycle

A

shared nerve pathways in the pelvis in the presence of endometriosis

43
Q

crohn’s and UC: cyclic or noncyclic pelvic pain?

A

noncyclic

44
Q

sx of appendicitis

A

mid-abdominal or RLQ pain, fever, anorexia, bloating

- perforation leads to increased peritoneal sx, shock, sepsis

45
Q

list the musculoskeletal related causes of pelvic pain

A
  1. abdominal wall hernias
  2. incisional hernias
  3. inguinal hernias
  4. trauma
46
Q

what is the most common hernia in women

A

indirect inguinal hernias

47
Q

sx of hernia vs sx of incarcerated hernia

A

normal hernia: bulge, protrustion with strain, mass more prominent with strain or cough

incarceration: pain, bowel obstruction sx, peritonitis, shock, sepsis

48
Q

list the neurological related causes of pelvic pain (4)

A
  1. radiation from spine
  2. neuralgia from varicella zoster (shingles)
  3. nerve entrapment (illioginguinal, genitofemoral)
  4. pelvic floor neuralgia (pudendal neuralgia)
49
Q

sx of pelvic floor neuralgia (pudendal neuralgia)

A

pain is deep in the pelvis and often affects ability to defecate or void
- can be chronic, escalating, related to exercise, strain, lift, or surgery

50
Q

causes of nerve entrapment leading to pelvic pain

A

can happen with spinal stenosis, but usually have antecedent trauma, injury, or surgery

51
Q

define dyschezia

A

painful bowel evacuation

52
Q

define dyspareunia

A

painful intercourse

53
Q

define dyssnergia

A

disturbance of muscular/neuromuscular coordination

54
Q

compare acute vs chronic pelvic pain

A

acute: sudden onset of lower abd pain, less than 3 months duration

chronic: occurs in lower abd and present for 4 months or longer
- neither related to, or separated from any organ system or menses

55
Q

A-F ddx for pelvic pain

if you find the A-Z cards annoying feel free to rate them as a 5 and move on

A 
A: adenomyosis
B: bacteroides/abscess
C: coelomic metaplasia
D: diverticular dz
E: ectopic pregnancy
F: fallopian tube filling (hemato, hydro, pyo)
56
Q

G-M ddx for pelvic pain

if you find the A-Z cards annoying feel free to rate them as a 5 and move on

A 
G: gardnerella or ascending infection
H: haemophilus and endometritis
I: ileus
J: jejunum
K: kancerous changes
L: leiomyoma
M: mittelschmerz
57
Q

N-S ddx for pelvic pain

if you find the A-Z cards annoying feel free to rate them as a 5 and move on

A 
N: novasure and post ablation syndrome
O: ovulation and ovarian cyst
P: primary dysmenorrhea
Q: quit contraception/pregnancy
R: retrograde menstruation
S: STI
58
Q

T-Z ddx for pelvic pain

if you find the A-Z cards annoying feel free to rate them as a 5 and move on

A 
T: torsion of ovary
U: ulcerative colitis, IBD
V: vascular congestion
W: water blockage (bladder or ureter)
X: eXuberant adhesions
Y: yucky bugs
Z: (for Z plasty) adhesion and their issues - hernias, infection, nerve entrapment

Maddy - PCM III EXAM II (3 decks)

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