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Women's Health > Pelvic Pain and Masses > Flashcards

Pelvic Pain and Masses Flashcards

1
Q

Common conditions that can cause acute abdominal pain

A

appendicitis, cholecystitis, choledocholithiasis, diverticulitis, pancreatitis, bowel, perforation, mesenteric ischemia, ischemic colitis, intestinal obstruction

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2
Q

three categories of gynocologically cause abdominal pain

A

acute cases in nonpregnant
chronic problems in nonpregnant
acute cases in pregnant

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3
Q

PID, adnexal torsion, ruptured ovarian cyst, horrhage corpus luteum cyst, ovarian torsion, endometriosis, tubovarian abscess all fall into what category of gynecologic cause of abdominal pain

A

acute causes in nonpregnant

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4
Q

Dynmenorrhea, Mittelscherz, Endometriosis, obstruction mullerian duct abnormalities, leiomyomas, cancer, pelvic congestion syndrome all fall under the category of what gynecologic cause of abdominal pain

A

chronic causes in nonpregnant

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5
Q

ectopic pregnancy, retained products of conception, septic abortion, and ovarian torsion all fall under what category of gynecologic cause of abdominal pain

A

acute causes in pregnancy

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6
Q

what do you want to include in your history when assessing a patient with abdominal pain

A

LMP, menstrual history, sexual history, family history

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7
Q

pain associated with menstural cycle

A

dysmenorrhea

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8
Q

primary vs secondary dysmenorrhea

A

primary has no pathologic findings.

Secdonary as some associated findings/pathology.

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9
Q

What is the etiology of dysmenorrhea?

A

increased production of endometrial prostaglandin → increases uterine tone and uterine contraction during menses

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10
Q

Patient presents with low midline cramping pain during peak flow; occasionally associated with nausea, vomiting, diarrhea, headahce, flushing, fatigue

A

primary dysmenorrhea

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11
Q

what symptoms would warrant further workup in primary dysmenorrhea?

A

dysmenorrhea before age 25
abnormal pelvic exam
infertility

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12
Q

Treatment for primary dysmenorrhea

A

NSAID, Cox 2 inhibitor

oral contraceptive, depo, levonorgestrel IUD

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13
Q

What fall under the category of secondary dysmenorrhea?

A

endometriosis, adenomyosis, uterine fibroids, ovarian cysts, ovarian torsion

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14
Q

abnormal growth of endometrial tissue outside of the uterus → irritates surrounding tissue and may develop scar tissue or adhesions

A

endometriosis

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15
Q

Endometriosis is the leading cause for what 2 things

A

chronic pelvic pain and infertility

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16
Q

when will a patient with endometriosis have the most pain?

A

occurs around cycle

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17
Q

What is believed to be the etiology of endometriosis?

A

retrograde menstruation

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18
Q

what can pelvic exam reveal in patient with endometriosis?

A

tender nodules in cul-de-sac or rectovaginal septum, decreased uterine mobility, cervical motion tenderness, adnexal mass or tenderness

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19
Q

How is endometriosis diagnosed?

A

histology of lesions removed at surgery

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20
Q

What is the preferred medical management for endometriosis?

A

hormonal therapy → lowers hormone levels and prevents cyclic stimulation of endometrial implants → induces atrophy

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21
Q

what is approved in treating endometriosis associated pain?

A

progestins → oral norethindrone acetate and subQ DMPA (Depo)
GnRH agonist

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22
Q

What are some side effects seen in GnRH agonists?

A

vasomotor symptoms and bone demineralization

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23
Q

What is the androgenic drug that may be used for endometriosis associated pain?

A

danazol

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24
Q

What are side effects of Danazol?

A

decreased breast size, weight gain, acne, hirsutism

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25
Q

If a patient with endometriosis desires fertility what is the preferred treatment management?

A

laparoscopic ablation of endometrial implants

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26
Q

If a patient with endometriosis does not desire fertility and/or if the pain is too bad, what is the preferred treatment??

A

total abdominal hysterectomy and bilaterial salpingo-oophrectomy
add HRT if premenopausal

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27
Q

Symptoms of endometriosis

A

dysmenorrhea, dyspareunia, pain with BM/urination, excessive bleeding, infertility

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28
Q

Term for endometrial tissues that grows into the muscular wall of the uterus

A

adenomyosis

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29
Q

Symptoms of adenomyosis

A

heavy/prolonged menstrual bleeding, dysmenorrhea, menstrual cramps throughout period, dyspareunia, blood clots pass during period

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30
Q

How will adenomyosis present on pelvic exam?

A

enlarged and tender uterus

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31
Q

What is the treatment for adenomyosis?

A

NSAID and hormonal contraceptive → hysterectomy if all fails

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32
Q

Most common benign neoplasm of female genital tract

A

uterine leiomyoma (fibroid)

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33
Q

Most common location for uterine fibroid → within the uterine wall

A

intramural

34
Q

Uterine fibroid develops just under the lining of the uterine cavity

A

submucosal or pedunculated subucosal

35
Q

uterine fibroid located near the outside of the uterus and may prodrude into the abdominal cavity

A

subserous or pedunculated subserois

36
Q

Uterine fibroid found in the supporting structures

A

intra-ligamentois

37
Q

Uterine fibroid that develops in the cervis

A

cervical

38
Q

What is believed to be the cause of uterine fibroids?

A

muscle cells that transform and is stimulated to grow into benign tumor

39
Q

When will uterine fibroids quit growing?

A

during menopause → usually hormonally responsive to estrogen and progesterone

40
Q

What race has greater lifetime risk for fibroids?

A

AA > Caucasians

41
Q

What are risk factors for fibroids?

A

AA, smoking, early menarche, nulliparity, EtOH use, HTN

42
Q

Two most common symptoms of uterine fibroids and are what makes women seek treatment (otherwise asymptomatic)

A

abnormal uterine bleeding (heavier and longer)

pelvic pain/pressure

43
Q

If a fibroid degenerates, how will the patient feel?

A

intense pain

44
Q

How can uterine fibroids complicate pregnancy?

A

increase risk of miscarriage if they distort uterine cavity, possible preterm labor and delivery

45
Q

What lab finding may you find in patient with uterine fibroid?

A

IDA

46
Q

what imaging technique can you used to confirm and monitor the growth of uterine fibroid?

A

US

47
Q

What imaging technique would you use to differentiate intramural and submucous myomas?

A

MRI

48
Q

What imaging technique is used to confirm cervical or submucous myomas?

A

hysterography or hysteroscopy

49
Q

What is the treatment for acute torsion of pedunculated myoma?

A

emergency surgery

50
Q

If you are performing emergency surgery for uterine fibroid and the patient is severely anemic, what do you give them pre-operatively?

A

DMPA or GnRH agonist

51
Q

What is the only emergency indication for myomectomy during pregnancy?

A

torsion

52
Q

What would be indication for surgical removal of uterine fibroid?

A

patient symptoms and desire for fertility

53
Q

What uterine fibroids require removal?

A

cervical myomas > 3-4 cm

pedunculated myoma that protrude through the cervix

54
Q

How can you preoperatively reduce the size of myoma?

A

GnRH analogs

55
Q

What is the curative treatment for uterine fibroid?

A

surgery

56
Q

What treatment can a woman get for uterine fibroid if she desires fertility in the future? What are some risk factors?

A

myomectomy → recurrence is common and post OP pelvic adhesions

57
Q

Three types of functional ovarian cysts

A

follicular, corpus luteum, theca luteum

58
Q

This cyst is common in reproductive age women → forms when follicle fails to rupture and release the egg → often spontaneously resolves

A

follicular cyst

59
Q

This cyst is common in reproductive age women → forms when corpus luteum fails to regress → may produce progesterone and may be hemorrhagic

A

corpus luteum cyst

60
Q

when does follicular cyst become clinically significant?

A

large enough to cause pain or persists beyond one menstural cycle

61
Q

Symptoms that patient with follicular cyst present with

A

lower abdominal/pelvic pain, irregular bleeding

62
Q

What occurs when corpus luteum cyst develops?

A

when the follicle ruptures and releases the egg and if fluid accumulates when it is sealing off → cyst forms

63
Q

What cyst is considered postovulatory?

A

corpus luteum cyst

64
Q

What fertility drug increases risk for for cyst formation?

A

clomiphene (Clomid)

65
Q

What are symptoms of corpus luteum cyst?

A

pain and missed period (produce progesterone longer than usual and delay menstruation)

66
Q

The least common cyst and often associated with pregnancy (high HCG)

A

theca lutein cyst

67
Q

Cyst containing tissue (such as hair, skin, teeth) since they are derived from germ cells (oocytes)

A

dermoid cyst

68
Q

cyst that develops from ovarian tissue and may be filled with watery liquid or mucous → mostly benign

A

cystademonas

69
Q

cyst that develops as a result of endometriosis tissue within the ovary → “Chocolate Cyst”

A

endometriomas

70
Q

If ovarian cyst gets too large what is the patient at risk for?

A

torsion of ovary

71
Q

What would occur that would require prompt intervention with a cyst?

A

rupture or bleed

72
Q

What labs would you order for patient with ovarian cyst?

A

pregnancy test, CA 125

73
Q

What is the only way to diagnosi ovarian cyst?

A

pelvic US

74
Q

How do you diagnose and treat ovarian cyst?

A

laparoscopic surgery

75
Q

How do you treat cysts and prevent others from forming?

A

watchful waiting

hormone therapy may prevent new cysts

76
Q

ovary twists around supporting structures → occlusion of vascular supply to ovary →ischemia → pain

A

ovarian torsion

77
Q

Two etiologies of ovarian torsion

A

complication of ovarian cyst and pregnancy is risk factor

78
Q

signs and symptoms of ovarian torsion

A

sudden, acute abdominal/pelvic pain (constant or intermittent), pelvic tenderness

79
Q

How do you diagnose ovarian torsion?

A

US with Doppler

80
Q

How do you definitely diagnose and treat ovarian torsion ?

A

laparoscopy

81
Q

How do you treat recurrent ovarian cysts that cause torsion?

A

salpingo-oophrectomy

Women's Health (9 decks)

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