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GOSH > Pelvic pain and pelvic inflammatory disease > Flashcards

Pelvic pain and pelvic inflammatory disease Flashcards

1
Q

What is pelvic inflammatory disease?

A

infection/inflammation of of female reproductive organs: uterus, fallopian tubes, ovaries and surrounding tissues

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2
Q

How is a diagnosis of PID made?

A

CLINICAL diagnosis (backed up by lab tests)

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3
Q

What are some symptoms of PID?

A

Lower abdo pain (usually bilateral)

Deep dyspareunia

Abnormal vaginal bleeding: IMB, PCB and menorrhagia

Abnormal vaginal or cervical discharge: usually purulent

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4
Q

Where does PCB generally originate from?

A

cervix (common sign of STI)

BUT

could be due to other causes e.g. trauma following intercourse with dry vagina

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5
Q

What examinations would you do on a woman who presents with new onset abdo pain, abnormal bleeding, dyspareunia?

A

Abdominal exam
Speculum
Bimanual palpation

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6
Q

What does LSI stand for?

A

Last sexual intercourse

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7
Q

What does PSI stand for?

A

Previous sexual intercourse

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8
Q

How would you investigate a 17 yr old girl with 2/52 Hx od lower abdo/pelvic pain, pain during sex, dysuria but no other urinary symptoms; PLUS OE: bilateral lower abdo tenderness, cervical motion tenderness and L adenexum tenderness?

A

Urine: urine dip (and MSU), urinary PT

VV swabs: chlamydia and gonorrhoea (NAAT)

High vaginal swab: Candida, BV, TV

Endocervical swab: gonorrhoea (culture)

Bloods: HIV and syphillis
(other general health bloods)

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9
Q

Would you treat someone with suspected chlamydia/PID if they are symptomatic before you had their swab results?

A

YES

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10
Q

If a test result comes back negative for chlamydia and gonorrhoea, does this exclude the diagnosis of PID?

A

no

75% of PID is not caused by an STI

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11
Q

What are the PID clinical criteria?

A

Lower abdominal pain

PLUS

pyrexia
leucocytosis
ESR > 15
Adnexal pain
Cervical motion tenderness
Adnexal mass
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12
Q

What are some complications of PID?

A

Ectopic pregnancy

Tubal factor infertility

Chronic dyspareunia and pelvic pain

Fitz-Hugh-Curtis syndrome (perihepatitis)

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13
Q

In women <30yrs (with/without indicative sexual history), what is RUQ pain suggestive of?

A

Perihepatitis (rather than cholecystitis)

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14
Q

Why don’t you delay treatment of PID?

A

Multiple episodes of PID or treatment is delayed = INCREASED RISK OF INFERTILITY

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15
Q

How would you manage PID?

A

Rest (in severe disease)

Analgesia

Admission for IV therapy in more severe disease

No sex until both they and their partner have completed treatment and follow up

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16
Q

What medication would you prescribe for someone with PID?

A

Ceftriaxone 500 mg im followed by
Doxycycline 100mg bd po 14 days
Metronidazole 400mg bd po 7-14 days

OR

Ofloxacin 400mg bd po 14days
plus
Metronidazole 400mg bd po 14 days

Trying to cover: gonorrhoea, chlamydia and anaerobes

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17
Q

Can women with PID go on to have children?

A

Most women - if there are recurrent or prolonged untreated episodes, fertility may be effected

18
Q

What are some causes of PID?

A

Neisseria gonorrhoea

Chlamydia trachoma’s

BV associated organisms

Other organisms (streptococci, staphylococci, E coli)

Mycoplasma genitalium

Mycobacterium tuberculosis

BUT! Always treat as an STI initially.

19
Q

If a patient comes in experiencing heavy and painful periods, what should you ask them about?

A

Bleeding: Normal cycle (incl. LMP and regularity)
When changes occurred
IMB or PCB

discharge

Pain - when is it worst, before to after menses
dyspareunia

Bladder Sx

Obstetric Hx

Sexual Hx

PMHx

DHx (incl. allergies)

20
Q

What are the two types of dyspareunia?

A

superficial and deep

superficial - on penetration

deep - pain deep in abdo/pelvis

21
Q

What is endometriosis?

A

Ectopic endometrial tissue - endometrial material in the pelvis

22
Q

What is adenomyosis?

A

Endometrial tissue in myometrium

23
Q

What are some symptoms of endometriosis?

A

dysmenorrhoea/cyclical pelvic pain
dyspareunia
urinary symptoms
rectal/anal Sx

24
Q

What are some risk factors for endometriosis?

A

C-section

TOP

25
Q

Does macroscopic appearance of endometriosis tally with severity of symptoms?

A

no

26
Q

What are some common sites of endometriosis?

A 
Peritoneum
Pouch of Douglas (POD)
Ovary / Tubes
Ligaments
Bladder
Myometrium
27
Q

How would you investigate endometriosis?

A

USS - endometrioma (can’t see scar tissue)

Laparoscopy

28
Q

How would you treat endometriosis medically?

A

Analgesics – NSAIDs (symptom relief)

Oral Contraceptives (ovarian suppression)

Mirena IUS (endometrial +- ovarian supp)

GnRH analogues (ovarian suppression)
eg prostap, gonapeptyl
29
Q

How would you treat endometriosis surgically?

A

Laparoscopic ablation of endometriotic spots e.g. diathermy

Laparoscopic resection of active lesions/scar tissue

Laparoscopic cystectomy/oophorectomy

Hysterectomy – concerns re age and will need HRT

30
Q

What is chronic pelvic pain?

A

Intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy.

31
Q

What other conditions might be associated with chronic pelvic pain?

A

IBS

Interstitial cystitis

32
Q

What is one of the main causes for non-gynae pelvic pain?

A

constipation

33
Q

How would you manage a woman with chronic pelvic pain?

A

TV Scan
Trial of OCP/GnRH analogues for 3-6 months
Mirena

Antispasmodics, analgesia, referral to pain clinic

Laprascopy

34
Q

What are some acute GYNAE causes of pelvic pain?

A

Ectopic pregnancy
Ovarian cyst accident
Primary dysmennorhoea
Mittleschmerz

35
Q

What are some of the symptoms of an ovarian cyst accident?

A

gradual onset
exclusively unilateral dyspareunia
palpation pain

36
Q

What is mittleschmerz?

A

menstrual pain due to fluid around ovum

37
Q

What are some acute NON-GYNAE causes of pelvic pain?

A

Gastrointestinal: appendicitis
IBS/IBD
Strangulated hernia

Urological:
UTI
Calculi

38
Q

What are some GYNAE causes of chronic pelvic pain?

A

Pelvic adhesions

Fibroids

Cervical stenosis

Asherman’s syndrome

NB Dysmenorrhoea is common!
1° = No cause
2° = underlying cause

39
Q

What are some NON-GYNAE causes of chronic pelvic pain?

A

Gastrointestinal: Constipation
hernias
IBS / IBD

Urological:
Interstitial cystitis
Calculi

40
Q

What are some symptoms that may lead you to think about constipation in pelvic pain?

A

colicky pain, exacerbated by stress,

L sided/posterior fornix

GOSH (33 decks)

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