Pelvic Pain LECT

Question 1

What is the 5 step approach in every patient encounter?

Answer 1

1. History
2. Physical examination
3. Differential diagnosis
4. Directed testing
5. Treatment plan

Question 2

What is crucial to investigate in a premenopausal woman with pelvic pain?

Answer 2

Menstrual profile

(menarche, cycle length, variability, menstrual flow, dysmenorrhea, cramping, pain patterns, radition, concomitant changes in bowel or bladder)

Question 3

What is the correct consistent pattern to follow when performing a pelvic exam?

Answer 3

Begin externally

Look carefully at the tissues

Evaluate for infectious processes

Feel the cervix, cul de sac, uterus and the ovaries

Question 4

What are examples differential diagnoses of cyclic pain?

Answer 4

Mittelschmerz (pain w/ ovulation)

Endometriosis (ectopic endometrial glands and stroma)

Dysmenorrhea (painful menses)

Question 5

What are examples differential diagnoses of non cyclic pain?

Answer 5

Interstitial cystitis

Diverticulosis

Hernia

Question 6

Define:

Catamenial

Answer 6

Menstrual related,

Linked to endometriosis

Question 7

What are the two theories behind the development of endometriosis?

Answer 7

Coelomic metaplasia [metaplasia of cells]

Retrograde menstruation [retrograde flow of endometrial cells through tubes onto pelvic surfaces]

Question 8

What are ovarian cysts?

Answer 8

Dynamic and elastic occurence in the functioning ovary

Cycsts may be [physiologic, endometriotic, teratoma, benign, borderline or cancerous]

Question 9

What is the most common reason for cyclic pain complaints?

Answer 9

Ovarian cysts

Question 10

What are most fallopian tube dysfunctions realted to?

Answer 10

Obstruction of flow

OR

Infection

Question 11

What are the three major fallopian tube issues?

Answer 11

Hematosalpinx

Pyosalpinx

Hydrosalpinx

Question 12

What is endometritis?

Answer 12

Infection of the uterine cavity

Question 13

Which general form of infection is highly correlated with STIs?

Answer 13

Cervicitis

Question 14

What is pelvic congestion?

Answer 14

Presence of dilated veins in the pelvis

Tend to occur after vigorous activity, standing, intercouse or menses

(these are seen in the broad ligament, paratubal/ovarian supporting tissues)

Question 15

What are the clinical features of interstitial cystitis?

Answer 15

Defect in the protective layer of the bladder

• Frequency
• Burning pain
• Decreased bladder compliance
• UTI like symptoms

Question 16

Ureteral pain usually presents as?

Answer 16

Flank/Colic pain

Question 17

What is the most common type of hernia in women?

Answer 17

Indirect, femoral hernia

Question 18

What are three good examples of neurological related issues that can cause pelvic pain?

Answer 18

Neuralgia from varicella zoster (shingles)

Pelvic floor neuralgia

Pudendal neuralgia

Question 19

Dys definitions:

Dysuria

Dysmenorrhea

Dyschezia

Dyspareunia

Dyssnergia

Answer 19

Dysuria = painful urination

Dysmenorrhea = painful menses

Dyschezia = painful bowel evacuation

Dyspareunia= painful intercourse

Dyssnergia = disturbance in muscular/neuromuscular coordination

Question 20

What is acute pelvic pain defined as?

What is chronic pelvic pain defined as?

Answer 20

Acute = less than 3 months

Chronic = 4 months or more

Question 21

What are the ABC’s of pelvic pain?

(A through J)

Answer 21

A = Adenomyosis

B= Bacteroides

C= Coelomic metaplasia

D= Diverticular disease

E = Ectopic pregnancy

F = Fallopian tube issue

G = Gardnerella or ascending infection

H = Haemophillus

I = Illeus

J = Jejunum

Question 22

What are the ABC’s of pelvic pain?

(K through R)

Answer 22

K = “K”ancerous changes

L = Leiomyoma

M = Mittelschmerz

N = Novasure and post ablation syndrome

O = Ovulation / Ovarian cyst

P= Primary dysmenorrhea

Q = Quit contraception/pregnancy

R = Retrograde menstruation

Question 23

What are the ABC’s of pelvic pain?

(R through Z)

Answer 23

R= Retrograde menstruation

S = Sexually transmitted infection

T = Torsion of ovary

U = Ulcerative colitis

V= Vascular congestion

W= Water blockage

X = eXuberant adhesions

Y= Yucky bugs

Z= Adhesions and their issues