Pelvic Pain LECT Flashcards
What is the 5 step approach in every patient encounter?
- History
- Physical examination
- Differential diagnosis
- Directed testing
- Treatment plan
What is crucial to investigate in a premenopausal woman with pelvic pain?
Menstrual profile
(menarche, cycle length, variability, menstrual flow, dysmenorrhea, cramping, pain patterns, radition, concomitant changes in bowel or bladder)
What is the correct consistent pattern to follow when performing a pelvic exam?
Begin externally
Look carefully at the tissues
Evaluate for infectious processes
Feel the cervix, cul de sac, uterus and the ovaries
What are examples differential diagnoses of cyclic pain?
Mittelschmerz (pain w/ ovulation)
Endometriosis (ectopic endometrial glands and stroma)
Dysmenorrhea (painful menses)
What are examples differential diagnoses of non cyclic pain?
Interstitial cystitis
Diverticulosis
Hernia
Define:
Catamenial
Menstrual related,
Linked to endometriosis
What are the two theories behind the development of endometriosis?
Coelomic metaplasia [metaplasia of cells]
Retrograde menstruation [retrograde flow of endometrial cells through tubes onto pelvic surfaces]
What are ovarian cysts?
Dynamic and elastic occurence in the functioning ovary
Cycsts may be [physiologic, endometriotic, teratoma, benign, borderline or cancerous]
What is the most common reason for cyclic pain complaints?
Ovarian cysts
What are most fallopian tube dysfunctions realted to?
Obstruction of flow
OR
Infection
What are the three major fallopian tube issues?
Hematosalpinx
Pyosalpinx
Hydrosalpinx
What is endometritis?
Infection of the uterine cavity
Which general form of infection is highly correlated with STIs?
Cervicitis
What is pelvic congestion?
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)
What are the clinical features of interstitial cystitis?
Defect in the protective layer of the bladder
- Frequency
- Burning pain
- Decreased bladder compliance
- UTI like symptoms
Ureteral pain usually presents as?
Flank/Colic pain
What is the most common type of hernia in women?
Indirect, femoral hernia
What are three good examples of neurological related issues that can cause pelvic pain?
Neuralgia from varicella zoster (shingles)
Pelvic floor neuralgia
Pudendal neuralgia
Dys definitions:
Dysuria
Dysmenorrhea
Dyschezia
Dyspareunia
Dyssnergia
Dysuria = painful urination
Dysmenorrhea = painful menses
Dyschezia = painful bowel evacuation
Dyspareunia= painful intercourse
Dyssnergia = disturbance in muscular/neuromuscular coordination
What is acute pelvic pain defined as?
What is chronic pelvic pain defined as?
Acute = less than 3 months
Chronic = 4 months or more
What are the ABC’s of pelvic pain?
(A through J)
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
What are the ABC’s of pelvic pain?
(K through R)
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
What are the ABC’s of pelvic pain?
(R through Z)
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
