Somatization and CPP: Rosenthal Flashcards

1
Q

What is somatization?

A

When the pt expresses emotional distress in terms of somatic complaints.
Very common in PC and Ob/Gyn.
Distress is out of proportion to physical findings.
Multiple, often shifting, somatic complaints at different times over the course of a pt’s life.
Pain is the most common.

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2
Q

What is somatic symptom disorder?

A

Causes significant impairment with distress.

Pt is often (wrongly) suspected of drug seeking behavior or malingering. This brings about negative interactions.

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3
Q

Describe the Cognitive-Behavioral mode of somatic symptom disorder.

A

Pt not only experiences symptoms, but also, anxiety and panic about the meaning of the symptoms themselves.

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4
Q

Chronic pelvic pain

A
  • pain in the pelvic/suprapubic region off and on every day, lasting for months
  • potential causes: endometriosis, PID, leiomyomata, ovarian cysts, adhesions, others like GI/UG/MS
  • fibroids won’t cause pain unless they are large and pressing on another organ; ovarian cysts normally don’t cause pain
  • evaluation: H&P, pelvic US (this is often normal and enough to reassure the pt)
  • there is an association between sexual abuse as a child and chronic pelvic pain (somatization); ask and she will talk
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5
Q

Treatment for chronic pelvic pain

A
  • team sport btw gyn, urologist, PT, pain mngmt centers, psych
  • counsel them about coping and offer non-narcotic drugs
  • never prescribe narcotics for chronic pelvic pain, beware of drug seekers
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6
Q

What else can you do if there’s still chronic pain and no explanation and failed medical treatment?

A

Diagnostic laparoscopy; may find things you can’t find on imaging/exam like endometriosis or adhesions to bowel/pelvis.
Also, studies show that women get better when told their pelvis is “clean” following laparoscopy.
Avoid laparotomy at all costs! - this may cause adhesions, more pain, etc.

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7
Q

Adenomyosis

A
  • disorder of endometrial glands/stroma/blood in the wall of the uterus (so it’s like endometriosis but not ectopically)
  • pts present with “boggy” enlarged, tender uterus, pelvic pain, pressure, dysmenorrhea, menorrhagia
  • dx can only be made by pathology after hysterctomy
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8
Q

Treatment of adenomyosis

A
  • prevent ovulation with OCPs, which prevents bleeding
  • NSAIDs to block PG synthesis
  • if failed, do hysterectomy
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9
Q

Dyspareunia

A
  • pain with intercourse
  • dx with H&P: how long (forever vs. recent), at what point/position, interfering with relationship
  • potential causes:
    1. if on insertion: vaginitis, vulvitis, vestibular adenitis
    2. deep: cervicitis, endometriosis, adhesions, PID, mass effect of fibroids, bladder neck
    3. after sex: seminal fluid can cause contractions of uterus (via PGs) which feels like menstral-type cramps
  • if no dx can be made, need to consider deeper issue and consult specialist
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