W10_04 Acute Chronic Pelvic Pain

Question 1

what are the two types of pathophysiology of pelvic pain?

Answer 1

nociceptive and neuropathic pain

Question 2

what’s the difference between A and C fibre nociceptive pain?

Answer 2

A - quick, sharp.
C - slow, dull

Question 3

define dysmenorrhea

Answer 3

painful menstruation.
Mechanism is through prostaglandins PGEs, inflammation, and finally altered uterine contractions

Question 4

what to look for in the history?

Answer 4

context, age, duration

Question 5

how long for chronic pelvic pain?

Answer 5

> 6 months (but 3 months is more practical)

Question 6

if bilateral pelvic pain, what’s the likely diagnosis?

Answer 6

PID

Question 7

if episodic pelvic pain, what’s the likely diagnosis?

Answer 7

torsion

Question 8

if flank/colicky pelvic pain, what’s the likely diagnosis?

Answer 8

ureteric stone

Question 9

define dyspareunia

Answer 9

pain during intercourse

Question 10

what tests to consider ordering with pelvic pain?

Answer 10

serum beta hCG;
CBC;
ESR, CRP;
cultures;
urinalysis for blood/crystals;
stool for OB

Question 11

degenerating fibroids present with which symptoms?

Answer 11

25-50% asymptomatic;
menorrhagic and dysmenorrhea;
pressure symptoms;
acute pain with degeneration, torsion, prolapse

Question 12

what’s the treatment for degenerating fibroids?

Answer 12

conservative pain meds and anti-inflammatories, as they typically resolve themselves

Question 13

non-surgical treatments of adhesions?

Answer 13

NSAIDs, tylenol, avoid narcotics (don’t want constipation), oral contraceptives, stool softeners, pee more, alternate positions for intercourse

Question 14

surgical treatments of adhesions?

Answer 14

remove scar tissue and take precautions to prevent additional adhesions, including adhesion barriers, meticulous hemostasis, gentle handling of tissues,