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Women's Health > Presentation: Pelvic Pain > Flashcards

Presentation: Pelvic Pain Flashcards

1
Q

What provides innovation to the vulva, perineum and lower vagina?

A

Pudendal nerve. S2 - S4

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2
Q

What innervates the uterus, tubes, ovaries and visceral peritoneum?

A

Autonomic nervous system T10 - L1

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3
Q

What processes may lead to pelvic pain?

A
  • distension / contraction of an organ
  • stretching of an organ capsule
  • irritation of the parietal peritoneum
  • ischaemic tissues
  • inflammation, neoplasia or fibrosis stimulating nerves
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4
Q

DDx for gynaecological causes of pelvic pain?

A
  • Cyclical (see other card)
  • Endometriosis / adenomyosis
  • PID
  • PCOS
  • Residual ovary, ovarian remnant syndrome
  • Neoplasia
  • Pelvic venous congestion
  • Levator muscle spasm
  • Pelvic adhesions
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5
Q

What are non - gynaecological causes of pelvic pain?

A
  • GIT (diverticulitis, malignancy, BO, IBD, IBS)
  • Urinary tract (calculus, infection, retention malignancy, interstitial cystitis)
  • MSK (OA, prolapsed disc, fibro, myofascial pain, peripartum MSK pain, psoas muscle pain)
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6
Q

CFx cyclical pelvic pain?

A

Dysmenorrhoea during cycle. Often associated with endometriosis and adenomyosis

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7
Q

What are the cyclical causes of pelvic pain?

A
  • dysmenorrhoea
  • ovulation pain
  • endometriosis
  • adenomyosis
  • excacervbation of other aetiologies (e.g. IBS and interstitial cystitis)
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8
Q

What are the CFx of ovulation pain?

A
  • acute onset of pain is followed by dull ache for several hours
  • pain corresponds to LH peak (1 day pre ovulation)
  • prostaglandin F2 causes contractility of ovarian perifollicular smooth muscle
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9
Q

How is PID diagnosed?

A
  • only 60% correctly diagnosed on Hx

- Dx = laparoscopy

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10
Q

What are the sequelae of PID?

A
  • chronic infection
  • pelvic pain
  • dyspareunia
  • menstrual changes
  • infertility
  • ectopic pregnancy
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11
Q

What are the features of malignant neoplasia causing pelvic pain?

A
  • weight loss
  • nausea
  • abdo / pelvic pain
  • ascites
  • lymphadenopathy
  • irregular mass in pelvis
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12
Q

What is the proposed aetiology of pelvic venous congestion?

A

May be due to oestrogen causing dilation of thin walled unsupported pelvic veins

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13
Q

What is the most informative investigation for pelvic pain?

A

Laparoscopy

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14
Q

What radiological investigations can be useful in evaluating pelvic pain?

A
  • US pelvis
  • XR lumbar spine / hip joints
  • other if ? non gyn cause
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15
Q

What non radiological investigations can be helpful in evaluating pelvic pain?

A
  • MSU
  • Chlamydia swabs
  • laparoscopy
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16
Q

Mx chronic pelvic pain?

A
  • Exclude and treat treatable causes
  • Pharm (NSAIDs, OCP, GnRH agonist)
  • PT
  • Psych: pain clinics and management
  • pain assessment forms for long term management
17
Q

What is the definition of chronic pelvic pain?

A

Non specific pelvic pain of more than 6 months duration that may or may not be relieved with analgesia. Associated with occult somatic pathology, laparoscopically evident pathology and non somatic disorders.

18
Q

Describe the innervation of the individual pelvic organs.

A

Mullerian origin organs (uterus, tubes, upper vagina) transmit stimuli via SNS T10 - L1.

19
Q

What are the most common causes of acute pelvic pain related to reproductive organs?

A

Elevan most common:

    1. Mittelschmerz
    1. Functional ovarian cysts
    1. Intrauterine pregnancy
    1. Ectopic pregnancy
    1. Pelvic infections
    1. Uterine tumours
    1. Adnexal neoplasia
    1. Ovarian torsion
    1. Endometriosis
    1. Adenomyosis
    1. Dysmenorrhoea
20
Q

What are the features of follicular cysts?

A

Follicular cysts result from failure of egg release from a mature follicle during ovulation.

  • Sx: aching in RIF or LIF.
  • PEx: enlarged cystic ovary on exam or US
  • Sequelae: resolution, torsion / rupture with pain, rupture with haemorrhage and surgical evaluation
21
Q

How may uterine tumours cause pelvic pain?

A

E.g. leiomyomas / leiomyosarcomas

  • torsion
  • necrosis
  • stretching visceral peritoneum of uterus
  • pressure against surrounding intra abdo structures
22
Q

How may adnexal neoplasia cause pelvic pain?

A
  • Haemorrhage
  • necrosis
  • torsion
  • rupture
23
Q

How may ovarian torsion present?

A 
-Constant or severe and intermittent
A/w
-N/V
-diaphoresis
-severe pelvic pain
24
Q

What is the progression of blood supply interruption in ovarian torsion?

A

venous supply ceases first resulting in enlargement. arterial obstruction follows causing necrosis

25
Q

How do pelvic adhesions cause pelvic pain?

A

-Mechanical components postulated as source of pain; patients experience pain via mechanical stimulation (stretching) of visceral nociceptors

26
Q

What is vital to first ask about when evaluating pelvic pain?

A

LMP and exclude pregnancy

27
Q

How are myofascial trigger points detected?

A
  • Painful on compression (jump sign)

- May produce characteristic referred pain and autonomic phenomenon (tearing, choryza, tinnitus etc)

28
Q

How are myofascial trigger points treated?

A

-Hyperstimulation
-Analgesia (stretch and cold spray)
-Needling with local injection
-TENS
-accupuncture
Act as counter irritants altering central gate resulting in a prolonged response

Women's Health (39 decks)

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