Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Y4 reproductive health > Pelvic pain > Flashcards

Pelvic pain Flashcards

(56 cards)

Start Studying
1
Q

Acute pelvic pain causes

A

Ectopic pregnancy

Urinary tract infection

Appendicitis

Pelvic inflammatory disease

Ovarian torsion

Miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chronic pelvic pain causes

A

Endometriosis & adenomyosis

Irritable bowel syndrome

Ovarian cyst

Urogenital prolapse

MSK, nerve entrapment

Adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic pain management principles

A

Treat underlying cause

Cyclical pain - therapeutic trial using hormonal mx for a period of 3-6 months before having a diagnostic laparoscopy

IBS - antispasmodics & lifestyle changes

Optimise pain relief

Referral to dedicated chronic pelvic pain team

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ectopic pregnancy

A

Implantation of a fertilised ovum outside the uterus results in an ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ectopic pregnancy hx

A

Hx of 6-8 weeks amenorrhoea w/ lower abdo pain & vaginal bleeding

Lower abdominal pain - due to tubal spasm, typically the first symptom, pain is usually constant & may be unilateral

Vaginal bleeding - less than a normal period, may be dark brown in colour

Hx of recent amenorrhoea - 6-8 weeks from the start of last period

Peritoneal bleeding → shoulder tip pain & pain on defecation/urination

Dizziness, fainting or syncope

Symptoms of pregnancy may be reported

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ectopic pregnancy examination findings

A

Abdominal tenderness

Cervical excitation

Adnexal mass → NICE advise NOT to examine due to increased risk of rupturing pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ectopic pregnancy risk factors

A

Damage to tubes (PID)

Previous ectopic

Endometriosis

IUCD

POP

IVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ectopic pregnancy ix

A

Pregnancy test

Transvaginal USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ectopic pregnancy expectant mx

A

Size < 35mm, unruptured, asymptomatic, no fetal heartbeat, hCG < 1000IU/L

Compatible if another intrauterine pregnancy

Expectant management - involves closely monitoring the patient over 48 hours & if b-hCG levels rise again/symptoms manifest intervention is performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ectopic pregnancy medical mx

A

Size < 35mm, unruptured, no significant pain, no fetal heartbeat, hCG < 1,500IU/L

Not suitable if another intrauterine pregnancy

Involves giving methotrexate & can only be done if the patient is willing to attend follow-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ectopic pregnancy surgical mx

A

Size > 35mm, can be ruptured, pain, visible fetal heartbeat, hCG > 5,000 IU/L, compatible with another intrauterine pregnancy

Salpingectomy or salpingotomy

  • salpingectomy - first line for women with no other risk factors for infertility
  • salpingotomy - considered for women with risk factors for infertility eg. contralateral tube damage
    • 1 in 5 require further treatment (methotrexate +/- salpingectomy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ectopic pregnancy complications

A

Tubal abortion

Tubal absorption

Tubal rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PID

A

Used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries & surrounding peritoneum

Usually the result of ascending infection from the endocervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PID aetiology

A

STIs - chlamydia trachomatis, neisseria gonorrhoea, mycoplasma genitalium

Non-STIs - anaerobes (prevotella, atopobium, leptotrichia), gardnerella vaginalis, vaginal flora introduced by surgery, IUD

Polymicrobial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PID risk factors

A

No use of barrier contraception

Previous episodes

Earlier age at first intercourse

Multiple sexual partners

Immunocompromised

Co-existing endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PID clinical features

A

Lower abdominal pain - typically bilateral

Fever, rigors, chills, night sweats

Deep dyspareunia

Abnormal vaginal bleeding - IMB, PCB, HMB

Vaginal/cervical discharge - yellow or green

Cervical excitation - pain on movement of cervix

RUQ pain (Fitz-Hugh-Curtis syndrome)

Can be asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PID ddx

A

Gynae - ectopic, ovarian cyst, endometriosis

UTI

GI - inflammatory bowel, appendicitis, irritable bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PID ix

A

Pregnancy test

Bloods - FBC, CRP, WCC → only abnormal in moderate/severe PID

Urine dip +/- MSU

USG - pelvis

Endocervical/vaginal swab - often negative

Microscopy of vaginal/cervical discharge

Screen for chlamydia & gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PID mx

A

Low threshold for treatment

PO ofloxacin + PO metronidazole OR IM ceftriaxone + PO doxycycline + PO metronidazole (no alcohol)

In patient - IV ceftriaxone + IV doxycycline following by standard PO doxy + metronidazole

Surgical treatment - laparotomy for drainage

Removal of IUD should be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

PID sexual partners

A

Current male partner - screening for chlamydia & gonorrhoea, doxy 7 days

Partners within 6 months - offer screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PID complications

A

Perihepatitis (Fitz-Hugh Curtis syndrome) - more commonly associated with CT PID

Infertility

Chronic pelvic pain

Ectopic pregnancy

Tubo-ovarian abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Fitz-Hugh-Curtis syndrome

A

Adhesions form between the anterior liver capsule & anterior abdominal wall/diaphragm

LFTs are usually normal

Abdominal USS should be performed to rule out the presence of stones

Definitive diagnosis & treatment → laparoscopy & administration of abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ovarian cyst

Study These Flashcards
A

Fluid filled sac within the ovary

Common; especially in the premenopausal patients where benign, physiological cysts predominate throughout the menstrual cycle

24
Q

Ovarian cyst clinical features

Study These Flashcards
A

Often found incidentally on pelvic ultrasound scans

Occasionally, ovarian cysts can cause vague symptoms:

  • pelvic pain
  • bloating
  • fullness in abdomen
  • palpable pelvic mass - mucinous cystadenoma

Acute pelvic pain - torsion, haemorrhage or rupture of the cyst

25
Functional ovarian cyst
Follicular cysts - normally < 3cm, represent the developing follicle in the first half of the menstrual cycle Corpus luteal cysts - normally < 5cm, occur in the luteal phase of the menstrual cycle after the formation of the corpus luteum
26
Pathological ovarian cyst
Endometrioma (chocolate cyst) - present in those with endometriosis, bleeding into the cyst resulting in appearance Polycystic ovaries - USS diagnosis, ‘ring of pearls’ signs Theca lutein cyst - result of a consequence of markedly raised hCG eg. molar pregnancy
27
Epithelial tumours
Serous cystadenoma - most common type of malignant ovarian tumour Mucinous cystadenoma - often multioculated & usually unilateral Brenner tumour - unilateral with a solid grey/yellow appearance
28
Benign germ cell tumours
Mature cystic teratoma (dermoid cysts) - usually occur in young women and occur frequently in pregnancy; can contain teeth, hair, skin & bone
29
Sex-cord stromal tumours
Fibroma - most common type - Meig’s syndrome - triad of ovarian fibroma, pleural effusion, ascites - typically occurs in older women - removal of the tumour results in complete resolution of the effusion and ascites
30
Ovarian cyst pre-menopausal women mx
CA125 does not need to be undertaken when the diagnosis of a simple ovarian cyst has been made on USS LDH, AFP, hCG measured → possibility of germ cell tumours Rescan cyst in 6 weeks, if persistent the monitor with USS & CA125 3-6 monthly and calculate RMI Persistent/over 5cm - laparoscopic cystectomy/oophorectomy
31
Ovarian cyst postmenopausal women mx
Low RMI - follow up for 1 year with USS & CA125 if less than 5cm Moderate RMI - bilateral oophorectomy (if malignancy found → staging required) High RMI - referral for staging laparotomy
32
Ovarian torsion
May be defined as the partial/complete torsion of the ovary on its supporting ligaments that may in turn compromise the blood supply Fallopian tube → adnexal torsion
33
Ovarian torsion risk factors
Ovarian mass Being of reproductive age Pregnancy Ovarian hyperstimulation syndrome
34
Ovarian torsion clinical features
Usually the sudden onset of deep-seated colicky abdominal pain Associated with vomiting and distress Fever may be seen in a minority (possibly secondary to adnexal necrosis) Vaginal examination may reveal adnexial tenderness
35
Ovarian torsion ix and mx
USS - free fluid or a whirlpool sign (not required if torsion is first diagnosis) Admit, IV fluids & analgesia Laparoscopy is usually both diagnostic & therapeutic
36
Threatened miscarriage
Mild symptoms of bleeding with the foetus retained within the uterus as the cervical os is closed ‘threat of miscarriage’ → not certain Little/no pain USS reveals foetus is present intrauterine
37
Missed (delayed) miscarriage
Gestational sac which contains a dead fetus < 20 weeks without the symptoms of expulsion Mother may have light vaginal bleeding/discharge & the symptoms of pregnancy which disappear Cervical os is closed
38
Inevitable miscarriage
Heavy bleeding with clots and pain Cervical os is open Inevitable foetus will be lost
39
Incomplete miscarriage
Not all products of conception have been expelled Pain and vaginal bleeding Cervical os is open
40
Complete miscarriage
Intrauterine pregnancy which has now fully miscarried, with all products of conception expelled & uterus empty Os usually closed May have been alerted to the miscarriage by pain & bleeding
41
Miscarriage aetiology
Idiopathic Foetal pathology - genetic disorder, abnormal development, placental failure Maternal pathology - uterine abnormality, cervical incompetence, PCOS, poorly controlled diabetes, poorly controlled thyroid disease & anti-phospholipid syndrome
42
Miscarriage ix
Transvaginal USS - establish whether there are any foetal components within the uterine cavity & whether foetal heartbeat can be detected Serial serum hCG measurements: - levels fall → foetus will not develop/there has been a miscarriage - only slight increase/plateau in hCG levels → ectopic pregnancy - normal increase in hCG → foetus is growing normally, but does not exclude ectopic pregnancy
43
Miscarriage general mx
Revolves around ensuring complete removal of foetal material If woman is rhesus-, they may require anti-D prophylaxis
44
Miscarriage expectant mx
Waiting for a spontaneous miscarriage First-line & involves waiting for 7-14 days for the miscarriage to complete spontaneously Medical or surgical management may be offered
45
Miscarriage medical mx
Missed miscarriage - PO mifepristone - progesterone receptor antagonist - 48 hours later, misoprostol unless the gestational sac has already been passed - prostaglandin analogue - bleeding not started within 48 hours after misoprostol treatment → contact their healthcare professional Incomplete miscarriage - single dose of misoprostol Antiemetics & pain relief Pregnancy test at 3 weeks
46
Miscarriage surgical mx
Vacuum aspiration or surgical management in theatre Vacuum aspiration is done under local anaesthetic as an outpt
47
Recurrent miscarriage
Defined as a loss of 3 or more consecutive pregnancies
48
Recurrent miscarriage ix
Blood tests - antiphospholipid antibodies, thrombophilia screen Cytogenic analysis of products of conception Pelvic USS to identify uterine abnormalities
49
Recurrent miscarriage mx
Tailed to contributing pathology: - genetic disorder - refer to a clinical geneticist for genetic counselling - donor egg/sperm - continuing pregnancy attempts with prenatal diagnosis - uterine structural abnormality - surgical mx - cervical incompetence - USS monitoring - anti-phospholipid syndrome - heparin or low-dose aspirin
50
Endometriosis
Chronic condition in which endometrial tissue is located at sites other than the uterine cavity Can occur in the ovaries, pouch of Douglas, uterosacral ligaments, pelvic peritoneum, bladder, umbilicus & lungs
51
Endometriosis risk factors
Early menarche FHx of endometriosis Short menstrual cycles Long duration of menstrual bleeding Heavy menstrual bleeding Defects in the uterus or fallopian tubes
52
Endometriosis clinical features
Cyclical pelvic pain, occurring at the time of menstruation Dysmenorrhoea, dyspareunia, dysuria, dyschezia, subfertility Endometriosis at distant sites may experience focal symptoms of bleeding → ectopic endometrial tissue in the lungs = haemothorax O/E - fixed, retroverted uterus; uterosacral ligament nodules, general tenderness (enlarged, tender & boggy uterus = adenomyosis)
53
Endometriosis ix
Gold standard = laparoscopy - chocolate cysts - adhesions - peritoneal deposits Pelvic USS can also help determine the severity of endometriosis
54
Endometriosis mx
Based on the individual requirements of each patient Pain - can be managed through analgesia or NSAIDs Ovulation - low dose COCP/norethisterone; mirena can also be used Surgery - excision, fulgaration & laser ablation aim to completely remove the ectopic endometrial tissue in the peritoneum, uterine muscle & pouch of Douglas to reduce pain - surgery may have to be repeated - ultimate mx = hysterectomy & removal of ovaries
55
Fibroid degeneration
Degeneration due to excessive growth that outmatches blood supply or mechanical compression of feeder arteries Constant dull ache responding to opioids Ix - palpable mass, inflammatory markers raised Mx - conservative esp. in pregnancy, emergency surgery due to pedunculated fibroid torsion
56
Haematocolpos
Paediatric Cyclical pain, no bleeding O/E - bluish membrane at introitus Mx - admit, I&D, cruciate incision

Y4 reproductive health (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions