Pelvic pathology Flashcards
(37 cards)
What are the DDx of acute pelvic pain?
1) Preg
- Obs: labour, placenta abruptio, ligamentous pain
- Gyn: ruptured ectopic pregnancy, miscarriage / septic abortion, red degeneration of fiborid
2) Mass: ovarian cyst, pedunculated fibroid cx
3) Inf: PID, tubo-ovarian abscess
4) Others: appendicits, UTI/AROU
What are the DDx of chronic pelvic pain?
Gyne: PID, pelvic adhesion, post-operative pain, mass (endometriosis, adenomyosis, fibroid)
GI: IBS/IBD, diverticulitis, CRC
UG: chronic urethral syndrome, intestitial cystitis
Others: MSK, psycho
What are the DDx of central acute pelvic pain?
Uterus: fibroid, miscarriage, endometritis
What are the DDx of unilateral acute pelvic pain?
Ovary: cyst Cx
Tubal: ectopic pregnancy, tubo-ovarian abscess
RLQ: appendicitis
What are the DDx of sharp acute pelvic pain?
Ectopic pregnancy
What are the DDx of persistent acute pelvic pain?
Ectopic pregnancy
Ovarian cyst rupture
PID
What are the DDx of contractile acute pelvic pain?
Miscarriage
Protruding submucosal fibroid
What are the DDx of colicky acute pelvic pain?
Ovarian torsion
Colic (bowel, ureter)
What are the DDx of acute pelvic pain + PVB?
Pregnancy (miscarriage, ectopic)
Uterine / cervical (e.g. submucosal fibroid)
PID (IMB, post-coital B, breakthrough B)
What are the DDx of acute pelvic pain + fever?
Septic abortion
Acute PID
Appendicitis, UTI
What are the DDx of acute pelvic pain + hemodynamic compromise?
Ruptured cyst, ectopic pregnancy
What is uterine fibroid / leiomyoma?
Benign monoclonal tumors from sm cells & fibroblasts of myometrium
What is the prevalence of uterine fibroids?
MC gyne tumor
25% of women of reproductive age
Increases w/ age
What is the chance of malignant transformation of uterine fibroids?
Rare (<0.1%)
What affects the size of uterine fibroids?
Estrogen-dependent growth
- Size increases w/ exogenous estrogen
- Decreases w/ menopause
What are the types of fibroids?
Intramural (MC): menorrhagia, pressure symptoms
Submucosal: menorrhagia, dysmenorrhea, infertility -> 3 ESH subtypes
Subserosal: risk of torsion
Cervical (LC): menorrhagia, obst bladder
What are the S/S of uterine fibroids?
Hx
1) Acute pain
2) Menses (menorrhagia, dysmenorrhea)
3) Pressure symptoms (abd discomfort, urinary freq/retention, constipation)
4) Subfertility
5) Pregnancy: red degen (acute localized uterine pain in 2nd/3rd trimester), miscarriage/preterm/malpresentation, PPH
PE
- Abd: enlarged uterus (asm vs sym)
- Bimanual: prolapsed submucosal fibroid
How to Ix uterine fibroids?
USG pelvis: distinct mass w/ capsule
Hysteroscopy & saline infusion sonography: for submucosal fibroid
MRI
How to Mx uterine fibroids?
x symp: expectant, medical (for menorrhagia)
Small fibroid <5cm: hysteroscopic myomectomy
Large fibroid >5cm OR sig symp: fertility wish (myomectomy), x fertility wish (hysterectomy), x fit for surg (UAE)
What is endometriosis?
Endometrial tissue outside of uterine cavity
What are the factors affecting the growth of endometriosis?
Increase: estrogen
Protective: pregnancy, lactation
What is the prevalence of endometriosis?
10-20% of females
Increasing b/c fewer pregnancies and more late pregnancies
What is the pathogenesis of endometriosis?
Sampson’s theory: retrograde flow of menstrual tissue through tube -> transported trans-abdominally
What is the gross pathology of endometriosis?
Red: recent hemorrhage
Blue: hemosiderin
White: fibrotic tissue
