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21 Cards in this Set
- Front
- Back
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#1 tx for dysmenorrhea?
Off label use? |
antiprostaglandins
NSAIDs - OCP or nuva ring |
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Someone plays tennis and sudden pelvic pain?
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ovarian torsion or rupture of ovarian or fallopian tube cyst (dx w/ pelvic ultrasound)
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Acute pelvic pain differential diagnosis (female)?
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Differential includes:
1. Ovarian Torsion or rupture of ovarian or fallopian tube cyst (diagnose with pelvic sonogram) 2. Functional ovarian cyst (diagnose with sonogram, looking for hemoperitoneum) 3. Endometritis/PID 4. Ectopic Pregnancy 5. Appendicitis 6. Acute Cystitis 7. Ureteral Stone Formation |
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Acute pain such as hanging out making a phone call... what might this lead to?
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ruptured ovarian cysts- looking for hemoperitoneum (free fluid)
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What is chronic pelvic pain defined?
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pelvic pain more than 6 months duration that has a significant effect on daily function and quality of life
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What is commonly presented as same as acute appendicitis?
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PID
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Trick to diagnosing severe acute pelvic pain as ectopic pregnancy?
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Should show + pregnancy test
If negative pregnancy test it should be ovarian cyst |
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What is dysmennorhea?
What is thought to be cause? |
painful menses accounts for 600 million lost work hrs and 2 billion in lost productivity annually
- thought to be caused by release of prostaglandins in the menstrual fluid |
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Chronic pelvic pain differential (Gynecologic)?
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1. Endometriosis
2. Gynecologic malignancies 3. Pelvic inflammatory disease 4. Pelvic adhesions 5. Adenomyosis- endometrial glands in myometrium 6. Chronic Endometritis 7. Symptomatic pelvic relaxation (prolapse pain) |
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Runner who had twins and can no longer run long before pressure in vag is too much what type of pain is this?
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prolapse pain (symptomatic pelvic relaxation)
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D/d of pelvic chronic pain for urologic cause?
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1. bladder malignancy
2. interstitial cystitis 3. chronic urinary tract infection 4. urolithiasis |
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Interstitial cystitis defined?
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urine is irritating the bladder all the time ... chronic inflammatory condition of bladder characterized by irritative voiding symptoms of urgency and frequency – suprapubic pain, UTI symptoms with negative urine cultures frequent findings)
- bladder infection feel with negative cultures all the time |
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Define endometriosis?
What is adenomyosis? |
endometrial glands and stroma found outside uterus
- endometrial glands and stroma in uterine musculature |
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What are the theories behind the causes of endometriosis?
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a. Retrograde menstruation (altered humoral and cell mediated immunity)
B. Coelomic metaplasia C. Vascular/lymphatic spread D. Direct spread (ex. Endometriosis in a csection scar) E. Likely a combination with immunologic changes and genetic predisposition |
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Classic triad of pain of endometriosis?
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dysmenorrhea, intermenstrual pain, dyspareunia
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What is the therapeutic trial associated with treatment of endometriosis?
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Data suggests that GNRHa (Depo-Lupron) likely to improve symptoms. However, follow up surgery may demonstrate
that 20% of these patients may not have had endometriosis |
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Gold standard to dx endometriosis?
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Laparoscopy with excisional biopsy and confirmatory histology (preferred
but not required) |
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MC spot for endometriosis to be found?
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50% ovary but...
- uterine cul-de -sac • Uterosacral ligaments • Posterior surfaces of uterus • Pelvic peritoneum • Look at bladder, bowel, appendix,ureter |
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What do you see in laparoscopic findings of endometriosis?
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chocolate cysts, powder burns (blue black lesions), red/purple raspberry spot
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What is non-surgical treatment for endometriosis?
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1. Observation-if desire pregnancy Mild disease.
Surgery vs.. Expectancy NO DIFFERENCE 2. Analgesia- NSAIDs for pain- narcotics only if nothing else works 3. OCPs- (seasonique, lybrel-- continuous pill for 6-12 months) could cause decidual changes in the tissue (suppressive effect) 4.. rogesterone (medroxyprogesterone, megestrol acetate, depo medroxyprogesterone, IUS) 5. Danazol- weak androgen Inhibits gonadotropin release at the hypothalmus- NO FSH/LH surge at midcycle (gives a HYPO-estrogenic effect which prevents endometrial growth) 6. GNRH agonist- causes suppression of gonadotropin secretion and suppression of endometrial implants (lupron "leuprolide acetate") add Norethindrone |
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Surgical treatment of endometriosis
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conservative vs. definitive surgery
conservative- lyse adhesions, remove endometriosis and restore anatomy (w/laproscopy) Definitive treatment- failed conservative and or past child bearing remove lining and ovaries |
