tailieunhanh - HIGH-YIELD FACTS IN - Pelvic Pain

Definition and Criteria ≥ 6 months of pain Incomplete relief by medical measures Altered activities due to pain (., missed work, homebound, depression, sexual dysfunction) Etiologies Leiomyoma Endometriosis Adhesions, adenomyosis Pelvic inflammatory disease (PID) Infections other than PID Neoplasia Workup 1. Detailed history (focusing on above etiologies): Temporal pattern Radiation Associated symptoms Past surgeries Last menstrual period (LMP) 2. Physical exam: Look for: Masses Cervical motion tenderness Gastrointestinal (GI) complaints Neurological testing 3. Relation of pain to basal body temperature elevation (to rule out mittelschmerz pain associated with ovulation) 4. . | high Pelvic Pain CHRONIC PELVIC PAIN Definition and Criteria 6 months of pain Incomplete relief by medical measures Altered activities due to pain . missed work homebound depression sexual dysfunction Etiologies Leiomyoma Endometriosis Adhesions adenomyosis Pelvic inflammatory disease PID Infections other than PID Neoplasia Workup 1. Detailed history focusing on above etiologies Temporal pattern Radiation Associated symptoms Past surgeries Last menstrual period LMP 2. Physical exam Look for Masses Cervical motion tenderness Gastrointestinal GI complaints Neurological testing 3. Relation of pain to basal body temperature elevation to rule out mit-telschmerz pain associated with ovulation 4. Blood work Complete blood count CBC Pregnancy test Pelvic pain accounts for 12 of hysterectomies 40 of diagnostic laparoscopies and 40 of 2 and 3 office visits. Chronic pelvic pain Think of leapin pain. Leiomyoma Endometriosis Adhesions adenomyosis Pelvic inflammatory disease PID Infections other than PID Neoplasia PID is the most common cause of chronic pelvic pain. 173 Mittelschmerz is pelvic pain associated with ovulation. rC- Laparoscopy is the final conclusive step in diagnosing pelvic pain but it should only be done once psychogenic causes are considered carefully. STS serotest for syphilis Urinalysis UA Occult blood Blood culture 5. Radiographic studies Abdominal and vaginal sonogram Computed tomography CT Magnetic resonance imaging MRI Barium enema Bone scan Renal sonogram intravenous pyelogram IVP 6. Colonoscopy and or cystoscopy should be perfomed if all above are inconclusive 7. Rule out psychosomatic pain. 8. Diagnostic laparoscopy HIGH-YIELD FACTS ACUTE PELVIC PAIN Differential of acute pelvic pain A ROPE Appendicitis Ruptured ovarian cyst Ovarian torsion abscess PID Ectopic pregnancy Differential of Acute Pelvic Pain Appendicitis Ruptured ovarian cyst most common Ovarian torsion abscess PID Ectopic pregnancy spells A rope See Table 17-1. You always want to .