Gynecologic Pain: Acute Pain...Recurring Pelvic Pain...Chronic Pain...Vulvar Pain...Pain Due to Complications of Gynecologic Surgery...Summary...Test Questions (CME)

From: Helen Dynda (olddad66@runestone.net)
Fri Apr 18 13:47:13 2003


X> Gynecologic Pain (September 20 2002).....Acute Pain ... Recurring Pelvic Pain ... Chronic Pain ... Vulvar Pain ... Pain Due to Complications of Gynecologic Surgery ... Summary ... Test Questions (CME)

http://author.emedicine.com/MED/topic3341.htm

1.) ACUTE PAIN:

Ectopic pregnancy ..... Adnexal masses (Corpus luteum hematoma; Ruptured ovarian cyst; Ovarian torsion) ..... Acute pelvic inflammatory disease (Diagnostic criteria for PID; Outpatient management of PID; Inpatient management of PID; Admission criteria for PID) ..... Tubo-ovarian abscess ..... Fibroids (Degenerating fibroid; Twisted subserous fibroid; Submucous fibroid)

2.) RECURRING PELVIC PAIN:

Mittelschmerz ..... Endometriosis ..... Primary dysmenorrhea ..... Secondary dysmenorrhea ..... Adenomyosis

3.) CHRONIC PELVIC PAIN:

Dyspareunia as a significant factor ..... Adhesions ..... Chronic pelvic inflammatory disease ..... Ovarian remnant syndrome ..... Irritable bowel syndrome (Rome criteria for IBS) ..... Myofascial pain ..... Interstitial cystitis (Required findings; Automatic exclusions; Treatment options) ..... Urethral syndrome ..... Post-hysterectomy syndrome ..... Treatment modalities for chronic pelvic pain (Laparoscopy; Laparoscopic uterine nerve ablation; Presacral neurectomy; Hysterectomy; Other treatments)

4.) VULVAR PAIN:

Contact vulvitis ..... Contact vulvitis ..... Atrophic vaginitis ..... Microbial vaginitis ..... Vulvodynia

5.) PAIN DUE TO COMPLICATIONS OF GYNECOLOGIC SURGERY:

"Thermal bowel injury is a serious complication of surgery. It occurs in 0.5-3.2 per 1000 cases, and symptoms may not develop for days or weeks. Patient presentation includes bilateral lower quadrant pain, tenderness, fever, leukocytosis, and peritonitis. Ileus or free gas under the diaphragm may be noted on a plain abdominal x-ray film.

"Peritonitis may occur as a consequence of undetected bowel perforations. Other complications include abscess, enterocutaneous fistula, and septic shock.

"Thermal injury to the bladder or ureter may manifest up to 14 days postoperatively with abdominal or flank pain, fever, and peritonitis. Findings from an intervenous pyelogram demonstrate extravasation of urine or urinoma. Patients with mechanical obstruction may present in 1 week with a similar clinical picture.

"Incisional herniae rarely become incarcerated. Patients present with abdominal pain and signs of bowel obstruction or perforation.

"Hysteroscopy commonly leads to uterine perforation, which may involve the bowel. Such a possibility should be kept in mind when evaluating a patient.

"Following a vaginal hysterectomy, patients may present with pelvic pain due to vaginal cuff hematoma, cellulitis, or ovarian abscess. Wound compilations such as dehiscence, renal angle pain due to ureteric injury, and retention should be considered.

"Osteitis pubis is a possibility in patients who undergo a Marshall-Marchetti-Krantz procedure and operations for vaginal vault prolapse and urinary incontinence that use bone-anchoring systems."

6.) SUMMARY: Table. Causes of Gynecologic Pain

7.) TEST QUESTIONS (CME)


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