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Pelvic Pain Mr James Campbell.

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Presentation on theme: "Pelvic Pain Mr James Campbell."— Presentation transcript:

1 Pelvic Pain Mr James Campbell

2 Overview Causes of pelvic pain Gynaecological terminology
Common gynae. pathologies Chronic pelvic pain Case study

3 Causes of pelvic pain Gynaecological – Dysmenorrhoea Endometriosis
Adenomyosis Infection Fibroids Post-operative pain Ectopic pregnancy

4 Causes of pelvic pain Gastrointestinal IBS Inflammatory bowel disease
Diverticulitis Colon / rectal carcinoma appendicitis

5 Causes of pelvic pain Urological Musculoskeletal Psychological
Painful bladder syndrome Bladder infection Musculoskeletal Referred pain from lower back Psychological Depression; sexual abuse

6 Terminology Dysmenorrhoea Primary / spasmodic Secondary / congestive
pain associated with menstruation Primary / spasmodic not associated with organic pathology Secondary / congestive due to organic pathology

7 Dysmenorrhoea Prostaglandin production Myometrial contractions
Decreased blood flow PAIN

8 Dyspareunia Pain associated with intercourse
Superficial – pain at / around the labia Deep – pelvic pain (associated with organic pathology)

9 Gynaecological Pathology

10 Endometriosis Deposits of endometrial tissue outside the uterine cavity Most common sites are the ovary (chocolate cysts) and uterosacral ligaments

11 Aetiology Implantation theory Coelomic metaplasia theory
Retrograde menstruation Coelomic metaplasia theory Mullerian duct Peritoneal and pleural cavities Ovaries (all derive from the coelomic epithelium)

12 Symptoms and signs Dysmenorrhoea Dyspareunia Sub-fertility
Menstrual dysfunction Signs in severe disease Fixed tender uterus Adnexal mass Nodular POD

13 Investigations Laparoscopy USS / MRI Tissue biopsy

14 Management Conservative Medical Surgical Analgesia (+ counselling)
Hormonal agents Surgical Laparoscopic ablation Cystectomy Hysterectomy

15 Adenomyosis Endometrial tissue within the myometrium
Main risk factor is high parity Causes HMB and dysmenorrhoea

16 Histological diagnosis

17 Pelvic inflammatory disease
Chlamydia Gonococcus Lower abdominal pain Deep dyspareunia Abnormal bleeding / discharge IMB in young patient think chlamydia

18 PID - examination Cervical discharge / tenderness Adnexal mass

19 Management Investigations – Treatment Temperature Bloods Swabs
Urinary PT USS Treatment Antibiotics (oral / IV) Partner tracing / treatment

20 Ovarian cysts Simple / complex Benign / malignant

21 Cysts are painless unless -
Twist – torted ovary Haemorrhage Rupture They are very large and cause pressure

22 Ectopic pregnancy Symptoms – Investigations Management
Acute unilateral lower abdominal pain Bleeding Collapse Investigations PT / serial HCG’s USS Management Supportive / medical / surgical Collapse in young woman think ectopic

23 Fibroids Benign tumours of the myometrium
Common – 1 in 3 over 30 years Hormone dependent Symptoms related to size and position

24 Fibroids Asymptomatic HMB Pressure Pain rarely occurs
Usually associated with complications Degeneration torsion

25 Chronic pelvic pain Can arise form any system either de novo or following acute pelvic pain “pain not occurring with menses, intercourse or pregnancy causing distress and /or disability that has persisted for greater than 6 months”

26 Types of chronic pelvic pain
Organic – Due to tissue damage (endometriosis) Psychological – Can occur without tissue damage Cancer Benign Occurs despite tissue healing (adhesions)

27 Case study 45 yr old woman attends the clinic with pelvic pain of 2 years duration Consultant is away and you are in charge

28 History Intermittent pain / 2-3 episodes daily Unrelated to menses
Bilateral / no associated factors Heavy periods Sexually active / on cerazette LSCS 1990 / appendicectomy 2006 Mother had hysterectomy No bowel / urinary dysfunction

29 Examination Speculum Normal Bimanual Bulky uterus No adnexal masses

30 Investigations PT – negative Swabs – negative USS –
Multiple small intramural fibroids, largest 2cm, ovaries normal

31 Differential diagnosis
Surgery related pain Fibroids / endometriosis IBS Psychological Diagnosis – made at laparoscopy Post operative adhesions / ovarian entrapment

32 Ovarian adhesions

33 Pelvic pain Thanks for your attention. Questions?

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