Abdominal and Pelvic Pain - PowerPoint PPT Presentation

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Abdominal and Pelvic Pain

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... (PID) Bacterial inflammation of cervix, uterus, tubes and ovaries Bilateral disease 1st infection single agent Repeat:multiple agents Two categories: ... – PowerPoint PPT presentation

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Title: Abdominal and Pelvic Pain


1
Abdominal and Pelvic Pain
CAPT Mike Hughey, MC, USNR
2
Uncertainty of Diagnosis
When I see a woman with abdominal or pelvic
pain, I often haven't a clue as to what the
problem is, even using ultrasound, a full lab,
and countless consultants. All I know is that
the patient is sick with something.
3
The Point is
In gynecology, the diagnosis is often obscure.
You must frequently treat the patient before
you know the correct diagnosis.
4
The Other Point is
More important than knowing the correct
diagnosis is doing the right thing for the
patient.
5
Pain of Unknown Cause
Bedrest for a few days is never the wrong thing
to do.
6
Pain and Fever
  • Give antibiotics to cover PID
  • Mild symptoms respond to PO drugs.
  • Severe symptoms respond to IVs.

7
Chronic Pelvic Pain
  • Doxycycline
  • OCPs
  • Refer to GYN if pain persists

8
Pregnancy Test
Every patient complaining of lower abdominal pain
should have a pregnancy test.
9
BCPs and Pain
  • Most with chronic pain benefit from BCPs
    -dysmenorrhea -ovarian cysts
    -endometriosis -adenomyosis
  • Monophasic better
  • Cyclic vs. Continuous

10
Dysmenorrhea
  • Painful Periods
  • Back ache
  • Pelvic cramps
  • NSAIDs
  • BCPs
  • If persistent and severe, laparoscopy to rule out
    endometriosis

11
Mittelschmerz
  • Mid-cycle pain
  • Unilateral
  • NSAIDs
  • BCPs

P
12
IUDs and Pain
ALWAYS, remove the IUD
13
IUDs and Pain
5 become infectedPain, tenderness,
feverRemove IUD and begin ABxOral or IV,
depending on high fever or severe symptoms.
14
IUDs and Pain
  • Never push an IUD back in place if it is partway
    expelled.
  • Always remove an IUD if the patient complains
    of -pelvic pain -tenderness
    -abnormal bleeding

15
Ovarian Cysts
  • May be normal (lt4 cm)
  • 95 disappear within 1-2 months
  • May cause problems -delay menstruation
    -Rupture -Torsion -Pain

16
Ovarian Cyst Ruptured
  • May go unnoticed
  • May cause abdominal or shoulder pain
  • Usually resolves with rest alone
  • Sometimes requires surgery (bleeding)

17
Ovarian Cyst Unruptured
  • May go unnoticed
  • May cause pain
  • Usually resolve spontaneously
  • Sometimes requires surgery (pain)
  • Ultrasound scan of persistent cysts

18
Ovarian Cyst Torsioned
  • Severe unilateral pain
  • Marked rebound and rigidity
  • Surgery indicated within 24 hours
  • If surgery unavailable -IVs, NPO, bedrest
    -Metabolic acidosis -20-50 Mortality

19
Pelvic Inflammatory Disease (PID)
  • Bacterial inflammation of cervix, uterus, tubes
    and ovaries
  • Bilateral disease
  • 1st infection single agent
  • Repeatmultiple agents
  • Two categories
  • Mild
  • Moderate to Severe

20
PID Mild
  • No fever
  • Bilateral pelvic pain
  • Cervical motion tenderness
  • WBC near normal
  • Doxy 100 BID 28, plus
  • Cefoxitin/Probenecid
  • Ceftriaxone
  • Ceftizoxime
  • Cefotaxime

21
PID Moderate to Severe
  • Fever gt 100.4
  • Bilateral pelvic pain
  • Cervical motion tenderness
  • WBC elevated
  • IV antibiotics

22
PID Treatment Moderate to Severe
  • Clinda/Gent
  • Ofloxacin/Flagyl
  • Amp/Sulbactam/Doxy
  • Cipro/Doxy/Flagyl
  • Doxy/Cefoxitin/Cefotetan

23
Endometriosis
  • Progressive pelvic pain
  • Deep Dysparunia
  • Dysmenorrhea
  • Tender nodules in cul-du-sac

24
Endometriosis Treatment
  • Conservative Surgery
  • Radical Surgery
  • Danazol, Lupron
  • Continuous BCPs

25
Degenerating Fibroid
  • Bulky, irregular, tender uterus
  • 40 of women gt40 have them
  • Supportive treatment
  • Symptoms gradually resolve over 3 weeks
  • Surgery for anemia, chronic pain, size gt12 weeks

26
Cystitis
  • Urgency, frequency, dysuria
  • Always treat
  • Push fluids (citric acid)
  • Any broad-spectrum ABx -Ampicillin (Amox)
    -Keflex -Bactrim DS -Doxycycline
  • Pyridium helps symptoms

27
Pyelonephritis
  • Urgency, frequency, dysuria
  • Fever, flank pain/tenderness, chills
  • Push fluids (citric acid)
  • Any broad-spectrum Abx
  • Probably will need IV antibiotics

28
Gastroenteritis
  • Diffuse, cramping pain
  • Nausea, vomiting, diarrhea
  • Fever, chills, distension
  • Pain moves from place to place
  • Supportive therapy
  • IVs
  • Antibiotics
  • Cultures

29
Functional Bowel Syndrome
  • Intermittent pain
  • Diarrhea/Constipation
  • Stress related
  • Moves from place to place
  • Supportive Rx
  • Antispasmotics
  • No narcotics
  • No psychoactives

30
Appendicitis
  • Progressive RLQ pain
  • Nausea/Anorexia
  • Guarding/Rigidity
  • Rebound
  • WBC variable

31
Appendicitis Treatment
  • Surgery
  • NPO/IVs
  • Antibiotics
  • Mefoxin/Gent
  • Flagyl/Gent
  • Amp/Sulbactam/Doxy
  • Clinda/Gent
  • Oflaxacin/Flagyl
  • Cipro/Doxy/Flagyl
  • Doxy/Cefoxitin/Cefotetan

32
Bowel Obstruction
  • Cramping pain and distension
  • Hx abdominal surgery
  • X-ray distended loop
  • Most are partial obstructions
  • IV fluids
  • Decompression
  • Surgery

33
Diverticular Disease
  • Variable presentation (mild to severe)
  • Cramping pain and distension
  • Blood streaked stool
  • Fever, WBC
  • IV fluids
  • Antibiotics
  • Sometimes Surgery

34
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