Tubal and Uterine Pelvic Pain

  1. Infectious causes of fallopian tube pathologies:
    • Salpingitis
    • PID (upper gyn organs)
    • Abscess
  2. Benign neoplasms etiologies of fallopian tube pathologies:
    • Endometriosis
    • Paratubal cyst
    • Teratoma
  3. What is/are the most common cause(s) salpingitis/ PID/ fallopian tube abscess?
    Gonorrhea and Chlamydia
  4. T/F: there is increased risk for PID with IUD insertion
    True; after initial placement, that is why it is important to culture prior to placement
  5. What is pelvic inflammatory disease?
    acute infection of upper genital tract, this includes uterus, ovaries, fallopian tubes, and often with surrounding organs
  6. How is PID diagnosed? (criteria for diagnosis)
    Lower abd or pelvic pain PLUS CMT or uterine/adnexal tenderness
  7. What is the timing for treatment of PID?
    Treat empirically and do not wait until results confirm the diagnosis, just give them antibiotics
  8. Why would you order CT scan to evaluate PID when ultrasound is the preferred imaging for pelvic organs?
    Because appendicitis could also mimic PID, so CT to r/o appendicitis
  9. What is fitz-hugh-curtis?
    • Perihepatic adhesions (liver adheres to walls of peritoneum and diaphragm) and this can cause RUQ pain.
    • This is associated with PID
  10. Fitz-hugh-curtis treatment?
    Possibly with laparoscopy to break up adhesions between the liver to the peritoneum walls
  11. Which imaging is recommended post-PID or ectopic pregnancy?
    HSG – to evaluate tubes patency
  12. When benign fallopian tube neoplasms are found on exam, when is the time to intervene?
    • If there is pain/ torsion or growth of the neoplasm
    • Otherwise just follow with serial US to make sure it is not growing out of control
  13. 98% of ectopic pregnancy occurs in _____ while the rest is found in _____
    • Fallopian tube
    • 2% is cervical, interstitial, ovarian or abdominal
  14. 28 year old patient comes in complaining of lower abdominal pain and irregular spotting that is less than her regular period. LMP was 6 weeks ago. _____ should ALWAYS be in the DDx
    Ectopic pregnancy (hallmark sxs are first trimester bleeding and abd pain)
  15. T/F PID is a risk factor for ectopic pregnancy
    True; so treat PID with abx to help prevent this
  16. Clinical presentation for ectopic pregnancy:
    • Amenorrhea
    • First trimester spotting
    • Pelvic pain
    • Hypotensive from hemorrhage if ruptures (this is the scariest presentation)
  17. hCG should double in _____ days. Over ______ IU/L should see intrauterine pregnancy on TVUS
    • 2-3
    • 1500 IU/L
  18. Progesterone level during pregnancy should be ____
    Less than 10
  19. What are treatments for ectopic pregnancy?
    Must terminate via either medical (use of methotrexate) or surgical (salpingectomy vs salpingostomy vs hysterectomy)
  20. T/F: fallopian tube cancers are rare, with no evidence of increased risk with h/o PID, HPV, or hysterectomy
  21. What is the Latzko’s triad?
    • Signs and symptoms of fallopian tube malignancy
    • Serosanguinous vaginal discharge (watery and bloody)
    • Pelvic pain
    • Pelvic mass
  22. Malignant uterine masses include:
    • Endometrial adenocarcinoma
    • Uterine sarcoma
  23. Nonmalignant uterine masses include:
    • Uterine polyps
    • Leiomymata/myomata/fibroid
    • Adenomyosis
    • Endometriosis
    • Pregnancy (fetus is a benign mass)
  24. T/F: uterine polyps are stimulated by progesterone
    False; they are stimulated by estrogen
  25. How do uterine polyps present clinically?
    Present as irregular menses, post coital spotting, post menopausal bleeding
  26. T/F: uterine polyps are benign, there is no need to remove unless it is causing severe pain
    False; it should be removed via D&C or hysteroscopy
  27. What is uterine leiomyomata?
    • freaking fibroids!
    • Benign monoclonal tumors arising from muscle cells of myometrium can be found in various uterine locations
  28. Patient c/o heavy prolonged menses with pelvic pain, GU and infertility issues, think ______
    Fibroids, aka uterine leiomyomata
  29. Bimanual exam revealed enlarged uterus and irregular adnexa, likely ______, and this would be confirmed via _____
    • Uterine leiomyomata
    • Ultrasound, (also workup for anemia could point to uterine fibroids)
  30. T/F: It patient is anemic, it is possible that she has uterine fibroids
  31. Treatments for symptomatic uterine leiomyomata:
    • NSAIDs
    • GnRH agonists
    • Uterine artery embolization (UAE)
    • Mymomectomy (removing a single fibroid)
    • Hysterectomy
  32. What is uterine artery embolization?
    Destroys artery that is bleeding, contraindicated if the patient wants to become pregnant later, cuz this may affect uterine blood supply
  33. T/F: uterine fibroids can outgrow their blood supply and undergo necrosis; it can also release prostaglandins
    True; this occurs when pt has undergone UAE and menopause and ischemic tissue causes pain and shrinkage of fibroid and eventual calcification
  34. What is adenomyosis?
    Endometrial glands and stroma grown present WITHIN uterin musculature
  35. Patient c/o severe dysmenorrhea and pelvic pain, bimanual exam revealed enlarged and boggy uterus, you are thinking it is ______, and would treat with ______
    • Adenomyosis
    • Treat medically with hormones or surgically with hysterectomy
  36. T/F: adenomyosis is a type of endometriosis but smaller in endometrial gland growth
    False; it is not endometriosis, endometriosis is present of glands and stroma OUTSIDE of the endometrium and uterine musculature, whereas Adenomyosis is WITHIN uterine musculature. Sizes have nothing to do with it, I made it up
  37. ______ can present as mass on pelvic ultrasound anywhere, can occur as far away and as bizarrely as in the lungs/ diaphragm
    Endometriosis (vs adenomyosis would just be within the uterine musculature)
  38. What is the most common form of uterine cancer?
    Endometrial adenocarcinoma
  39. What is endometrial adenocarcinoma?
    • Malignant transformation of endometrial glands
    • Most common form of uterin cancer
  40. 60 year old female comes in with postemenopausal bleeding with associated urinary problems and pelvic pain, think _____
    • Malignancy
    • Endometrial adenocarcinoma
  41. Pathological endometrium on ultrasound would show ____ walls
  42. T/F: smoking, coffee and tea use would decreased the risk of endometrial cancer
    • True!
    • But don’t go and recommend people to start smoking to prevent endometrial cancer, you’ll probably get sued
  43. What factors could decrease the risk for endometrial cancer?
    • postemenopausal progestins
    • Combined E&P OCP
    • Coffee/Tea/ smoking
    • Over 25 years of age at last birth
  44. What factors could increased the risk of endometrial cancer?
    • prolonged estrogen exposure
    • DM
    • HTN
    • Early menarche
    • Late menopause (basically whatever that gives you more estrogen exposure)
    • Nulliparity (never been pregnant, so always had estrogen at some point)
    • PCOS
    • H/O breast ca
  45. What is the PAP smear screening recs for pt with h/o endometrial cancer?
    Need to do it annually because high risk of recurrence occur at vaginal cuff
  46. T/F: pt with endometrial cancer who cannot undergo surgery, can be treated with strong progestins instead
Card Set
Tubal and Uterine Pelvic Pain
Endo Exam 4