骨盆腔疼痛課件

骨盆腔難過急性骨盆腔難過慢性骨盆腔難過診斷急性骨盆腔難過-常見緣由早期懷孕併發(fā)癥,像ectopicpregnancy&miscarriagePIDAppendicitisOvariancyst”accident”orMittelschmerz急性骨盆腔難過-其它緣由OHSSHematomatraorhematocolposNecrosisofuterinefibroid其他非婦產(chǎn)科的緣由,像腸道或泌尿道疾病OvariancystaccidentDermoidcysts,teratomas,orsimplecystsaremorecommoncauseoftorsionResultoftorsion(leadingtoocclusionofbloodsupplyandnecrosis)Presentingsymptomofovarianneoplasm,morecommonassociatedwithfunctionalovariancystsinyoungerAcutechemicalperitonitisiftheycontainirritantmaterial(asendometrioticordermoidcysts)OvariancystaccidentPainpatternoftorsion:-suddenonsetofcolikypelvicpain-locatedtooneorotherofiliacfossa-moreconstantafterseveralhoursordisappear-initiallyapyrexial,lateronnecrosiscancausepyrexiaMittelschmerzFromgermanmittel=middleandschmerz=painMiddlecyclepainoccuringatthetimeofovulationMorecommonlyinteenagersandolderwomen慢性骨盆腔難過-定義難過的時候超過六個月慢性骨盆腔難過是影響生殖年齡女性最常見的婦科問題常見緣由EndometriosisChronicpelvicinflammatorydiseasePelvicadhesionBowelrelatedpainUrologicalcausesMusculoskeletalpainNeuropathicpainPsychologicalfactors骨盆腔沾粘引起難過的緣由還不清晰Inuncontrolledstudies,adhesionlysisreliefpainInarandomizedcontrolledtrial,adhesionlysis只徵對嚴重緻密血管豐富牽連到腸子的沾粘有幫助,對一般的簡單骨盆腔沾粘沒用Ovarianremnantsyndrome-卵巢周圍有緻密的纖維沾黏所引起的難過,藉由抑制或移除卵巢可緩解難過骨盆腔充血PelvicveindilatationcyclicaldraggingpelvicpainOccureinpremenstrualphaseofcycleandworseninstandingorwalking發(fā)生的位置與強度變異性大,和深度的性交難過有關(guān)Dilatedvein有時可由laparoscopyorultrasound看到骨盆腔充血-治療MPA(medroxyprogesteroneacetate)30-50mgdailyfor3months-sideeffect:weightgain,amenorrhea,bloatingGnRHanalogue-inhibitovarianfunctionSeverecases-TAH+BSOcurative腸道有關(guān)的難過Irritablebowelsyndrome-是最常見引起腸道有關(guān)的慢性骨盆腔難過,影響10-20%的一般族群,?？捎绊懮衬挲g的女性-它是功能性的疾病,由難過的病史及腸胃道的癥狀診斷,可用高纖食物及anti-spasmodicdrugsconstipation-也是常見腸子脹及慢性骨盆腔難過的緣由Inflammatoryboweldisease-painandbloodydiarrhea泌尿道的緣由(I)Interstitialcystitis-不明緣由的發(fā)炎情況,它可引起難過及泌尿道的癥狀,像frequency,urgency,nocturia;當(dāng)膀胱脹滿,難過會增加,當(dāng)解尿後,難過會緩解-可用膀胱鏡診斷(submucosaledemaandpetechiae)-dyspareunia(+)泌尿道的緣由(II)Chronicurethralsyndrome-symptomsofirritation,postvoidingfullness,incontinenceOtherconditions:urethraldiverticulae,urinarycalculi,bladderneoplasm,orradiationcystitis肌肉骨骼難過Sacroiliacdysfunction-難過發(fā)生在關(guān)結(jié)本身或有關(guān)的肌肉經(jīng)巒,難過在移動時會惡化Abnormalposture-chronicmuscletensionandstrainonjointsandligamentsTensionmyalgiaofthepelvicflooritself神經(jīng)引起的難過難過源自受傷的神經(jīng)而不是受傷的組織NerveentrapmentinscartissueorfasciaSharp,stabbinginnature,orconstantdullacheDiagnosis-confirmedbyinjectinglocalanaestheticatthesiteofmaximaltendernessPrescaralneurectomyforpatentswithendometriosiswithmixedresults精神上的緣由促進因子:精神上,身體上及社會的緣由這些因子的平衡將隨著病人間與個別疾病的不同時間而有變化它會惡化睡覺品質(zhì)與造成憂鬱沮喪精神上的問題較常是結(jié)果而不是緣由它常常在身體檢查或腹腔鏡檢查上沒問題但一半以上的病人都有情緒困擾問題有慢性骨盆腔難過的病人在過去有較高的性暴力的發(fā)生率診斷(I)History-locationofpain,modeofonset,constantorcolikyinnature,radiaion,andrelationtothemenstrualcycle-LMP?-usedcontraception?-vaginaldischargeorbleeding-bowelorurinarysymptoms?診斷(II)Physicalexamination-moveorcrouchedupinbed?-checkvitalsign-abdominalexamination:locationofpain,reboundingtendernessorguarding,anymassorhernia-pelvicexamination:vaginaldischargeorpelvicmassorassessthepelvictenderness-cervicalliftingpainbloodintheperitonealcavity(ectopicpregnancy)orinflammationintheperitoneal(PID)-OHSSPVwasnotdone(riskofruptureofovariancysts),butsuspectedectopicpregnancyimmediatelaparotomy診斷(III)Investigations-tripleswabs(highvagina,cervix,endocervix)r/oSTDaschlamydiaorgonorrhea-sentmidstreamuriner/oUTI-checkCBC/CRP-checkurineorserumHCGr/oectopicpregnnacy-pelv