骨盆腔疼痛课件

骨盆腔疼痛急性骨盆腔疼痛慢性骨盆腔疼痛診斷急性骨盆腔疼痛-常見原因早期懷孕併發症,像ectopicpregnancy&miscarriagePIDAppendicitisOvariancyst”accident”orMittelschmerzOvariancystaccidentDermoidcysts,teratomas,orsimplecystsaremorecommoncauseoftorsionResultoftorsion(leadingtoocclusionofbloodsupplyandnecrosis)Presentingsymptomofovarianneoplasm,morecommonassociatedwithfunctionalovariancystsinyoungerAcutechemicalperitonitisiftheycontainirritantmaterial(asendometrioticordermoidcysts)OvariancystaccidentPainpatternoftorsion:-suddenonsetofcolikypelvicpain-locatedtooneorotherofiliacfossa-moreconstantafterseveralhoursordisappear-initiallyapyrexial,lateronnecrosiscancausepyrexiaMittelschmerzFromgermanmittel=middleandschmerz=painMiddlecyclepainoccuringatthetimeofovulationMorecommonlyinteenagersandolderwomen常見原因EndometriosisChronicpelvicinflammatorydiseasePelvicadhesionBowelrelatedpainUrologicalcausesMusculoskeletalpainNeuropathicpainPsychologicalfactors骨盆腔沾粘引起疼痛的原因還不清楚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疼痛,藉由抑制或移除卵巢可緩解疼痛骨盆腔充血PelvicveindilatationcyclicaldraggingpelvicpainOccureinpremenstrualphaseofcycleandworseninstandingorwalking發生的位置與強度變異性大,和深度的性交疼痛有關Dilatedvein有時可由laparoscopyorultrasound看到腸道有關的疼痛Irritablebowelsyndrome-是最常見引起腸道有關的慢性骨盆腔疼痛,影響10-20%的一般族群,常可影響生殖年齡的女性-它是功能性的疾病,由疼痛的病史及腸胃道的症狀診斷,可用高纖食物及anti-spasmodicdrugsconstipation-也是常見腸子脹及慢性骨盆腔疼痛的原因Inflammatoryboweldisease-painandbloodydiarrhea泌尿道的原因(I)Interstitialcystitis-不明原因的發炎情況,它可引起疼痛及泌尿道的症狀,像frequency,urgency,nocturia;當膀胱脹滿,疼痛會增加,當解尿後,疼痛會緩解-可用膀胱鏡診斷(submucosaledemaandpetechiae)-dyspareunia(+)泌尿道的原因(II)Chronicurethralsyndrome-symptomsofirritation,postvoidingfullness,incontinenceOtherconditions:urethraldiverticulae,urinarycalculi,bladderneoplasm,orradiationcystitis神經引起的疼痛疼痛源自受傷的神經而不是受傷的組織NerveentrapmentinscartissueorfasciaSharp,stabbinginnature,orconstantdullacheDiagnosis-confirmedbyinjectinglocalanaestheticatthesiteofmaximaltendernessPrescaralneurectomyforpatentswithendometriosiswithmixedresults精神上的原因促進因子:精神上,身體上及社會的原因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與造成憂鬱沮喪精神上的問題較常是結果而不是原因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疼痛的病人在過去有較高的性暴力的發生率診斷(I)History-locationofpain,modeofonset,constantorcolikyinnature,radiaion,andrelationtothemenstrualcycle-LMP?-usedcontraception?-vaginaldischargeorbleeding-bowelorurinarysymptoms?診斷(III)Investigations-tripleswabs(highvagina,cervix,endocervix)r/oSTDaschlamydiaorgonorrhea-sentmidstreamuriner/oUTI-checkCBC/CRP-checkurineorserumHCGr/oectopicpregnnacy-pelvicultrasoundr/opelvicpathology-laparoscopy-