[医学保健]骨盆腔疼痛_11007.pptVIP

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ectopic pregnancy miscarriage PID Appendicitis Ovarian cyst ”accident” or Mittelschmerz 急性骨盆腔疼痛-其它原因 OHSS Hematomatra or hematocolpos Necrosis of uterine fibroid 其他非婦產科的原因,像腸道或泌尿道疾病 Ovarian cyst accident Dermoid cysts,teratomas,or simple cysts are more common cause of torsion Result of torsion(leading to occlusion of blood supply and necrosis) Presenting symptom of ovarian neoplasm,more common associated with functional ovarian cysts in younger Acute chemical peritonitis if they contain irritant material(as endometriotic or dermoid cysts) Ovarian cyst accident Pain pattern of torsion: -sudden onset of coliky pelvic pain -located to one or other of iliac fossa -more constant after several hours or disappear -initially apyrexial,later on necrosis can cause pyrexia Mittelschmerz From German mittel=middle and schmerz=pain Middle cycle pain occuring at the time of ovulation More common ly in teenagers and older women 慢性骨盆腔疼痛-定義 疼痛的時候超過六個月 慢性骨盆腔疼痛是影響生殖年齡女性最常見的婦科問題 常見原因 Endometriosis Chronic pelvic inflammatory disease Pelvic adhesion Bowel related pain Urological causes Musculoskeletal pain Neuropathic pain Psychological factors Treatment of Pain in Endometriosis Acute Pain: NSAIDS Hormonal Oral Contraceptive Systemic analgesia, opioids Other techniques (TENS, Acupuncture) Pain Ladder Moderate pain: combination with minor opioids Co-proxamol (propoxifine), Co-dydramol (codeine) Minor opioids alone - eg Pethidine, Tramadol Severe pain: Opioids: Morphine etc Endometriosis and Inflammatory Pain: Use of NSAIDS Cyclo-oxygenase pathway blocked 2 forms: COX1 COX2 COX1 always present COX2 only induced by inflammation Also have central role, where both COX1 COX2 are found as neuro-transmitters NSAIDS COX 2 antagonists preferable where there is high-risk of peptic ulceration / bleeding Still not 100% guarantee Treatment of Pain in Endometriosis Chronic / Intractable Pain: Multiple modality pain clinic - holisti