骨盆腔疼痛总结概括.pptVIP

骨盆腔充血 Pelvic vein dilatation?cyclical dragging pelvic pain Occurred in premenstrual phase of cycle and worsen in standing or walking 發生的位置與強度變異性大,和深度的性交疼痛有關 Dilated vein 有時可由laparoscopy or ultrasound看到 骨盆腔充血-治療 MPA(medroxyprogesterone acetate) 30-50 mg daily for 3 months-side effect:weight gain,amenorrhea,bloating GnRH analogue-inhibit ovarian function Severe cases-TAH +BSO?curative 腸道有關的疼痛 Irritable bowel syndrome-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-spasmodic drugs constipation-也是常見腸子脹及慢性骨盆腔疼痛的原因 Inflammatory bowel disease-pain and bloody diarrhea 泌尿道的原因(I) Interstitial cystitis -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(submucosal edema and petechiae) -dyspareunia (+) 泌尿道的原因(II) Chronic urethral syndrome-symptoms of irritation,postvoiding fullness,incontinence Other conditions:urethral diverticulae,urinary calculi,bladder neoplasm,or radiation cystitis 肌肉骨骼疼痛 Sacroiliac dysfunction-疼痛發生在關節本身或有關的肌肉經巒,疼痛在移動時會惡化 Abnormal posture-chronic muscle tension and strain on joints and ligaments Tension myalgia of the pelvic floor itself 神經引起的疼痛 疼痛源自受傷的神經而不是受傷的組織 Nerve entrapment in scar tissue or fascia Sharp,stabbing in nature,or constant dull ache Diagnosis-confirmed by injecting local anaesthetic at the site of maximal tenderness Prescaral neurectomy for patents with endometriosis with mixed results 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 骨盆腔疼痛 急性骨盆腔疼痛 慢性骨盆腔疼痛 診斷 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