KEY WORDS

Abscess. Localized collection of pus.

Adenomyosis. Endometrial glands invade the myometrium causing a painful uterus and menorrhagia.

Adnexa. The regions of the ovaries, fallopian tubes, and broad ligaments.

Anteverted. The body of the uterus is tilted forward.

Crohn’s Disease. Bowel inflammation that can affect any level of the bowel from stomach to anus. Fistula is a common complication.

Cul-de-Sac. An area posterior to the uterus and anterior to the rectum where fluid often collects.

Diverticulitis. Bowel outpouchings typically found in the distal large bowel. May become infected and painful.

Dysmenorrhea. Difficult or painful menstruation.

Dyspareunia. Difficult or painful intercourse.

Endometrial Cavity, Canal. A potential space in the center of the uterus where blood or pus may collect.

Endometrium. Membrane lining of the uterine cavity.

Hydrosalpinx. Accumulation of watery fluid in the fallopian tube. The tube is blocked at the peritoneal end by adhesions and fibrosis due to a prior infection or other causes such as endometriosis.

Laparoscopy. Surgically invasive technique for viewing the pelvic anatomy in situ through a small tube using fiber-optics. The tube is inserted into the peritoneum through a small incision near the umbilicus.

Leukocyte Count. The number of circulating white blood cells. This count increases when an inflammatory process is present, as in pelvic inflammatory disease, but remains normal in ectopic pregnancy and endometriosis.

Myometrium. Smooth muscle of the uterus.

Pelvic Inflammatory Disease (PID). Infection that spreads from the uterine tubes and ovaries throughout the pelvis; commonly due to gonorrhea.

Retroverted Uterus. The long axis of the uterus points posteriorly toward the sacrum.

Salpinx. Fallopian tube.

Vulva. Region where the urethra and the vagina exit in the perineum.

Clinical

Chronic pelvic pain is common and responsible for approximately 10% of gynecologic outpatient visits. Two common causes are endometriosis and the long-term consequence of PID. Typical symptoms are pain on intercourse (dyspareunia) and dysmenorrhea (painful menstruation). Some causes such as muscular trigger pain cannot be recognized with ultrasound.

Anatomy

See Chapter 29.

Technique

TENDERNESS

The endovaginal probe is superior to an examining finger because one can find the site of pelvic pain while pushing with the vaginal probe and see where the pain originates; for example, the pain may be arising from a neighboring portion of bowel rather than a gynecologic structure.

■ Introduce the vaginal probe with care in symptomatic patients so as not to cause vaginal spasm and lack of cooperation in finding the cause of the pain.

■ Carefully push with an even pressure on the pelvic structures, including the proximal fallopian tubes, asking the patient to grade the severity of the pain from 1 to 10. (A score of 10 is the worst, usually equivalent to labor pains.) Repeat the procedure several times if it is unclear where the pain is most severe so you can be sure where the pain originates. However, if it is obvious where the patient is maximally tender you do not need to repeat this painful test. Do not be unnecessarily cruel; the test only works with patient cooperation!

■ If the tenderness is superior to the area that can be examined with vaginal probe, feel the abdomen for the most painful site and look with the abdominal probe.

MOVEMENT

Only gold members can continue reading. Log In or Register to continue