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Query: UMLS:C0242172 (pelvic inflammatory disease)
 3,755 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The knowledge needed to formulate proper indications for hysterectomy include a thorough understanding of the physiology and pathology of the female reproductive organs, the clinical manifestations of pelvic disease, and normal and abnormal psycho/social/sexual development. This basic and thorough knowledge and understanding is the absolute foundation on which to base the practice of gynecologic surgery. After the right operation has been selected for operation, the right operation must be selected for the patient. The successful practice of gynecologic surgery also requires proper preparation of the patient for the operation, proper performance of the operation, and proper postoperative care. A competent gynecologist who has followed a patient for several years, has kept careful records of findings and treatment, and has the patient's full confidence is most likely able to make the most accurate judgment about the necessity for hysterectomy. Yet, in most circumstances a 2nd opinion should still be sought. Apprpriate indications for hysterectomy include benign uterine disease and/or symptoms -- dysfunctional uterine bleeding; uterine pain, bleeding, and enlargement; uterine descensus and prolaspe; uterine leiomyomas; septic abortions; and obstetric catastrophs. Other indications include benign diseases of the tubes and ovaries in which the uterus is not primarily involved -- pelvic inflammatory disease, pelvic endometriosis, and ectopic pregnancy -- and neoplastic disease, namely, cervical intraepithelial carcinoma (carcinoma in situ), early invasive cervical cancer, endometrial adenocarcinoma and sarcoma, trophoblastic disease, ovarian and fallopian tube neoplasms, and malignant disease of other adjacent organs. Miscellaneous and usual indications for hysterectomy include cervical problems such as servical stenosis with recurring pyometra following unsuccessful attempts to keep the cervix open, chronic pelvic pain, pelvic congestion syndrome, and surgical sterilization. A partial list of inappropriate indications for hysterectomy includes prophylaxis against uterine cancer, contraception in a gynecologically normal patient, management of the menopause, leukorrhea and chronic cervictis, primary dysmenorrhea and premenstrual tension, mild urinary incontinence, postmenopausal bleeding, abnormal vaginal/cervical cytology, and cervical dysplasia.
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PMID:Indications of hysterectomy. 733 47

Progestins in oral contraceptives (OCs) produce potential complications, as well as noncontraceptive benefits, according to Robert A. Hatcher, MD, MPH, professor of gynecology and obstetrics, Emory University Medical School. Hatcher told CTU that lowering the progestin content in an OC may decrease complications, but could also decrease the benefits experienced by women. "The extent to which that will happen remains to be seen," he said. Hatcher cited the following potential complications of progestins in OC: hypertension; decreased levels of high density lipoproteins; acne; oily skin; headaches between pill cycles; dilated leg veins; pelvic congestion syndrome; thrombosis of superficial leg veins; gallstones; Monilia vaginitis; cholestatic jaundice; and depression, fatigue, and decreased libido. Progestins, according to Hatcher, also produce these noncontraceptive benefits: protection against PID; decreased dysmenorrhea; decreased menstrual blood loss, decreased iron deficiency anemia; protection against endometrial cancer; protection against fibrocystic breast disease, and fibroadenomas of the breast; decreased bleeding from fibroids; decreased growth of fibroids. When ovulation is suppressed, Hatcher emphasized, additional benefits that may occur include the following: decreased risk of functional ovarian cysts; elimination of mittleschmerz pain; decreased rick of ovarian cancer; protection against endometriosis.
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PMID:Potential risks, benefits of progestins in birth control pills outlined. 1231 83

Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more accurate diagnosis of this entity since it enables differentiation between acute and chronic stages based on analysis of the vascular resistance. Hemorrhagic ovarian cysts may be presented by variety of ultrasound findings since intracystic echoes depend upon the quality and quantity of the blood clots. Color Doppler investigation demonstrates moderate to low vascular resistance typical of luteal flow. Leiomyomas undergoing degenerative changes are another cause of acute pelvic pain commonly present in patients of reproductive age. Color flow detects regularly separated vessels at the periphery of the leiomyoma, which exhibit moderate vascular resistance. Although the classic symptom of endometriosis is chronic pelvic pain, in some patients acute pelvic pain does occur. Most of these patients demonstrate an endometrioma or "chocolate" cyst containing diffuse carpet-like echoes. Sometimes, solid components may indicate even ovarian malignancy, but if color Doppler ultrasound is applied it is less likely to obtain false positive results. One should be aware that pericystic and/or hillar type of ovarian endometrioma vascularization facilitate correct recognition of this entity. Pelvic congestion syndrome is another condition that can cause an attack of acute pelvic pain. It is usually consequence of dilatation of venous plexuses, arteries or both systems. By switching color Doppler gynecologist can differentiate pelvic congestion syndrome from multilocular cysts, pelvic inflammatory disease or adenomyosis. Ovarian vein thrombosis is a potentially fatal disorder occurring most often in the early postpartal period. Hypercoagulability, infection and stasis are main etiologic factors, and transvaginal color Doppler ultrasound is an excellent diagnostic tool to diagnose it. Acute pelvic pain may occur even in normal intrauterine pregnancy. This may be explained by hormonal changes, rapid growth of the uterus and increased blood flow. Ultrasound is mandatory for distinguishing normal intrauterine pregnancy from threatened or spontaneous abortion, ectopic pregnancy and other complications that may occur in patients with positive pregnancy test. Incomplete abortion is visualized as thickened and irregular endometrial echo with certain amount of intracavitary fluid. If applied, color Doppler ultrasound reveals low vascular resistance signals in richly perfused intracavitary area. Transvaginal sonography has high sensitivity and specificity in visualization of uterine and adnexal signs of ectopic pregnancy. Color Doppler examination may aid in detection of the peritrophoblastic flow. Furthermore, it facilitates detection of ectopic living embryo, tubal ring or unspecific adnexal tumor. Corpus luteum cysts and leiomyomas are another cause of pelvic pain during pregnancy, which can be correctly diagnosed by ultrasound. Detection of uterine dehiscence and rupture in patients with history of prior surgical intervention on uterine wall relies exclusively on correct ultrasound diagnosis. In patients with placental abruption sonographer detects hypoechoic complex representing either retroplacental hematoma, subchorionic hematoma or subamniotic hemorrhage. In closing, ultrasound has already become important and easily available tool which can efficiently recognize patients with possibly threatening conditions of different origins.
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PMID:[Ultrasonography in acute pelvic pain]. 1276 97

Chronic pelvic pain is a common and disabling condition affecting women of childbearing age. A specific diagnosis for the condition is often difficult, and referred pain from the abdominal viscera, neurogenic and psychogenic factors have all been implicated, as have pelvic conditions such as endometriosis, pelvic inflammatory disease and ovarian cysts; no diagnosis is made in 60% of patients. Pelvic congestion syndrome (PCS), the presence of varices of the pelvic veins, has been shown to be the underlying aetiology in a significant proportion of patients with chronic pelvic pain; the development of these varices is caused by a combination of endocrine and mechanical factors. Given the positional nature of these varices, they are rarely diagnosed with conventional methods such as B-mode ultrasound and diagnostic laparoscopy. Diagnosis is best made with selective ovarian venography, although newer, non-invasive methods such as magnetic resonance imaging and duplex ultrasound are increasingly gaining favour. Pelvic varices are eminently treatable, either using ovarian suppression or by the ligation or embolization of the pelvic veins.
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PMID:Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. 1826 60

Chronic pelvic pain (CPP) is a common complaint of women presenting for gynecologic and primary care. Evaluation of CPP requires obtaining a careful history including not only obstetrical and gynecologic information but also screening for gastrointestinal, urologic, musculoskeletal, and neurological disorders. A detailed physical examination is also necessary. Management of CPP depends largely on the cause. Gynecologic causes include endometriosis, pelvic inflammatory disease, adhesive disease, pelvic congestion syndrome, ovarian retention syndrome, ovarian remnant syndrome, adenomyosis, and leiomyomas. Some non-gynecologic causes are interstitial cystitis/painful bladder syndrome, irritable bowel syndrome, pelvic floor tension myalgia, and abdominal myofascial pain syndrome. Treatments may be directed toward specific causes or may be targeted to general pain management. The most effective therapy may involve using both approaches. The diagnosis and treatment of each of the above disorders, and the management of CPP itself, is discussed.
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PMID:Management of chronic pelvic pain. 2093 29

Menstrual complaints are common and include pain, abnormal bleeding, and menstrual irregularity. The etiology is wide-ranging and includes endometriosis, fibroids, adenomyosis, pelvic congestion syndrome, pelvic inflammatory disease, endometrial hyperplasia, and polyps. Polycystic ovarian syndrome and some congenital uterine anomalies may present with menstrual disturbance and have been included in this review. Transvaginal ultrasound is widely used as first-line investigation. Magnetic resonance imaging is used increasingly with high diagnostic accuracy and confidence. Its multiplanar capacity and superior tissue contrast resolution enable accurate presurgical mapping of fibroids, deep pelvic endometriosis, and adenomyosis. Similarly, accurate differentiation of congenital uterine anomalies depends on multiplanar imaging with either 3-dimensional ultrasound or magnetic resonance imaging. Recent advances in imaging and radiological intervention, combined with an understanding of the underlying causes of menstrual dysfunction, therefore aid in accurate diagnosis and optimal treatment planning.
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PMID:Radiology of benign disorders of menstruation. 2097 60

Pelvic congestion syndrome (PCS) is a cause of chronic pelvic pain in women and is defined as pelvic pain lasting for more than six months.The diagnosis of PCS is a challenging task for the gynaecologist. It can be due to many varied causes like endometriosis, adhesions, chronic pelvic inflammatory disease (PID), ovarian cyst, fibroids, pelvic varicosities. Radiology plays an important role in the diagnosis and management of PCS. Pelvic UltraSonography (PUS),transvaginal sonography (TVS) with doppler, Magnetic resonance imaging (MRI), computed tomography (CT) and ovarian venography are usually used in the diagnosis of this condition. We report a case of a 35-year-old multiparous patient with history of pain in lower abdomen, vaginal discharge and general lethargy for past three years who was diagnosed as a case of PCS based on typical TVS and Doppler findings.
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PMID:Role of trans vaginal ultrasound and Doppler in diagnosis of pelvic congestion syndrome. 2517 7

Pelvic ultrasound with endovaginal ultrasound is often the imaging test of choice in the initial evaluation of nonpregnant women with pelvic pain. This article considers the sonographic observations and techniques useful in diagnosis of a variety of gynecologic causes of pelvic pain in these women, including ovarian hemorrhage, ovarian torsion, pelvic inflammatory disease, endometriosis (particularly deeply infiltrating endometriosis), endometriomas, adenomyosis, pelvic congestion syndrome, and malpositioned intrauterine contraceptive devices. Sonographic observations regarding a number of non-gynecologic causes of pelvic pain are also described.
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PMID:Ultrasound of Pelvic Pain in the Nonpregnant Woman. 3092 80