Pelvic Pain

Acute and chronic pelvic pain are common symptoms that may result from a variety of causes, including gastrointestinal, urinary, musculoskeletal, and emotional as well as gynecological conditions.

Required Skills/Procedures:

1. Perform situation-appropriate (problem-focused or complete) history and physical examinations
2. Interpret clinical information to formulate a prioritized differential diagnosis
3. Guide the creation of a patient-specific management plan

Appropriate Setting: Inpatient and Outpatient

Expected level of Responsibility: Direct supervision with real patients

Learning Topics during encounters with a patient with PELVIC PAIN can include:

Medical Knowledge Learning Topics related to PELVIC PAIN:

1. Clinical features that help to differentiate etiologies:

gastrointestinal
urinary
musculoskeletal
psychiatric
gynecological

2. Signs and symptoms that suggest gynecological etiology

3. Signs and symptoms associated with pelvic pain due to non-gynecological disease and conditions:

gastrointestinal
urinary
musculoskeletal
psychiatric

4. Risk factors associated with pelvic pain

5. Lab studies used in the evaluation of pelvic pain, including their indications, limitations, and cost

6. Imaging studies used in the evaluation of pelvic pain, including their indications, limitations, and cost

Diagnostic Evaluation Learning Topics related to PELVIC PAIN

1. Age-appropriate medical history that differentiates among etiologies of disease
2. Physical exam, including a pelvic exam, to establish the diagnosis and severity of disease
3. Differential diagnosis recognizing specific history and physical exam findings that distinguish causes of pelvic pain (GI, urinary, musculoskeletal, and psychiatric as well as gynecological conditions)
4. Utility of imaging and laboratory tests, both prior to and after initiating treatment, based on the differential diagnosis. Justify ordering them and consider test cost and performance characteristics as well as patient preferences
5. Indications and interpretation (with consultation) of the results of appropriate clinical tests
6. Relevant basic clinical diagnostic procedures

Management Plan Learning Topics related to PELVIC PAIN

1. Indications, mechanism of action, side effects, adverse reactions, and significant interactions of medications that could be prescribed for patients with pelvic pain
2. Indications, benefits and disadvantages of interventions and surgical therapy
3. Cost-effectiveness of:

various agents within each class of medications
interventional strategies
surgical approaches

4. Treatment for the patient with pelvic pain based on the diagnosis, evidence about treatment options, patient characteristics, and patient preferences
5. Prognosis for the patient with pelvic pain based on the diagnosis, the treatment plan, and the patient’s characteristics
6. Communication of the diagnosis, treatment plan, and prognosis of the disease to patients and their families in a caring and compassionate manner, reflecting an understanding of the emotional impact of a diagnosis related to pelvic pain and its potential effect on lifestyle (work performance, sexual functioning, etc.)
7. Education for the patient about his or her treatment plan
8. Counseling to patients when indicated about issues related to prevention
9. Referral for psychological support if indicated
10. Follow-up planning

Potential Differential Diagnosis Topics Include:

Acute and/or Chronic

GYN

Ectopic pregnancy
Abortion, spontaneous, incomplete
Acute salpingitis/ Chronic
Tubo-ovarian abscess
Endometritis
Ovarian neoplasms
Ovarian torsion
Uterine fibroids
Endometriosis
Abnormal embryology (blind uterine horn)
Adhesions

Appendicitis
Diveticular disease
Meckel’s diverticulum
Constipation/ Hemorrhoids

IBS

Ulcerative colitis/ Crohn’s
Adhesions

Urinary tract infection
Pyelonephritis
Nephrolithiasis
Interstital cystitis

Symphyseal separation
Piriformis syndrome
Neuropathy

Psychosocial

Sexual/physical/emotional abuse
Anxiety disorder
Depression