Fitz-Hugh-Curtis syndrome: Difference between revisions
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==Background== | ==Background== | ||
*A complication of [[Pelvic Inflammatory Disease]], involving acute [[gonococcal]] peritonitis of the right upper quadrant in women | [[File:Perihepatic adhesions 2.jpg|thumbnail|"Violin string sign", adhesions between the liver and abdominal wall.]] | ||
*A complication of [[Pelvic Inflammatory Disease]], involving acute [[gonococcal]] or [[chlamydia]] trachomatis peritonitis of the right upper quadrant in women | |||
*Pain is caused by liver capsule inflammation | *Pain is caused by liver capsule inflammation | ||
==Clinical Features | ==Clinical Features<ref name="multiple">Livengood et al. Clinical features and diagnosis of pelvic inflammatory disease. Uptodate.</ref>== | ||
*Sudden onset of severe [[right upper quadrant abdominal pain]] | |||
*Distal pleuritic component +/- radiation to the shoulder | |||
*May not have symptoms of PID | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX RUQ}} | {{DDX RUQ}} | ||
==Evaluation== | |||
*Aminotransferases usually normal or mildly elevated <ref name="multiple">Livengood et al. Clinical features and diagnosis of pelvic inflammatory disease. Uptodate.</ref> | |||
**Generally not markedly elevated <ref>Curtis AH. A cause of adhesion in the right upper quadrant.JAMA. 1930;94(16):1221-1222. doi:10.1001/jama.1930.02710420033012.</ref><ref>Peter, N. G.; Clark, L. R.; Jaeger, J. R. (2004). "Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain". Cleveland Clinic journal of medicine 71 (3): 233–239. doi:10.3949/ccjm.71.3.233. PMID 15055246</ref> | |||
*If CT obtained, may show inflammatory changes in pelvic and perihepatic regions | |||
*Ultimately a diagnosis of exclusion with supporting evidence of gonorrhea or chlamydia | |||
==Management== | ==Management== | ||
*Fully treat [[pelvic inflammatory disease]] | |||
==Disposition== | |||
*Admission criteria same for [[PID]] | |||
**Pregnancy | |||
**Toxic, systemic symptoms | |||
**Poor compliance | |||
**Failure of outpatient therapy | |||
**[[Tubo-ovarian abscess]] | |||
==See Also== | |||
*[[PID]] | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:OBGYN]] | ||
Revision as of 21:53, 23 October 2018
Background
- A complication of Pelvic Inflammatory Disease, involving acute gonococcal or chlamydia trachomatis peritonitis of the right upper quadrant in women
- Pain is caused by liver capsule inflammation
Clinical Features[1]
- Sudden onset of severe right upper quadrant abdominal pain
- Distal pleuritic component +/- radiation to the shoulder
- May not have symptoms of PID
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluation
- Aminotransferases usually normal or mildly elevated [1]
- If CT obtained, may show inflammatory changes in pelvic and perihepatic regions
- Ultimately a diagnosis of exclusion with supporting evidence of gonorrhea or chlamydia
Management
- Fully treat pelvic inflammatory disease
Disposition
- Admission criteria same for PID
- Pregnancy
- Toxic, systemic symptoms
- Poor compliance
- Failure of outpatient therapy
- Tubo-ovarian abscess
See Also
References
- ↑ 1.0 1.1 Livengood et al. Clinical features and diagnosis of pelvic inflammatory disease. Uptodate.
- ↑ Curtis AH. A cause of adhesion in the right upper quadrant.JAMA. 1930;94(16):1221-1222. doi:10.1001/jama.1930.02710420033012.
- ↑ Peter, N. G.; Clark, L. R.; Jaeger, J. R. (2004). "Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain". Cleveland Clinic journal of medicine 71 (3): 233–239. doi:10.3949/ccjm.71.3.233. PMID 15055246