Difference between revisions of "Fitz-Hugh-Curtis syndrome"

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==Background==
 
==Background==
Fitz-Hugh–Curtis syndrome' is a complication of [[Pelvic Inflammatory Disease]] (PID) named after Drs. Thomas Fitz-Hugh, Jr and Arthur Hale  Curtis, which involves acute gonococcic peritonitis of the right upper q&shy;rant in womenPain is caused by liver capsule inflammation.  Since the disease is a peri-hepatitic, liver function tests will not be 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>
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[[File:Perihepatic adhesions 2.jpg|thumbnail|"Violin string sign", adhesions between the liver and abdominal wall.]]
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*A complication of [[Pelvic Inflammatory Disease]], involving acute [[gonococcal]] or [[chlamydia]] trachomatis peritonitis of the right upper quadrant in women
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*Pain is caused by liver capsule inflammation
  
==Clinical Features==
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==Clinical Features<ref name="multiple">Livengood et al. Clinical features and diagnosis of pelvic inflammatory disease. Uptodate.</ref>==
Sudden onset severe right upper quadrant abdominal pain, distal pleuritic component +/- radiation to the shoulder
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*Sudden onset of severe [[right upper quadrant abdominal pain]]
 
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*Distal pleuritic component +/- radiation to the shoulder
==Investigations==
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*May not have symptoms of PID
Aminotransferases usually normal or mildly elevated
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{DDX RUQ}}
 
{{DDX RUQ}}
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==Evaluation==
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*Aminotransferases usually normal or mildly elevated <ref name="multiple">Livengood et al. Clinical features and diagnosis of pelvic inflammatory disease. Uptodate.</ref>
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**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>
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*If CT obtained, may show inflammatory changes in pelvic and perihepatic regions
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*Ultimately a diagnosis of exclusion with supporting evidence of gonorrhea or chlamydia
  
 
==Management==
 
==Management==
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*Fully treat [[pelvic inflammatory disease]]
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==Disposition==
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*Admission criteria same for [[PID]]
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**Pregnancy
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**Toxic, systemic symptoms
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**Poor compliance
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**Failure of outpatient therapy
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**[[Tubo-ovarian abscess]]
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==See Also==
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*[[PID]]
  
==Sources==
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==References==
 
<references/>
 
<references/>
  
[[Category:OB/GYN]]
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[[Category:OBGYN]]

Latest revision as of 21:53, 23 October 2018

Background

"Violin string sign", adhesions between the liver and abdominal wall.

Clinical Features[1]

Differential Diagnosis

RUQ Pain

Evaluation

  • Aminotransferases usually normal or mildly elevated [1]
    • Generally not markedly elevated [2][3]
  • 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

Disposition

  • Admission criteria same for PID
    • Pregnancy
    • Toxic, systemic symptoms
    • Poor compliance
    • Failure of outpatient therapy
    • Tubo-ovarian abscess

See Also

References

  1. 1.0 1.1 Livengood et al. Clinical features and diagnosis of pelvic inflammatory disease. Uptodate.
  2. Curtis AH. A cause of adhesion in the right upper quadrant.JAMA. 1930;94(16):1221-1222. doi:10.1001/jama.1930.02710420033012.
  3. 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