Fitz-Hugh-Curtis syndrome: Difference between revisions

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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 women. <ref>''J Am Med Assoc'' 1934;102:2094-2096. Curtis AH. A cause of adhesion in the right upper q&shy;rant.  JAMA. 1930;94:1221-122.</ref> Pain is caused by liver capsule inflammation.  Since the disease is a peri-hepatitis, liver function tests will not be markedly elevated <ref>Curtis AH. A cause of adhesion in the right upper quadrant. JAMA 1930;94:1221-122</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>
[[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 leading to the creation of adhesions


==Sources==
==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==
{{DDX RUQ}}
 
==Evaluation==
[[File:PMC4499951 jpts-27-1641-g003.png|thumb|CT abdomen (A–D = portal venous phase): A. Homogeneously thickened strip of enhancement (black arrow); B. Lesion in the right paracolic gutter area without exact anomaly density; C. Pelvic fat spaces with increased density, inhomogeneous enhancement, and visible rectal effusion (cross); D. Bilateral ovarian abscess (white arrow) and surrounding uterus effusion.]]
*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==
*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:OBGYN]]

Latest revision as of 16:13, 6 October 2021

Background

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

Clinical Features[1]

Differential Diagnosis

RUQ Pain

Evaluation

CT abdomen (A–D = portal venous phase): A. Homogeneously thickened strip of enhancement (black arrow); B. Lesion in the right paracolic gutter area without exact anomaly density; C. Pelvic fat spaces with increased density, inhomogeneous enhancement, and visible rectal effusion (cross); D. Bilateral ovarian abscess (white arrow) and surrounding uterus effusion.
  • 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