Approach to gynaecology patient

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Approach to gynaecology patient

  1. 1. DR HALIMATUN MANSOR SPECIALIST DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY HSNZ
  2. 2.  Gynaecology history and examination are a modification of a standardized history taking design for  elucidation of the presenting problems,  concluding provisional and differential diagnosis  Planned for further management
  3. 3.  Depending on the presenting complaint  Age of menarche/menopause  Marital status- infertility  LNMP  Length of menstruation and cycle  Frequency and regularity of cycle  Menstrual loss , presence of clots and flooding  Duration of dysmenorrhea and relation to period
  4. 4.  Abnormal bleeding  Intermenstrual  Postcoital  Postmenopausal  Abnormal PV discharge  Color, pruritus, offensive odour
  5. 5.  Sexual history  Dyspereunia  Contraception  Previous STD  Hormonal therapy  Oral / injectable  HRT
  6. 6.  Menopausal symptoms  Pain  Onset, duration , nature , site  Relation to menstrual cycle  Symptoms of prolapse, unconfortable lumps in vagina
  7. 7.  Urinary problems  Incontinence, (stress or urge)  Frequency, nocturia or dysuria  Other systemic review  Past obstetric and gynaecology history  Past medical and surgical history
  8. 8.  Social history  Smoking, alcohol consumption  Drug history
  9. 9.  Always begin with  Inspection  Palpation  Purcussion  Auscaltation  Genaral examination  Specific examination
  10. 10.  Inspection of genitalia and urethral meatus  Evidence of estrogen deficiency, prolapse or abnormal masses  Presence of abnormal bleeding or discharge
  11. 11.  Speculum Examination  Inspection of vagina and cervix  Taking of cervical cytology or microbiology swab  Assess uterovaginal prolapse and incontinance
  12. 12. 13 Candidiasis Strawberry cervix: Trichomonas Bacteria vaginosis Herpes Simplex Actinomyces infection Atrophic cervicitis
  13. 13. Stage IV Complete eversion
  14. 14.  Perform bimanual examination  Assess uterine size, shape, ante/retroverted, mobility of uterus  Tenderness- cervical motion, POD, adnexas  Presence of abnormal masses at POD or adnexa  Uterosacral ligament- presence of nodule  Thickness of the rectovaginal space
  15. 15. Imperforate hymen
  16. 16. Differential diagnosis Revise/Prioritise diagnosis Investigations Treatment / Management
  17. 17.  Ultrasound  PAP Smear for cervical screening  Colposcopy procedure
  18. 18.  Cheap  Acceptable  Good sensitivity and specificity  Achieved of screening must be 70-80%
  19. 19. 23 Cervical Biopsy Exfoliative cytology test cells collected are from normally shedding epithelium . collected using spatulas or brushes. Specimen is fixed, stained and studied for morphology under microscope.
  20. 20. 24  Initially using vaginal pool smears to study hormonal status .  Found cancer cells on a slide containing a specimen from a woman's uterus.  Dr. George Papanicolaou reported the usefulness of the technique for detecting neoplastic cervical cells in 1941.  late 1940s to early 1950s, Pap smear became widely used as a screening technique. Dr. George Nicholas Papanicolaou
  21. 21. 25 1. Approximately 80% of cells sample containing important diagnostic imformation is removed with sampling devices. 2. False negative rate at least 20% (mainly due to sampling error). 3. Sampling is a factor in up to 90% of false negative pap smear. ( JosephMG. Diagn Cytopathol 1991;7(5):477) 4.Up to 40% of all Pap smears are compromised by blood, mucus and inflammation. (Davey DD.Arch Pathol Lab Med 1992;116:90)
  22. 22. 27  Sampling Scanty cells Blood, mucous, pus Mainly endocervical cells *  Preparation Too thick due to poor spreading Air drying artifact
  23. 23. VIA : Visual inspection with acetic acid. VILI : Visual inspection with Lugol’s iodine. 28
  24. 24.  A tool for screening as well as treatment of cervical pathology especially at preinvasive and early stage  Need training and practice  Available
  25. 25. smooth featureless covering of the cervix
  26. 26. Low grade lesion in a satellite pattern

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