This document defines and discusses menorrhagia (heavy menstrual bleeding). It defines menorrhagia as excessive menstrual bleeding that interferes with quality of life. The document discusses causes (functional/organic), symptoms, risk factors, complications like anemia, common causes like fibroids or adenomyosis, and treatments including medications, procedures, and surgery. Treatments aim to regulate hormones, reduce bleeding, or remove the uterus if family planning is complete.
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
Dysfunctional uterine Bleeding is type of Abnormal bleeding from the genital ...sonal patel
Dysfunctional uterine Bleeding is type of Abnormal bleeding from the genital tract- Factore, Types, Diagnosis, Treatment in that one type DUB- Define, sign and Symptoms, Diagnosis, Treatment, Management, hormonal Therapy in PPT made By sonal Patel
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Definition
Cyclical bleeding at normal
interval ; the bleeding is either
excessive in amount(>80 ml) or
duration(>7 days) or both
3. DEFINITION
DEFINITION
Menorrhagia is excessive menstrual blood loss
over several consecutive cycles which interferes
with the woman's physical, emotional, social,
and material quality of life. (Nice 2007)
Commonest cause of iron deficiency anaemia in
women of reproductive age
4. OTHER IMPORTANT DEFINITION…
TERMS DEFINITION
Metrorrhagia Menstrual flow at irregular
intervals
Menometrorrhagia Irregular and excessive flow
Polymenorrhoea Bleeding at intervals of less
than 21 days
Postcoital bleeding Is non-menstrual bleeding
that occurs immediately after
sexual intercourse
6. Symptoms
• Soaking through 1 or > sanitary pads or tampons
every hour for several consecutive hours
• Needing to use double sanitary protection to
control menstrual flow
• Needing to wake up to change sanitary protection
during the night
• Bleeding for longer than a week
• Passing blood clots with menstrual flow for more
than one day
• Restricting daily activities due to heavy menstrual
flow
• Symptoms of anemia, such as tiredness, fatigue or
shortness of breath
7. When to see a doctor
• Vaginal bleeding so heavy it soaks at least
one pad or tampon an hour for more than a
few hours
• Bleeding between periods or irregular
vaginal bleeding
• Any vaginal bleeding after menopause
8. Risk factors
• Adolescent girls who have recently started
menstruating.
• Girls are especially prone to anovulatory cycles in the
first year after their first menstrual period
(menarche).
• Older women approaching menopause.
• Women ages 40 to 50 are at increased risk of
hormonal changes that lead to anovulatory cycles.
9. Complications
Iron deficiency anemia:
Menorrhagia may decrease iron levels enough
to increase the risk of iron deficiency anemia.
Severe pain.
with heavy menstrual bleeding, one might
have painful menstrual cramps
(dysmenorrhea).
10. Common causes of Menorrhagia
• Dysfunctional Uterine Bleeding
• Fibroid Uterus
• Adenomyosis
• Chronic Tubo-Ovarian Mass
13. DUB
•Heavy or irregular menstrual
bleeding , not caused by an underlying
anatomical abnormality, such as a fibroid, or
tumor (abnormal uterine bleeding without any
obvious structural or systemic pathology)
•Dx of exclusion
•Hormonal imbalance, hypothalamus-pituitary-
ovary axis
•Women who Just started
menstruation/perimenopausal
•Heavy or irregular menstrual
bleeding , not caused by an underlying
anatomical abnormality, such as a fibroid, or
tumor (abnormal uterine bleeding without any
obvious structural or systemic pathology)
•Dx of exclusion
•Hormonal imbalance, hypothalamus-pituitary-
ovary axis
•Women who Just started
menstruation/perimenopausal
Anovulatory
90%
Anovulatory
90%
Ovulatory
10%
Ovulatory
10%
Unopposed
estrogen
Unopposed
estrogen
Associated with increased
prostaglandin release
(hemostatic deficiency)
Associated with increased
prostaglandin release
(hemostatic deficiency)
Mx:
1.Medical
2.Surgical
Hysterectomy
endometrial
ablation
14. • Anovulatory cycles
Unpredictable cycle
length
•
Unpredictable
bleeding pattern
•
Frequent spotting
•
Infrequent heavy
bleeding
Monophasic
temperature curve
•Ovulatory cycles
Regular cycle length
Presence of premenstrual
symptoms
-Dysmenorrhea
-Breast tenderness
-Change in cervical mucus
-Mittleschmertz Pain
Biphasic temperature
curve
Positive result from use of
luteinizing-hormone
predictor kit
20. Endome
triosis
Age: reproductive
age
Bleeding pattern:
menorrhagia,
usually lasts more
than 7 days short
interval
Ass.symp:
dysmenorrhoea/
chronic pelvic pain,
dyspareunia,
difficulty
conceiving
Examination:
wide spectrum,
depends
menstruating/n
ot
abdominal
tenderness,
mass
Speculum:
red,
hypertrophic
lesions ,
bleeding on
contact seen at
post.fornix
Inv:
laparoscop
ic, TVUS,
21. Adenomy
osis
•Age: 40 and 50
years
old,parous/prior
uterine surgery
•bleeding pattern:
menorrhagia
,postccoital,
Intermenstrual
•ass, Symp.:
dysmenorrhea,
dyspareunia
•Exam:
•The uterus
is enlarged
and boggy
•Tenderness
•mass
(adenomyo
ma)
Inv :
TAS/TVS
(diffuse
thickening
within
wall),
MRI,
hysterosco
pic/laparos
copic
biopsy
25. Diagnosis
• Long duration Of flow
• Passage of big clots
• Use of incresed number of
thick sanitary pads
• Pallor
• Low level of Hemoglobin
26. History
• Full gynaecological history
• Notoriously inaccurate amount of blood loss
• Number of pads/tampons used
• Clots/ flooding
• Frequency of accidents
• Menstrual chart can be useful
27. Examination
• Weight
• Any signs of endocrine disturbance
• Abdominal and pelvic examination
• Cervical smear if indicated
28. Tests and diagnosis
Blood tests. evaluate for iron deficiency (anemia)
and other conditions, such as thyroid disorders or
blood-clotting abnormalities.
Pap test. cells from cervix are collected and
tested for infection, inflammation or cancerous
changes.
Endometrial biopsy.
Ultrasound scan. For uterus, ovaries and pelvis.
Based on the results of initial tests, you may
recommend further testing, including:
29. Sonohysterogram.
During this test, a fluid is injected through a
tube into uterus by way of vagina and
cervix. using ultrasound to look for
problems in the lining of uterus.
Hysteroscopy.
This exam involves inserting a tiny camera
through vagina and cervix into uterus,
which allows to see the inside of uterus.
31. • Drug Used to treat Menorrhagia:
• NSAID- Mefenamic Acid
• Ibuprofen
• Indomethacin
• Antifibrinolytic – Tranexamic Acid
• Amino caproic Acid
• Hormones-Progesterone
• Norethisterone
• Combined Estrogen –Progesterone
• Other- Danazol
• GnRH A
32.
33.
34. Treatment
• If any pathology is found it must be treated, rest
aim to treat dysfunctional uterine bleeding
• Anovulatory- extremes of age.
• OCP can help.
• Cyclical progestogens used to induce regular
withdrawl bleeds.
• Acute arrest for heavy bleeding- high dose
reducing course of progestogen
35. Treatments and drugs
Iron supplements. If have anemia, recommend
iron supplements regularly.
Nonsteroidal anti-inflammatory drugs. such as
ibuprofen or naproxen - reduce menstrual
blood loss.
relieving painful menstrual cramps
(dysmenorrhea).
Mefanamic acid, given for a few days during
menstruation
38. Oral contraceptives-
ovulation suppressed .
oestrogen levels remain constant. Help
regulate menstrual cycles and reduce episodes
of excessive or prolonged menstrual bleeding.
Oral progesterone. help correct hormone
imbalance and reduce menorrhagia.
39. The hormonal IUD (Mirena).
Can cause amenorrhoea
releases a type of progestin
called levonorgestrel,
• makes the uterine lining thin
• decreases menstrual blood
flow & amenorrhoea
• decrease cramping.
40. • Danazol:
anti gonadotrophin.
Induces atrophy of endometrium due to low
level of circulating sex steroids.
Androgenic side effects not tolerated well-
virilizing effects
41. Surgical Treatment
Dilation and curettage (D&C).
Uterine artery embolization.
Fibroids-
goal to shrink it in uterus by blocking the
uterine arteries and cutting off their blood
supply.
42. Myomectomy. surgical
removal of uterine fibroids.
Endometrial
ablation. permanently
destroying the lining of
uterus .
hysteroscopically and
ablated.
Many methods-laser,
rollerball, hydrothermal,
cryoablation, microwave.
amenorrhoeic .
43. Endometrial resection
Hysterectomy.
surgery to remove your uterus and cervix .
permanent procedure , causes sterility and
ends menstrual periods.
definative treatment if family complete.