uterine fibroid.pptx
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Uterine fibroids are benign tumors that develop in the uterus. They are composed of smooth muscle and connective tissue and are the most common tumors found in females. The highest prevalence occurs in women between ages 35-45. While the exact cause is unclear, genetic and hormonal factors likely play a role. Fibroids can be asymptomatic but may cause heavy periods, pelvic pain, infertility, or pregnancy complications. Diagnosis involves ultrasound, MRI, or other imaging. Treatment options include medication, myomectomy (surgical removal of fibroids), hysterectomy (removal of the uterus), or embolization (blocking the blood supply).
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Definition
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Aetiology
Congenital
Acquired
Clinical features
Symptoms :
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Trichomonas vaginitis.pptx
Introduction
Causative agent : Trichomonas vaginalis
Transmission : Sexual contact
Incubation period : 3 – 28 days.
Clinical features
Sudden profuse and offensive vaginal discharge.
Severe irritation and itching around introitus.
Dysuria and increased frequency of urine.
Examination:
Thin, greenish yellow frothy offensive vaginal discharge.
Inflammed vulva
Vaginal examination may be painful.
Diagnosis:
Culture of discharge :
Diamonds TYM or Feinberg
Whittington medium.
Treatment:
DOC : Metronidazole
200mg TDS x 1 week.
Tinidazole
syphilis.pptx
Introduction
Causative agent : Treponema pallidium
Transmission : Abraded skin / mucosal surface.
Spreads through direct contact.
Incubation period : 9 -90 days.
Clinical features
Phases of syphilis :
Primary syphilis
Lesion / Chancre : Single/ Multiple
Site : Labia, fourchette, anus, cervix or
nipples.
Small papule gets eroded into an ulcer. The margins of ulcer are raised and floor is smooth and shiny.
Healing of primary chancre takes place in 1-8 weeks.
Secondary Syphilis
Secondary syphilis is evident in form of Condyloma lata in vulva.
Condyloma lata : coarse, flat topped, moist, necrotic lesions.
Maculopapular rashes : Palms and soles.
Alopecia, lymphadenopathy, mucosal ulcers.
Latent Syphilis
Quiescence phase.
Duration : 2 -20 years.
Tertiary Syphilis
Progression of tertiary syphilis occurs only in condition of untreated syphilis.
Damages CNS, CVS, Musculoskeletal system.
Cranial nerve palsies III, VI, VII and VIII.
Gummatous ulcer : deep punched ulcer with rolled out margins. Painless with moist leather base.
Diagnosis
History of exposure.
Identification of organism.
Serological test
VDRL (Venereal disease research laboratory)
TPHA (Treponoma pallidum haemagglutination)
EIA (Enzyme immunoassay)
FTA (Fluorescent treponomal Antibody)
TPI (Treponoma pallidum immobilisation)
Treatment
Benzathine penicillin IM
Tetracycline 500 mg
Doxycycline 100 mg
Serological test should be performed 1, 3, 6 and 12
month after treatment of syphilis.
pruritis vulvae.pptx
Pruritis vulvae
Etiology:
1. Vaginal discharge : Trichomonas vaginalis, Candida albicans
2. Local skin lesion: Psoriasis, Dermatitis
3. Vulvar infection: Fungal, Viral, Parasitic, STD
4. Medical disorders: Glycosuria
5. Deficiency: Fe, Folic acid, Vit B12 Vit A
6. Psychosomatic causes
Investigations
Age of onset
Intensity of itching
Duration
Vaginal discharge
Contraceptive practice
Allergy- nylon, soap, detergent.
DM
Liver disorder
Thyroid
Hematological disorder
Special Investigations
Microscopic examination: Vaginal discharge / vulval scarping
Urine examination: Sugar, Protein and pus cells.
Blood examination: CBC, Thyroid profile, Glucose, LFT, RFT
Stool examination: Ova, Parasite, Cyst.
Treatment
Maintain local hygiene.
Loose fitting clothing
Local topical application: antibiotics/ clobetasol propionate
Treat specific disease
Surgery: Neoplasia invasion
POP.pptx
Pelvic organ prolapse
Pelvic Organ Prolapse
Most common gynaecological problem.
Amongst parous women.
A form of hernia.
Anatomy of Uterus
Anteversion and anteflexion position.
Lies between rectum and bladder.
Cervix pierces the vagina at the right angle to the axis of vagina.
Supports of Uterus
Uterus is held in position by 3 tier support system.
Upper tier
Middle tier
Inferior tier.
Upper tier
Primarily, maintains the uterus in anteverted position.
The structures responsible are:
Endopelvic fascia.
Round ligaments.
Broad ligaments.
Middle tier
Constitutes the strongest support of uterus.
Responsible structures are:
Pericervical ring.
Pelvic cellular tissues.
Inferior tier
Indirect support of uterus.
Responsible structures are pelvic floor muscles including:
Levator ani
Endopelvic fascia
Levator plate
Perineal body
Urogenital diaphragm
Anatomical Factors
Gravitational stress.
Parturition stress.
Pelvic floor weakness.
Inherent weakness of supporting structures.
Acquired Predisposing Factors
Trauma of vaginal delivery causing injury :
Ligaments
Endopelvic fascia
Levator muscle
Perineal body
Pudendal nerve and muscle damage due to
repeated child birth.
Congenital Predisposing Factors
Inborn weakness of supporting structure.
Aggravating factors
Post menopausal atrophy
Poor collagen tissue repair with age.
Increased intra abdominal pressure.
Occupational hazards
Asthenia
Obesity
Fibroid/Polyp
Clinical Degrees Of Uterine Prolapse
Symptoms
Feeling of something coming out per vaginum.
Backache or dragging pain in pelvis
Dyspareunia
Urinary symptoms
Bowel symptoms
Clinical examination
Inspection and palpation.
General examination.
Pelvic examination
Uterine prolapse
Management of Prolapse
Preventive
Conservative
Surgery
Preventive Measures
Pelvic floor exercise during puerperium.
Avoid strenuous activities.
Avoiding prolonged cough.
Avoiding constipation.
Avoiding heavy weight lifting.
Avoiding future pregnancy too early.
Conservative Management
Indications :
Asymptomatic women
Mild degree prolapse
POP in early pregnancy
Treatment :
Oestrogen replacement therapy.
Kegel exercise
Pessary treatment
Surgical Management of Prolapse
Restorative
Extirpative
Obliterative
pid.pptx
Definition
PID is a disease of the upper genital tract.
It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures.
Epidemiology
Occurs both in the developed and developing
countries.
85 per cent are spontaneous infection in sexually active females of reproductive age.
The remaining 15 per cent follow procedures, which favors the organisms to ascend up.
Two-thirds are restricted to young women of less than 25 years and the remaining one-third limited among 30 years or older.
Risk factors
Menstruating teenagers.
Multiple sexual partners.
Absence of contraceptive pill use.
Previous history of acute PID.
IUD users.
Area with high prevalence of sexually transmitted diseases.
Protective factors
Contraceptive practice
Barrier methods
Oral steroidal contraceptives
Monogamy / Vasectomy
Others
Pregnancy
Menopause
Vaccines
CLINICAL FEATURES
Bilateral lower abdominal and pelvic pain dull in nature.
Fever, lassitude and headache.
Irregular and excessive vaginal bleeding .
Abnormal vaginal discharge (purulent or copious)
Nausea and vomiting.
Dyspareunia.
Pain and discomfort in the right hypochondrium.
Signs
Temperature >38.3°C.
Abdominal palpation
(1) Tenderness on both the quadrants of lower abdomen.
(2) The liver may be enlarged and tender.
Vaginal examination
(1) Abnormal vaginal discharge (purulent).
(2) Congested external urethral meatus or openings of Bartholin’s ducts through which pus may be seen escaping out on pressure.
(3) Speculum examination shows congested cervix with purulent discharge from the canal.
Clinical diagnostic criteria of PID (CDC-2006)
Minimum Criteria
Lower abdominal tenderness.
Adnexal tenderness.
Cervical motion tenderness.
Additional Criteria
Oral temperature > 38.3°C.
Mucopurulent cervical or vaginal discharge.
Raised C-reactive protein and/or ESR.
Definitive Criteria
Histopathologic evidence of endometritis on biopsy.
Imaging study (TVS/MRI) evidence of tubo-ovarian complex.
Laparoscopic evidence of PID
Investigations
Identification of organisms
Blood: Leucocyte count shows leucocytosis to more than 10,000 per cu mm and an elevated ESR value of more than 15 mm per hour.
Laparoscopy
Complications Of Pid
Immediate
Pelvic peritonitis or even generalized
Septicemia
Late
Dyspareunia
Infertility
Chronic pelvic inflammation
Formation of adhesions or hydrosalpinx or pyosalpinx and tubo-ovarian abscess.
Chronic pelvic pain and ill health.
Ambulatory Management Of Acute PID (CDC-2006)
Patient should have oral therapy for 14 days
Regimen A
Levofloxacin 500 mg (or, ofloxacin 400 mg) PO
Metronidazole 500 PO bid
Regimen B
Ceftriaxone 250 mg IM single dose
Doxycycline 100 mg PO BID with or without
Metronidazole 500 mg PO BID for 14
hsg.pptx
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
endo.pptx
Definition
Presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa is called endometriosis.
It is a benign but it is locally invasive.
Prevalence
The real one is due to delayed marriage, postponement of first conception and adoption of small family norm.
The apparent one is due to increased use of diagnostic laparoscopy as well as hightened awareness of this disease complex amongst the gynecologists
Sites
Abdominal: Usually confined to the abdominal structures below the level of umbilicus.
Extra-abdominal: Common sites are abdominal scar of hysterotomy, cesarean section, tubectomy and myomectomy, umbilicus, episiotomy scar, vagina and cervix.
Remote
Pathology
Naked Eye Appearance: The appearance of the lesion depends on the organs involved, extent of lesion and reaction of the surrounding tissues.
Pelvic endometriosis: Small black dots, called ‘powder burns’ seen on the uterosacral ligaments and pouch of Douglas.
Fibrosis and scarring
Symptoms
Dysmenorrhea (70%)
Abnormal menstruation (20%)
Infertility (40–60%)
Dyspareunia (20–40%)
Chronic Pelvic Pain
Abdominal Pain
Urinary— frequency, dysuria, back pain or even hematuria.
Sigmoid colon and rectum—painful defecation (dyschezia), diarrhea, constipation, rectal bleeding or even melena.
Chronic fatigue, perimenstrual symptoms (bowel, bladder).
Hemoptysis (rarely), chest pain.
Surgical scars—cyclical pain and bleeding.
Examination
Abdominal palpation
A mass may be felt in the lower abdomen arising from the enlarged tubo-ovarian mass due to endometriotic adhesions. The mass is tender with restricted mobility.
Pelvic Examination
Pelvic tenderness, nodules in the pouch of Douglas, nodular feel of the uterosacral ligaments, fixed uterus or unilateral or bilateral adnexal mass of varying sizes
Diagnosis
Bichemical parameters:
Serum CA 125
Monocyte Chemotactic Protein (MCP-1)
Imaging:
TVS - ovarian endometriomas
Endorectal USG - Rectosigmoid endometriosis
MRI - deep infiltrating endometriosis.
Colonoscopy, rectosigmoidoscopy and cystoscopy
Differential Diagnosis
Chronic pelvic infection / symptomatic endometriosis. Laparoscopy is helpful in actual diagnosis.
Ovarian endometrioma / benign ovarian tumor / malignant ovarian.
Ultrasonography or Laparoscopy
Rupture of the chocolate cyst / torsion or rupture of the ovarian tumour, disturbed ectopic pregnancy, appendicitis or diverticulitis.
Complications
Endocrinopathy
Rupture of chocolate cyst
Infection of chocolate cyst
Obstructive features:
Intestinal obstruction
Ureteral obstruction → hydroureter
hydronephrosis → renal infection
Endocrinopathy in Endometriosis
Corpus luteum insufficiency
Luteolysis due to ↑ PGF.
Luteinized unruptured follicle (LUF)
Anovulation
Elevated prolactin level
Double LH peak.
Staging
Endometrios is should be staged appropriately.
To predict prognosis.
To choose therapy.
To evaluate the treatment protocol.
The stage is determined by adding specific points given to each.
contraception.pptx
Contraception
Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures.
The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.
Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.
Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods
Natural
Barrier
IUDs
Emergency contraception
Terminal methods
Male fertilisation
Female fertilisation
Natural Methods
Coitus inteyrruptus / withdrawal
Rhythm Method
Lactational Amenorrhoea
Barrier Methods
Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
Combination
Combined use of Chemical and Mechanical methods.
Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.
Female condom
Femidom
Diaphragm
Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
Intrauterine Contraceptive Devices
Cu T200
T shaped device Polyethylene frame.
215 mm2 surface area of Cu wire.
Contains 124 mg of copper
Cu is lost at the rate of 50 µg/day.
Polyethylene monofilament tied at vertical stem.
Cu is radio opaque so additionally barium is
incorporated in the device.
Supplied in a sterilised sealed packet.
Lifetime 4 years.
Cu T 380A
380 mm square surface area of copper wire.
Replacement 10 years.
Multiload Cu 250
60-100 ug/day
Replacement 3 years
Multiload - 375
Mode of action
Biochemical and histological changes in endometrium.
Increased tubal motility.
Endometrial inflammatory response.
Prevents implantation.
Contraindication for insertion of IUCD
Presence of pelvic infection
Genital tract bleeding (undiagnosed)
Suspected pregnancy
Uterine fibroid
Severe dysmenorrhoea
Ectopic pregnancy history
Caesarean section
Cu allergy
Time of insertion
Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
Postabortal
Done immediately following termination of pregnancy.
Postpartum
After 6 weeks of delivery.
Postplacental delivery
Post delivery of placenta.
Method of Insertion
Preliminary steps:
History taking and examination
Patient is informed and consent is obtained.
Insertion is done in OPD aseptic conditions.
Placement of device in inserter.
Steps of operation
The patient is asked to remain empty bladder.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
The device is placed in the inserter and introduced through cervical
BARTHOLINS.pptx
Bartholin’s Gland
Function :
The production of mucoid secretion that lubricates the
distal end of the vagina during intercourse.
The glands become active after menarche and are non
palpable.
Bartholinitis
Causative agent:
Gonococcus
Streptococcus
Staphylococcus
E. coli
End result :
Complete resolution
Recurrence
Abscess
Cyst formation
Clinical features :
Local pain discomfort.
Difficulty in walking / sitting.
Examination :
Tenderness
Induration of post half of vagina.
Secretion coming out from the duct when pressed.
Treatment
Local :
Systemic:
Ampicillin 500 mg TDS
Bartholin’s Abscess
End result of acute Bartholinitis.
Clinical features:
Severe local pain and discomfort.
Difficult / painful walking and sitting.
On examination:
Unilateral tender swelling.
Oedomatous red overlying skin.
Treatment:
Rest.
Sitz bath.
Systemic antibiotic Ampicillin 500 mg.
Drainage of abscess.
Bartholin’s cyst
The content is colourless glairy liquid.
C/f :
Small cyst : usually unnoticed.
Larger cyst : Local discomfort and dyspareunia.
Examination:
Unilateral swelling on post half of labia majora.
Projection on vulval cleft into S-shape.
Overlying skin is shiny and thin.
Cyst remains non tender and fluctuant.
Treatment:
Marsupilisation.
Moniliasis(Candida vaginitis)
Candida vaginitis
Dr. Yashika
Introduction:
Causative agent: Candida albicans (Gram positive fungus)
Clinical features:
Intense vulvovaginal discharge
Dyspareunia
On examination:
Thick, curdy white discharge.
Cottage cheese type flakes discharge often adherent to the vaginal wall.
Red swollen vulva.
Tender PV examination.
Diagnosis:
Wet smear
Treatment:
Removal of predisposing factors.
Local anti fungal prep.
Creams, ointments, pessary.
Single dose oral therapy
Fluconazole/ itraconazole
Thank you
Lgv (Lymphogranuloma Venereum)
Lymphogranuloma Venereum
Dr. Yashika
Causative agent : Chlamydia trachomatis
Incubation period: 3-30 days
Clinical features :
Initial phase:
Painless papule, pustule or ulcer in vulva, urethra,
rectum or cervix.
Involved inguinal nodes feels rubbery.
Acute lumphangitis and lymphadenitis.
Necrosed glands and abscess formation.
Rupture of abscess occurs within 7-15 days.
Sinus and fistula formation.
Intense fibrosis with lymphatic drainage.
Secondary phase : Painful adenopathy.
Classical clinical sign:
Groove sign
A depression between the groups of inflammed nodes.
Complication:
Vulval elephantiasis
Perineal scarring
Rectal stricture
Sinus and fistula formation.
Diagnosis
Culture and isolation
Detection of LGV
Treatment:
Doxycycline 100 mg BID x 21days.
Azithromycin 1 gm PO weekly x 3 weeks
Abscess aspiration
Leucorrhoea
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Hysterectomy
HYSTERECTOMY
Hysterectomy
Hysterectomy
Term origin:
hyster + ectomy
uterus surgical removal
Definition:
Hysterectomy is defined as the surgical removal of uterus.
Routes for Hysterectomy
Abdominal Hysterectomy
Vaginal Hysterectomy
Laparoscopic Hysterectomy
Caesarean Hysterectomy
Types of Hysterectomy
Total Hysterectomy
Removal of entire uterus.
Subtotal Hysterectomy
Removal of body or corpus leaves behind the cervix.
Panhysterectomy / Hysterectomy with bilateral salpingo oophorectomy
Removal of uterus along with tubes and ovaries of
both sides.
Indications
Hsv Herpes Genitalis
Herpes Genitalis
Dr. Yashika
Introduction
Causative organism : Herpes Simplex virus type 1 and 2
Transmission : Orogenital contact
Incubation period : 2 – 14 days.
Clinical features:
First attack with 7 days of sexual contact.
Red painful inflammatory area around clitoris, labia, vestibule, vagina, cervix and perineum.
Appearance of multiple vesicles which progress into ulcers then heals up by crusting
Lymphadenopathy
Fever, malaise and headache.
Diagnosis:
Virus tissue culture and isolation
ELISA
Fluorescent method
PCR test
Treatment
Specific treatment is yet to b explored.
Acyclovir 200 mg 5 times x 5days.
Saline water bath.
Hsg
Hysterosalpingography
Dr. Yashika
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
Human Immunodeficiency Virus - Acquired Immuno Deficiency Disease
AIDS
Dr. Yashika
Introduction
Causative agent : Human Immunodeficiency Viruses (HIV)
HIV belongs to retrovirus family (double stranded RNA).
Mode of transmission
Sexual intercourse
IV drug abusers
Blood transfusion
Use of contaminated needles
Breastfeeding
Perinatal transmission
Immunopathogenesis
Immunological Markers
CD4 T lymphocyte count
RT-PCR
Raised P-24 antigen titre
Raised serum β2 microglobulin
Clinical Presentation
Development of Ab marks the stage of seroconversion aka flu-like syndrome.
Acute infection syndrome characterized by fever, skin rash, arthralgia, lymphadenopathy and diarrhoea. This is called seroconversion illness lasts upto 2-3 weeks and gets resolved itself spontaneously.
Gynaecological Symptoms
Infections of genital tract.
Neoplasm of genital tract.
Menstrual abnormalities.
Fertility and pregnancy are not affected.
Diagnosis
Detection of IgG antibody.
ELISA
Western blot
PCR
Treatment
Gonorrhoea
GONORRHOEA
Dr. Yashika
Introduction
Causative agent : Neisseria gonorrhoea (gram negative diplococcus).
Incubation period : 3-7 days.
Site of invasion : columnar and transitional epithelium of the genitourinary tract.
Primary sites of infection : endocervix, urethra and Bartholins gland.
Other sites of infection : Oropharynx, anorectal and conjuctiva.
Clinical features :
Local:
Excessive irritant vaginal discharge
Dysuria
Acute unilateral pain
Swelling over labia.
Pharyngeal infection
Intermenstrual bleeding.
Rectal discomfort.
Signs :
Swollen labia and inflammed.
Mucopurulent vaginal discharge.
Speculum examination reveals congested endocervix.
Distant symptoms :
Perihepatitis
Septicaemia
Complications:
PID
Infertility
Ectopic pregnancy
Chronic pelvic pain
Tubo ovarian mass
Bartholins gland abscess.
Diagnosis
Nucleic acid amplification test (NAAT)
urine culture
Drug sensitivity test.
Treatment
Adequate therapy for gonococcal infection.
To treat both the partner simultaneously.
To avoid multiple sex partner.
To use condom till free from disease.
Dilatation and Insufflation
Dilatation and Insufflation
Dr. Yashika
Dilatation and Insufflation (D&I)
Also known as Rubin’s test.
Operation for dilatation of cervix and insufflation of air (CO2) in to the uterine cavity to know the patency of fallopian tubes.
Indications of D&I
Investigation for fertility.
Following tuboplasty.
Contraindication : Pelvic infections.
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomic position
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forceps.
7. Uterine sound is introduced to confirm the position and to note the length of cervical canal.
Cervical canal is dilated with graduated dilators.
After the desired dilatation, the insufflation cannula is introduced into the cervical canal.
10. Air is introduced in the uterus and the hissing sound is auscultated over the flanks.
Test
Positive Test:
An audible hissing sound on the flanks due to exit of air.
Patient complains of shoulder painon sitting.
Negative Test:
No hissing sound over the flanks.
Complications
Complications
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Physiology of Special Chemical Sensation of Taste
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
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ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Introduction
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Fitness Regimen
Workout Routine
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O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
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Physiology of Chemical Sensation of smell.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
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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
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uterine fibroid.pptx
- 2. Fibroid Commonest benign tumour in females. Histologically composed of Smooth muscles fibres and fibrous connective tissues. Aka lieomyoma, myoma and fibromyoma.
- 3. Incidence Higher incidence in dark coloured females. More common in nulliparous or child bearing age. Prevalence is higher in 35 – 45 years.
- 4. Aetiology Aetiology is unclear at present. Hypothesis Chromosomal abnormality: Rearrangement or deletion at chromosome 6 or 7. Somatic mutations in myometrial cells. Role of polypeptide growth factors : Epidermal GF, Insulin-like GF Transforming GF stimulate the growth.
- 6. Types of Uterine Fibroids
- 7. Pathology Naked eye appearance: Enlarged uterus, distorted shape. Firm appearance on touch. Cut section : Smooth, whitish, whorled and trabeculation. False capsule formation. Periphery is more vascular.
- 8. Cut section of Uterine Fibroid
- 9. Secondary changes in fibroids: Degeneration Atrophy Necrosis Infection Vascular changes Sarcomatous changes
- 10. Clinical features Asymptomatic Menstrual abnormalities menorrhagia, metrorhhagia Dysmenorrhoea Dyspareunia Infertility Recurrent pregnancy loss Abdominal enlargement Pelvic pain
- 11. Investigations USG Pelvis, TVS MRI HSG Hysteroscopy Uterine curettage
- 12. Management of Uterine Fibroids Symptomatic Medical Surgery Myomectomy Hysterectomy Myolysis Embolothera py Asymptomati c Regular supervision Surgery
- 13. Medical Management Objectives : To improve menorrhagia To correct anaemia To reduce vascularity and size of tumour To postpone surgery
- 14. Drug Therapy Antiprogesterones (Mifeprestone) Danazol GnRH analogues LNG-IUS Prostaglandin synthetase inhibitors.
- 15. Surgical Management of Uterine Fibroids Myomectomy Embolotherapy Hysterectomy
- 16. Cervical Fibroids Symptoms : Anterior Cervical Fibroids Posterior Cervical Fibroids Lateral Cervical Fibroids Central Cervical Fibroids
- 17. Treatment Supravaginal cervix : Myomectomy Infravaginal cervix : a. Sessile tumour : Myomectomy b. Pedunculated tumour : Polypectomy