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APPROACH TO AN GYNAECOLOGIC PATIENT

APPROACH TO AN GYNAECOLOGIC PATIENT. HISTORY. HISTORY TAKING IS AN ART SHOULD SPEND SUFFICENT TIME TAKING GOOD HISTORY FROM THE PATIENTS. PARTICULARS OF THE PATIENTS. NAME AGE : menarche, menopause, malignancies, consider during hysterectomy ADDRESS MARITAL STATUS DATE OF ADMISSION

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APPROACH TO AN GYNAECOLOGIC PATIENT

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  1. APPROACH TO AN GYNAECOLOGIC PATIENT

  2. HISTORY • HISTORY TAKING IS AN ART • SHOULD SPEND SUFFICENT TIME TAKING GOOD HISTORY FROM THE PATIENTS

  3. PARTICULARS OF THE PATIENTS • NAME • AGE: menarche, menopause, malignancies, consider during hysterectomy • ADDRESS • MARITAL STATUS • DATE OF ADMISSION • DATE OF EXAMINATION

  4. CHIEF COMPLAINTS • CHIEF COMPLAINTS WITH DURATION IN CHRONOLOGICAL ORDER IN PATIENTS LANGUAGE • MAY PRESENT WITH : • MENSTRUAL DISTURBANCES • VAGINAL DISCHARGE • PAIN LOWER ABDOMEN

  5. CHIEF COMPLAINTS • MAY PRESENT WITH : • MASS IN LOWER ABDOMEN • SOMETHING COMING OUT PER VAGINA • POST MENOPAUSAL BLEEDING • FAILURE TO CONCEIVE • DIFFICULTY IN MICTURATION

  6. HISTORY OF PRESENT ILLNESS 1. MENSTRUAL DISTURBANCES How long? Menarche/menopause, LMP, dysmenorrhea 2. VAGINAL DISCHARGE: AMOUNT, COLOR, ODOUR, CONSISTENCY, ASSOCIATED PRURITUS.

  7. HISTORY OF PRESENT ILLNESS 3.PAIN LOWER ABDOMEN: SITE, DURATION, ONSET, SEVERITY, NATURE, RADIATION, RELATIONSHIP WITH MENSTRUATION/COITUS/MICTURATION, ASSOCIATED SYMPTOMS 4. MASS LOWER ABDOMEN DURATION, RAPIDITY OF GROWTH, PAINFUL OR NOT.

  8. HISTORY OF PRESENT ILLNESS 5. SOMETHING COMING OUT PER VAGINA: DURATION, PARITY, MENOPAUSE, OBSTETRIC H/O, MICTURATION / DEFECATION PROBLEM,VAGINAL DISCHARGE, ASSOCIATED MEDICAL ILLNESS 6. POST MENOPAUSAL BLEEDING DURATION, AMOUNT, VAGINAL DISCHARGE, POST-COITAL BLEEDING,USE OF PESSARY, EXOGENOUS OESTROGEN USE

  9. HISTORY OF PRESENT ILLNESS 7. FAILURE TO CONCEIVE: DURATION OF MARRIAGE, LIVING TOGETHER, SEXUAL PROBLEM (dyspareunia, premature ejaculation, impotency), H/O ABORTION, H/O CONTRACEPTION, H/O PELVIC SURGERY 8. DIFFICULTY IN MICTURATION: FREQUENCY, DYSURIA, DIFFICULTY IN EMPTYING THE BLADDER, SUPRAPUBIC PAIN, RETENTION OF URINE, INCONTINENCE, HAEMATURIA??

  10. HISTORY OF PAST ILLNESS • PAST MEDICAL HISTORY • PAST SURGICAL HISTORY-PELVIC • STDs • HTN, DM, PTB, ASTHAMA FAMILY HISTORY PERSONAL HISTORY DRUG HISTORY

  11. MENSTRUAL HISTORY • AGE OF MENARCHE • MENSTRUAL CYCLE • MENSTRUAL PERIOD • LMP • DYSMENORRHOEA CONTRACEPTIVE HISTORY

  12. OBSTETRICAL HISTORY

  13. PHYSICAL EXAMINATION • PRE-REQUISITS: CONSENT FEMALE ATTENDENT PRIVACY – CURTAIN EMPTY BLADDER ASEPTIC PRECAUTION PROPER-POSITION, ADEQUATE EXPOSURE, GOOD LIGHT

  14. PHYSICAL EXAMINATION • GENERAL PHYSICAL EXAMINATION : APPEARANCE ORIENTATION, MEMORY • PALLOR, ICTERUS, LYMPH NODES, CYANOSIS, CLUBBING, OEDEMA, DEHYDRATION

  15. PHYSICAL EXAMINATION • VITAL SIGNS : PULSE BLOOD PRESSURE RESPIRATORY RATE TEMPERATURE • BREAST EXAMINATION: SIZE, TENDERNESS, NODULARITY, DISCHARGE • SECONDARY SEXUAL CHARACTERS:

  16. ABDOMINAL EXAMINATION • INSPECTION: SKIN CONDITIONS, SCAR MARKS, SHAPE • PALPATION: SUPERFICIAL PALPATION: TEMPERATURE, TENDERNESS DEEP PALPATION: LUMP, ASCITES, ORGANOMEGALY

  17. ABDOMINAL EXAMINATION • PALPATION: DEEP PALPATION: LUMP SITE, SIZE, CONSISTENCY, MARGINS, SURFACE, MOBILITY, TENDERNESS • PERCUSSION: CONFIRM ASCITES –SHIFTING DULLNESS • AUSCULTATION: INTESTINAL SOUND – PRALYTIC ILEUS

  18. PELVIC EXAMINATION • INSPECTION OF VULVA: ULCERATION GROWTH DISCHARGE CONDITION O FPERINIUM EXTERNAL URETHRAL MEATUS

  19. PELVIC EXAMINATION • SPECULUM EXAMINATION: UNMARRIED GIRL WITH INTACT HYMEN – SPECULUM EXAMINATION CONTRAINDICATED • CUSCO’S BIVALVE VAGINAL SPECULUM • SIM’S SPECULUM • INSPECTION OF VAULT OF VAGINA & CERVIX • COLLECTION OF DISCHARGE • PAP SMEAR – BY AYER’S SPATULA

  20. PELVIC EXAMINATION • BIMANUAL EXAMINATION: DORSAL LITHOTOMY POSITION RT HAND – PV EXAMINATION LT HAND – LOWER ABDOMEN • POSITION OF CERVIX, ANY GROWTH • SIZE, CONSISTENCY & MOBILITY OF UTERUS • ADENEXAL CONDITION

  21. INVESTIGATIONS • Hb estimation • TLC, DLC, ESR • BLOOD GROUPING • URINE Re/Me / URINE C/S • BLOOS SUGAR, UREA, CREATITINE • X-RAY CHEST • ECG • USG

  22. INVESTIGATIONS • SEROLOGICAL TESTS FOR VENERAL DIS. VDRL, TPHT • SERUM ELECTROLYTES • BLOOD HORMONE ESTIMATION • BLOOD CULTURE • IVU • HYSTEROSALPINGOGRAM Tubal patency, Congenital anomalies

  23. INVESTIGATIONS • VAGINAL SWAB STUDY • CYTOGENETIC STUDY • ENDOMETRIAL BIOPSY • SEMEN ANALYSIS • BIOPSY FROM SUSPICIOUS LESIONS • COLPOSCOPY/ HYSTEROSCOPY • CYSTOSCOPY

  24. TREATMENT DIAGNOSIS

  25. THANK YOU!!!

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