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Assessing a Case of Acute Abdominal Pain in a 26-Year-Old Woman with Missed Periods and Shock

This case study discusses a 26-year-old woman presenting with acute abdominal pain, shock, and missed periods, suggesting early pregnancy. The examination reveals tenderness and muscle guarding in the abdominal wall. Ultrasound shows an empty and enlarged uterus with fluid in the pouch of Douglas. This text provides information on the clinical condition, reason for tenderness and muscle guarding, uterine tube hysterosalpingography, uterus subdivisions, uterine tube development, tubal pregnancy, tubectomy, uterine anatomy, uterine axis, ligaments, blood supply, age changes, applied anatomy, and more.

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Assessing a Case of Acute Abdominal Pain in a 26-Year-Old Woman with Missed Periods and Shock

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  1. A 26 year old woman with acute pain in the lower abdomen was rushed to the hospital in a state of shock. A history of two missed periods suggested early pregnancy. The abdominal wall showed tenderness and guarding.Ultrasound revealed empty and enlarged uterus and fluid in pouch of Douglas.

  2. Assess the clinical condition? • Reason for tenderness and muscle guarding in the abdominal wall?

  3. UTERINE TUBE

  4. HYSTEROSALPINGOGRAPHY

  5. Normal site of implantation • Length and parts of uterine tube? • Development of F.T • Tubal pregnancy? • Tubectomy?

  6. UTERUS • INTRODUCTION • SUBDIVISIONS • AXIS OF UTERUS • PRESENTING PARTS • RELATIONS • LIGAMENTS • STRUCTURE • BLOOD SUPPLY • AGE CHANGES • APPLIED ANATOMY

  7. SUBDIVISIONS • FUNDUS, BODY- 5cms. • CERVIX- 2.5cms. • Measurement - 7.5x5x2.5 cm. • BREADTH- 5cms. • THICKNESS- 2.5cms. • WEIGHT- 30- 40 gms. • Length of Uterine cavity & Cervical canal- 6cms. • Located at lesser pelvis

  8. AXIS OF UTERUS • ANTEVERSION & ANTIFLEXION. • ANTEVERSION (90º)-forward angle between cervical & vaginal axis. • ANTEFLEXION (125º)- forward angle between body & cervix.

  9. PARTS & RELATIONS • FUNDUS. • BODY- VESICAL & INTESTINAL SURFACES, LATERAL BORDERS, CAVITY. • CERVIX- SUPRA VAGINAL & VAGINAL PARTS, CERVICAL CANAL.

  10. PARTS & RELATIONS

  11. TRUE LIGAMENTS ROUND LIGAMENTS. TRANSVERSE CERVICAL (MACKENRODT’S) LIGAMENTS UTERO SACRAL LIGAMENTS. PUBO CERVICAL LIGAMENTS. PERITONEAL FOLDS UTERO VESICAL. RECTO VAGINAL. RECTO UTERINE(FORMS POUCH OF DOUGLAS). BROAD LIGAMENTS. LIGAMENTS

  12. LIGAMENTS

  13. SUB DIVISIONS. MESOSALPINX. MESOMETRIUM. MESOVARIUM. CONTENTS UTERINE TUBE. ROUND LIGAMENT. LIGAMENT OF OVARY. OVARIAN VESSELS. UTERINE VESSELS. BROAD LGAMENT

  14. BODY HAS TRIANGULAR CAVITY. ENDOMETRIUM. MYOMETRIUM. PERIMETRIUM. CERVIX CERVICAL CANAL SEROSA. MUSCLE LAYER WITH FIBROUS TISSUE. MUCOUS MEMBRANE- arbor vitae uteri STRUCTURE

  15. STRUCTURE

  16. SUPPORTS Primary supports Muscular - pelvic diaphragm, perineal body, urogenital diaphragm. Visceral – Urinary bladder , vagina uterine axis Fibro muscular - true ligaments Secondary supports – Peritoneal folds

  17. SUPPORTS

  18. SUPPORTS

  19. BLOOD SUPPLY • UTERINE VESSELS. • OVARIAN VESSELS.

  20. LYMPHATIC DRAINAGE FUNDUS & UPPER PART OF BODY • PRE & LATERAL AORTIC NODES. • SUPERFICIAL INGUINAL NODES. LOWER PART OF BODY • EXTERNAL ILIAC NODES. CERVIX • EXTERNAL ILIAC, OBTURATOR, INTERNAL ILIAC, SACRAL NODES.

  21. DEVELOPMENT FUNDUS & BODY • BY FUSION OF PARA MESONEPHRIC DUCTS. CERVIX • FROM UPPER PART OF UTERO VAGINAL CANAL.

  22. APPLIED ANATOMY • ENDOMETRITIS. • ENDOMETRIAL CARCINOMA. • FIBROID UTERUS. • LACERATIONS OF MACKENRODT’S LIGAMENTS. • UTERINE PROLAPSE. • CONGENITAL ANOMALIES.

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