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Gynacology

This guide covers detailed gynecological history, physical exam procedures, and investigative tests like bloodwork, imaging, and genital tract biopsies. Learn about key aspects and techniques in gynecology practice.

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Gynacology

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Presentation Transcript

  1. Gynacology HistoryPhysical ExaminationInvestigations

  2. HISTORY • ❏ includes ID, CC, HPI, PMH, Meds, Allergies, etc... • Obstetrical History • Gravida__ Para__ L__ • Year of marriage, hospital, outcome, mode of delivery, sex, gestational age, weight, complications

  3. Menstrual History • LNMP, LMP • age menarche, menopause • cycle length, duration, regularity • flow • associated symptoms • pain, PMS • abnormal menstrual bleeding • intermenstrual, post-coital

  4. Sexual History • age when first sexually active • number and sex of partners • history of sexual assault or abuse

  5. Contraceptive History • present and past contraception modalities • reasons for discontinuing • compliance • complications/failure/side-effects

  6. Gynecological Infections • STDs, PID (herpes, chlamydia, gonorrhea, etc...) • vaginitis, vulvitis • lesions • include treatments, complications, etc

  7. Gynecological Procedures • last Pap smear • history of abnormal Pap • follow-up and treatments • gynecological or abdominal surgery • previous ectopic pregnancies

  8. PHYSICAL EXAMINATION • height, weight, BP • breast exam • abdominal exam • pelvic exam including • observation of external genitalia • speculum exam +/– smears and swabs • bimanual exam • cervix size, consistency, os, and tenderness • uterus size, consistency, contour, position, shape, mobility, and other masses • adnexal mass, tenderness • rectovaginal exam • rectal exam

  9. INVESTIGATIONS • Bloodwork • ❏ CBC • evaluation of abnormal uterine bleeding, preoperative investigation • ßhCG • investigation of possible pregnancy or ectopic pregnancy, work-up for GTN • monitored after the medical management of ectopic and in GTN to assess for cure and recurrences • LH, FSH, TSH, PRL • amenorrhea, menstrual irregularities, menopause, infertility, etc...

  10. Imaging • ultrasound • transvaginal ultrasound provides enhanced details of structures located near the apex of the vagina; i.e. intrauterine and adnexal structures • may be used for • acute or chronic pelvic pain • rule in or out ectopic pregnancy, intrauterine pregnancy • assess uterine, adnexal, ovarian masses (i.e. solid or cystic) • uterine thickness • follicle monitoring during assisted reproduction

  11. hysterosalpingography • an x-ray is taken after contrast is introduced through the cervix into the uterus • contrast flows through the tubes and into the peritoneal cavity if the tubes are patent • used for evaluation of size, shape, configuration of uterus, tubal patency or obstruction

  12. sonohystography • saline infusion into endometrial cavity under ultrasound visualization expands endometrium, allowing visualization of uterus and fallopian tubes • useful for investigation of abnormal uterine bleeding, uncertain endometrial findings on vaginal U/S, infertility, congenital/acquired uterine abnormalities (i.e. uterus didelphys, uni/bicornate, arcuate uterus) • easily done, minimal cost, extremely well-tolerated, sensitive and specific • more accurate than hysterosalpingography and frequently avoids need for hysteroscopy

  13. Genital Tract Biopsy • vulvar biopsy • under local anesthetic • Keye’s biopsy or punch biopsy • hemostasis achieved with local pressure, Monsel solution or silver nitrate • vaginal and cervical biopsy • punch biopsy or biopsy forceps • generally no anesthetic used • hemostasis with Monsel solution • endometrial biopsy • in the office using an endometrial suction curette (Pipelle) • hollow tube guided through the cervix used to aspirate fragments of endometrium (well-tolerated) • a more invasive procedure using cervical dilatation and curettage may be done in the office

  14. Colposcopy • diagnostic use • provides a magnified view of the surface structures of the vulva, vagina and cervix • special green filters allow better visualization of vessels • application of 1% acetic acid wash dehydrates cells and reveals white areas of increased nuclear density (abnormal) or areas with epithelial changes • biopsy of visible lesions or those revealed with the acetic acid wash allows early identification of dysplasia and neoplasia

  15. therapeutic use • cryotherapy • tissue destruction by freezing • for dysplastic changes, genital warts • laser • cervical conization • encompasses the cervical • transformation zone and into the endocervical canal • methods include cold knife, laser excision, or electrocautery

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