prezentácia programu powerpoint - uniba.sk · 2020. 3. 17. · presentation acute pelvic pain ......
TRANSCRIPT
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Emergency situations
spectrum of gynaecological diseases
that causes an acute symptoms,
mecessitating urgent and prompt
management
presentation
acute pelvic pain
abnormal vaginal bleeding
abnormal vaginal discharge
acute pelvis sweeling
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Emergency situations - history
characteristics of pain
pelvic fullness, bleed, dicharge
associated symptoms
urinary, GIT, pyrexia
obstetrical and gynaecological
history
contraception
surgical history
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Emergency situations – physical
examination
general
looks unwell, dehydrated, colour
CVS
Chest
Abdominal
Back
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Emergency situations – pelvic
examination
empty bladder !!!
vaginal (lessions, discharge)
cervix (cervical os, lessions, TU)
uterus (size, shape, regularity,
tenderness, position, mobility)
adnexa (masses, tenderness, ovaries)
rectal
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Gynaecology emergencies
Pregnant
ectopic pregnancy
miscarriage
Non-pregnant
pelvic pain
ovarian cysts
massive menstrual blood loss
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Ectopic pregnancy
rising incidence – 1%of all
pregnancies
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Ectopic pregnancy
risk factors:
congenital malformations
higher age of women
surgery in small pelvis
„pelvic inflamatory disease“
endometriosis
apendicitis
IUD / IUS
methods of IVF – heterotopic pregnancy
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Ectopic pregnancy
clinical signs
pain
vaginal bleeding
amenoorhoe
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Ectopic pregnancy
diagnosis
history
physical examination
lab. – beta-hCG
ultrasound - TVS
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Ectopic pregnancy
Management
wait and see
laparoscopy / laparotomy
salpingectomy, ovarectomy, ...
MTX? salpingotomy?
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Miscarriage
expulsion of product of conception
or fetus less then 24 weeks of
gestation
very early misscariages can
sometimes be assumed as delayed
period
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Miscarriage
incomplete abortion
complete abortion
missed abortion
septic abortion
habitual abortion
„TOP“
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Miscarriage
60% due to chormosomal
abnormalities
uterine strucutral abnormalities
maternal illnesses
Congenital infections
autoimmune diseases, ...
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Miscarriage
INCOMPLETE
moderate or severe
pain
moderate to heavy
per vaginal loss
uterus less then
date
cervical os open
COMPLETE
severe pain earlier
heavy vaginal loss
cervical os usually
open
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Misscarriage
Missed abortion
history of absence of symptoms of early
pregnancy
spotting
uterus less then dates
cervical os closed
ultrasound
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Pelvic pain
CYCLICAL
PMS
primary
dysmenorrhoeae
pelvic
endometriosis
ovulation pain
(Mittelschmertz)
idiopathic
NON-CYCLICAL
PID
severe
endometriosis
pelvic TU
surgical causes
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Pelvic pain
cyclical, non-cyclical
acute, chronic
history of parity, dyspareunia, vaginal
discharge, ..
asses severity of symptoms,
exacerbating, relieving factors
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Pelvic pain
Examination
abdominal, vaginal
anaemia? wasted? mass arising from
pelvis? abdominal distension?
tenderness?
ultrasound
biopsy
TU markers
diagnostic laparoscopy
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Painful ovarian cyst
TWISTED
severe acute lower abdominal pain
ussually associated with nausea and
vomiting
abdominal tender ussually associated
with a palpable pelvic mass
UZV
RUPTURED
presentation similar