pg1 Group work on Gynecological history, examination, diagnostic procedures, annual gynecological control, preoperative care in gynecology. Gynecological history: Should include age, name, profession, passport data, presenting complaints, history of presenting complain, past medical history. I Gynecological: (a) Menstrual: menarche, menstruation duration(N 37d), regularity(N 2135d), amount(N 3080ml), painful or not, clots present or not, last menses, menopause. (b) Sexual history: beginning, regularity, libido, pain, bleeding, partners, protected or not. (c) Contraception: type, satisfied or not, regularity. (d) Gynecological diseases: STD’s II – Obstetric History: (a) Pregnancies: gravidity, term/pre term, abortions, living children, type of delivery, anesthesia, complications. (b) Diseases related to pregnancy: pregnancy induced HT, bleeding, gestational DM. III – History of past medical diseases: DM, HT, renal and cardiac diseases. IV – Surgical History: V – Allergic History: drugs, foods……etc. VI – Family History: Endocrine disorders, congenital abnormalities, multiple gestations, oncological. VII – Social History: mental state, education, living status, smoking, alcohol. Examination: Divided into general/gynecological/special/diagnostic procedures. I
General examination: *General: anemia, thyroid, lymph nodes, edema. *Heart: pulse, BP, ascultation. *Abdomen: palpation, percussion. *Lungs: auscultation and percussion.
II
Gynecological examination: *Inspection: looking, weight, BMI, skin is oily or dry, voice canes, hirsutism. *Palpation: Deep and superficial of abdomen. Palpation of breast: first inspect with hands at side then raised, palpation of the 4 quadrants symmetrical on both sides, palpation of supra clavicular and axillary glands. *Percussion: abdomen for dullness and fluctuation. *Auscultation:
III
Special Gynecological examination: Usually done on special gynecological chair. If virgin, then only rectal examination is done. Bladder should be done. External examination: Ext. geniytals present or not, inguinal area: hair, lymph nodes, hernia. Labia majora, labia minora, clitoris, urethral discharge, Bartholian gland inflammtion? Internal genitalia: Using Sim’s speculum or Cuscose or bivalve speculum Inspection of the vaginal portion of cervix, external os, fornices for laceration, scars, ulceration, growths. Digital exm. of cervix: shape, size, surface(smooth, firm, hard), ulcerations, tares, malignant growth. Bimanual examination: *uterus: tender or not, consistency – firm, position (anteflex, anteverted, retroverted), size, mobility. *Adenexes: (tubes and ovaries) usually not palpated. Per rectal exam: If virgin, can detect size, position, mobility of uterus and any abnormal swelling.
IV – Diagnostic procedures: *Lab diagnostics: TBC. Urine analysis and culture. Vagina: tests for infections, biopsy, smears (PAP, smear for bacterioscopy, smear taken from lateral wall of vagina for hormonal colpocytology ( raised estrogen increases superficial cells, raised progesterone increases intermediate cells, if no hormonal activity then raised parabasal and basal cells.
pg2 Cervix: (i) PAP smear for oncocytology. This is then classified as CIN 1,2,3. I – normal, II – more or less inflammation, IIIII – dysplasia: three degrees, 1 is mild, 2 is moderate, 3 is severe (carcinoma in situ). IV – Final: squamous cell carcinoma. (ii) Biopsy (iii) Fern test for ovulation: estrogen makes mucus more thicker, alkaline and increases elasticity. Progesterone makes mucus thicker and cellular. Endometrium: Biopsy. *Colposcopy: Allows the accurate localization of abnormal epithelium. Allows study of transformation zone and examination of epith. and subepith vascular patterns. This is a low powered binocular microscope. Natural colposcopy – looking at vagina and uterus with discharge in natural condition. Simple colposcopy – after cleaning out vagina and cervix. Complex colposcopy – application of 5% acetic acid ( patho tissue appears white), application of methyline blue ( patho places appear blue and healthy as rose), application of KI( normal stain as ark brown and patho. Does not stain). All P with abnormal PAP must undergo colposcopic exam. *Hysteroscopy: fiber optic tube passed through cervix. Look for polyps, submucosal myoma, products of conception, congenital uterine septa, i/u adhesions, missing IUD, abnormal bleeding evaluation. *Ultra sound: Trans abdominal or vaginal. To see uterus, adnexes, size, thickness, follicles. *Hysterography: Plain – calcified lesions, teeth, iud. Contrast – pelvic masses, tumors. *CT *Laproscopy Annual gynecological control: must check CBC, urinalysis and culture, BP and weight. Breast. Thyroid. Pelvis. PAP smear. Preoperative care in Gynecology: (a) General: admit 12 day prior to day of elective surgery. Guardian or P should be explained of operation. Written consent from P or guardian. (b) Drug history: allergies, present drugs. (c) Diet: light diet on previous evening, nothing on morning of operation.. (d) Bowel: should be empty. (e) sleep: diazepam 5mg to ensure sleep. (f) preoperative medication: antibiotics, i/v fluids, anesthetics. Preoperative examination: CBC – including blood group, rhesus, Hb. Urine – analysis and culture. Bio0chemical – glucose, liver enzymes, creatinine, urea. ECG – in elderly P. Three types of screening done in gynecology: Breast (US), Colposcopy, US of internal organs.
Group work on Gynecological history, examination, diagnostic procedures, annual gynecological control, preoperative care in gynecology. Report prepared by 1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom. 2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia. 3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania. Contact: publications [at] infekcijas.eu