BATCH 23 MEDICAL UST #دفعة الدكتور حسن العريفي

🔻Investigation : According to NICE (National Institute for health and Clinical Excellence ) guidlines : 🔅CBC 🔅Hormonal profile ( If there are indicators suggest endocrine diorder ) 🔅Coagulopathy screen ( If there are indicators suggest bleeding disorder ) 🔅UltraSound [ transvaginal u.s  is better than transabdominal u.s as it detect the size and site of the mass ] . 🔅Endometrial biopsy:       🔷 Indication :          🔸 Endometrial thickness > 4mm          🔸 Pt >45 years old (risk factor)          🔸 If medical ttt is failed          🔸 Ablation for endometrium          🔸 Hysteroscopic guided endometrial biopsy if the Ultrasound did not give enough information         🔸 Therapeutic for small polyps 🔻Treatment: 🥇. Reassurance 🥈. Medical :    🎯If there is no structural factors or if present but not significant.    🎯 Is not a final ttt    🎯 Needs good evaluation and concentratiin on case    🎯 Needs to ask about past medical and surgical history    🎯 Is of two types: 1. Hormonal [ progestron , GnRH (treating fibroids and cause estrogen shut down and amenorrhea) ] 2. Non hormonal [ NSAID, Tranexamic acid] 🥉. Surgical :         🔎 Indication:       🎯 If medical ttt failed [ no response]       🎯If surgical ttt is needed as if medical ttt is contraindicated or the pt is hemodynamically  unstable     🔎 Procedure : 🪡Endometrial Ablation :       🔸Uterus size =>10       🔸Fibroid < 3cm       🔸Done by radiologist        🔸 The results: 50% ---> amenorrhea 40% ---> decrease bleeding 10% ---> failure of ttt ( still has bleeding ) 🪡Hysterectomy :       🔸For case that            🫧Does not respond to any medical ttt           🫧 With no desire fertility      🔸May be done abdominally or vaginally . ♨️So if pt coming complaining of excessive bleeding : 1. Admission [ A B C D ] 2. Stabilization 3. Evaluation 4. Urgent ttt

Dr. Arwa Alrabie ✨ 🔴 Abnormal uterine bleeding (AUB) 🔷 Menorrhagia is a modern term that mean :            . Excessive menstruation            . Intermenstrual bleeding            . Post coital bleeding            . Post menopausal bleeding 🔷 Causes of AUB [ Mnemonic Category] :          [ PALM COEIN ]    1."Structural causes"   P : Polyp A : Adenomyosis L : Leiomyoma M : Malignancy     2. "Non structural causes" C : Coagulation disorder O : Ovarian   I : Iatrogenic for ex. IUD,Drugs as aspirin or warfarin.   E : Endometrial N : Non classified 🔺 Excessive menstrual bleeding:       🔅> 80ml       🔅Presence of clots       🔅Number of pads changed daily.       🔅It is subjectives diagnosis => depend on pt description of  her menses on her own words .       🔅80% of pt in reproductive age complaining of excessive menses . 🔺 Bleeding of endometrial origin = Dysfunctional Uterine Bleeding (DUB)        🔅Abnormal secretion of Prostaglandin.        🔅Chronic anovulation as in PCOS. 📌Evaluation is acheived by history , examination and investigation . 📌 History    - Onset , course , duration    -  Presence of clots , number of pads changed daily and if it soak to the clothes    - Fatiguability with exertion => anemia    - Gain weight & Fatiguability => hypothyroidism . 📌 Examination:   🔅 General look and examination      . Signs of anemia      . palpate for pelviabdominal mass.   🔅Gynaecological examination          _ Inspection (bleeding , swelling .....)          _ Bimanual (size, shape, consistency , contour and position of uterus )          _ Speculum examination

🐳  Dr. SABA 🐳 Monday Lecture 🌨Signs of heavy Bleeding =>      ❄️Number of pads > 4 /Day      ❄️ Presence of clots      ❄️ Interference with her daily activities      ❄️Symptoms of Anemia      ❄️ Associated with::             ☆ Pain             ☆ Dysmenorrhea             ☆Swelling             ☆Intermenstrual bleeding             ☆ Post_coital bleeding 🌨In case of  Watery discharge , think about  cervical or endometrial abnormality . 🌨 Causes of AUB :                  ❄️Structural :                  [PALM]                   P:olyp                   A:denomyosis                    L:eiomyoma                   M:alignancy           ❄️Non _ structural :                  [COEIN ]                  C:oagulation disorders                  O:varian Diseases E:ndometrial                  I:atrogenic                  N:non classified DUB 🌨High estrogenic state, could  occur due to ;            ❄️PCOS            ❄️Anovulation 🌨Examination , for pt with Heavy bleeding:        ❄️ General examination :                🧊 Face ;      🫧Acne      🫧 Abnormal hair grown on face (on androgen dependent areas)      Exophthalam( Hyperthyroidism)     🫧 Pallor (Anemia)          🧊 Neck ;                  🫧Thyroid swelling                  🫧Enlarged LNs                             🧊 Breast ;for Galactorrhea        🧊Abdominal Examination [As usual, but pay attentionto any swelling & detect if it is abdominal or pelvic swelling]     ❄️Local examination              🧊Inspection=> Search for blood , clots ,  discharge , swelling , ulcer , scar , change in color , abnormal hair distribution, etc ...         🧊 Specular inspection     🧊 Bimanual examination 🌨Investigations u should order for pt with AUB ;          ❄️CBC          ❄️ Swab & Smear          ❄️Hormonal profile ; if pt has signs&/or symptoms of Hyperthyroidism or Hyperprolactinemia          ❄️ Coagulation profile; for pt with bleeding tendency         ❄️ Tumor Factors; if U suspected Malignancy         ❄️ US ; Vaginal & Abdominal         ❄️ MRI ; More accurate for Adenomyosis         ❄️ Saline infusion sonography; to diagnose endometrial polyp         ❄️ Hysteroscopy         ❄️ Biopsy

#Protocol_in_the_treatment_of_malaria https://t.me/BATCH_23_UST/3711?single #سنه_خامسه #5th_year #Gynecology_obstetric

هذا كل مايخص النسائية عملي فيدوهات وتفريغات ، موفقين جميعاً 🌹