Diagnosis of Female genital disorders
Female genital disorders Diagnosis: Book Excerpts
Diagnostic Tests for Female genital disorders: Online Medical Books
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MENORRHAGIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there persistent or recurring abdominal or pelvic pain? The presence of pain with menorrhagia should make one suspect PID, endometriosis, and ectopic pregnancy.
- Are there abnormalities on the pelvic examination? The pelvic examination will usually be positive in cases of uterine fibroid, pregnancy, cervical polyp, pelvic inflammatory disease, and ectopic pregnancy. Endometriosis may not always be detected on pelvic examination.
- Is there anemia or other systemic symptoms or signs? The clinician should remember that iron deficiency anemia, hypothyroidism, lupus erythematosus, and cirrhosis of the liver are just a few of the systemic conditions that may present with menorrhagia.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, urinalysis, pregnancy test, chemistry panel, ANA titer, VDRL test, coagulation profile, thyroid profile, and flat plate of the abdomen. A Pap smear and vaginal smear and culture should be done.
If these tests are negative, referral to a gynecologist should be made before undertaking expensive tests such as pelvic ultrasound or CT scan of the abdomen and pelvis. Some clinicians will probably ignore this advice. A gynecologist will often be able to resolve the diagnostic dilemma with a good pelvic examination. Laparoscopy, culdocentesis, endometrial biopsy, and dilation and curettage are just a few of the diagnostic tools at his disposal.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Menorrhagia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
When the patient’s condition permits, obtain a history. Determine her age at menarche, the duration of menstrual periods, and the interval between them. Establish the date of the patient’s last menses, and ask about recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during her period.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about previous episodes of abnormal bleeding and the outcome of treatment. If possible, obtain a pregnancy history of the patient’s mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient’s past surgical procedures and recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Perform a pelvic examination, and obtain blood and urine samples for pregnancy testing.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Menorrhagia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
When the patient’s condition permits, obtain a history. Determine her age at menarche, the average duration of menstrual periods, and the interval between them. Establish the date of the patient’s last menses, and ask about any recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during the menstrual period.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about any previous episodes of abnormal bleeding and the outcome of any treatment. If possible, obtain a pregnancy history of the patient’s mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient’s past surgical procedures and any recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Perform a pelvic examination, and obtain blood and urine samples for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Menorrhagia:
History (2)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. A menstrual and reproductive history is necessary. First, assess the first day of the last menstrual period and the first day of the previous menstrual period; the regularity, duration, frequency, and intermenstrual flow; and the number of pads or tampons per period.
B. Pregnancy should always be considered and diagnosed, if present. Complications of pregnancy (e.g., spontaneous abortion, ectopic pregnancy, abruptio placentae, and placenta previa) need to be considered if pregnancy is diagnosed.
C. Weight loss or gain, excessive exercise, anxiety or stress disorders, as well as symptoms of systemic disease (e.g., coagulopathy; thyroid, renal, and hepatic disease), must be considered when taking the history.
D. A key question. Is the patient having ovulatory or anovulatory cycles? Do molimenal symptoms (e.g., edema, abdominal bloating, pelvic cramping, and breast fullness) precede menses that follow an ovulatory cycle. If these symptoms are not present and the patient has irregular, heavy periods, the patient is anovulatory and has dysfunctional uterine bleeding.
E. How old is the patient?
1. Menarche to 16 years. Without molimenal symptoms and with irregularity, the problem in the young woman is most probably anovulatory. Whereas some irregularity is normal, it is not normal to soak 25 to
30 tampons or pads per day. In this setting, pregnancy remains a consideration if the patient is sexually active. Fever and pelvic pain can indicate pelvic inflammatory disease (PID). Easy bruising suggests a coagulopathy and neurologic symptoms (e.g., blurred vision, visual field defects, and headache) point to a pituitary lesion.
2. Age 16 to 40 years. Anovulation is a less common cause of abnormal bleeding; up to 8% of problems are caused by pregnancy and contraception complications in this age group. Endometriosis, endometrial hyperplasia, and endometrial polyps increase in frequency as a woman ages. PID and endocrinopathies also occur in this age group.
3. Age 40 years and above. Abnormal bleeding in this age group should arouse suspicion of cancer, until proved otherwise. Of women in this age group, 90% who have abnormal bleeding are anovulatory. Menopausal symptoms, use of estrogens, and personal or family history of malignancy are important to elicit.
Physical examination
A. Assess vital signs and the patient’s general appearance. Signs of impending shock (e.g., hypotension and tachycardia) are likely related to pregnancy, particularly in the younger age group, but they can be related to trauma, sepsis, or cancer.
B. Pallor not associated with hypovolemia can be found with chronic blood loss associated with anovulatory cycles, leiomyoma, blood dyscrasia, or malignancy (Chapter 16.1).
C. Fever, leukocytosis, and pelvic tenderness are usually found in acute PID (Chapter 2.6).
D. Pelvic masses found on physical examination point toward abscess, ectopic pregnancy, or malignancy.
E. Signs of thyroid disease (e.g., rapid or slow pulse, reflex changes, hair changes, and thyromegaly) can be associated with menstrual abnormalities.
F. Excessive bruising can indicate nutritional deficiency, eating disorder, trauma, abuse, medication overuse, or coagulopathy (Chapter 15.3).
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Menorrhagia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When the patient's condition permits, obtain a history. Determine her age at menarche, the duration of menses, and the interval between them. Establish the date of the patient's last menses, and ask about recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use per period? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during her menses.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about previous episodes of abnormal bleeding and the outcome of any treatment. If possible, obtain a pregnancy history of the patient's mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient's past surgical procedures and recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Prepare the patient for a pelvic examination, and obtain blood samples and urine specimens for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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