Diagnostic Tests for Hysterectomy
Hysterectomy Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Hysterectomy:
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Hysterectomy Diagnosis: Book Excerpts
Diagnosis of Hysterectomy: medical news summaries:
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Diagnostic Tests for Hysterectomy: Online Medical Books
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for more information about the diagnostic tests for Hysterectomy.
PELVIC MASS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine diagnostic studies include a CBC, sedimentation rate, pregnancy test, urinalysis, urine culture, chemistry panel, VDRL test, and Pap smear. If there is vaginal discharge, a smear and culture of the material should be made. If a distended bladder is suspected, catheterization for residual urine must be done. Pelvic ultrasound or a CT scan will often be useful, but why not consult a gynecologist before ordering these more expensive tests? The gynecologist may do a laparoscopy, a culdocentesis, and, ultimately, an exploratory laparotomy.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
PELVIC PAIN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, pregnancy test, urinalysis, urine culture, chemistry panel, VDRL test, and Pap smear. A vaginal smear and culture should also be done routinely.
The next step would logically be a pelvic ultrasound, but it is wise to consult a gynecologist before ordering expensive tests. The gynecologist may proceed with laparoscopy, culdocentesis, and, ultimately, an exploratory laparotomy. A CT scan of the abdomen and pelvis may also be necessary.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Chronic Pelvic Pain:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. The general condition of the patient should be noted. Does the patient look chronically ill, which may suggest a pelvic lesion or an inflammatory bowel disorder? Does the patient appear anxious, stressed, or inappropriate?
1. Can the patient point to the pain with one finger? If so, this can indicate that the pain may have a discrete source.
2. An examination of the lower back, sacral area, and coccyx, including a neuologic examination of the lower extremities, is necessary. Herniated disc, exaggerated lumbar lordosis, and spondylolisthesis can all cause pelvic pain.
3. Examine the abdomen, looking for surgical scars, distension, and palpable tenderness, particularly in the epigastrium, flank, back, or bladder.
B. A thorough pelvic examination is the most important part of the evaluation.
Testing (3)
If no obvious cause is apparent, it is reasonable to obtain a complete blood count, urine analysis, sedimentation rate, and serum chemistry profile. A pelvic ultrasound may be helpful when the pelvic examination is inconclusive. Laparoscopy is best used to diagnose a definite pelvic mass. Laparoscopy has been used extensively in the past but various studies have shown a 66% negative laparoscopy rate for patients with chronic pelvic pain. A multidisciplinary approach using medical, psychologic, environmental, and nutritional disciplines showed decreased pain after 1 year.
Diagnostic assessment
Chronic pelvic pain has a wide differential diagnosis (1). These complex problems can be assessed using a multisystems approach. Whereas gastrointestinal, gynecologic, musculoskeletal, and psychiatric conditions can cause chronic pelvic pain, a thorough gynecologic history and pelvic examination are the cornerstones of the diagnostic assessment. Few laboratory tests are helpful. A pelvic ultrasound is useful when the pelvic organs cannot be adequately assessed during the physical examination. A team approach, coordinated by a trusted family physician, can bring much relief to patients with this frustrating clinical problem.
References
1. Ryder RM. Chronic pelvic pain. Am Fam Physician 1996;54(7):2225–2232.
2. Stiege JF, Stout AL, Somkuti SG. Chronic pelvic pain in women: toward an integrative model. Obstet Gynecol Surv 1993;48:95–110.
3. Chan PD, Winkle CR, eds. Gynecology and obstetrics, 1999–2000. Laguna Hills, CA: Current Clinical Strategies Publishers; 1999:23–25.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Abdominal/Pelvic Mass:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Consider the structures in the region of the mass for clues to its origin and the presence of tenderness as an indicator of inflammation/infection. It is possible to miss initially even a relatively large mass unless a systematic four-quadrant examination is performed.
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Source: Field Guide to Bedside Diagnosis, 2007
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