Diagnosis of Uterine prolapse
Uterine prolapse Diagnosis: Book Excerpts
Diagnostic Tests for Uterine prolapse: Online Medical Books
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VULVAL OR VAGINAL MASS:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is it tender? A tender vulval or vaginal mass would suggest vulvitis, hematoma, acute bartholinitis, or urethral caruncle.
- Is it reducible? A reducible vulval or vaginal mass would suggest pudendal hernia, varicocele, cystocele, rectocele, and uterine prolapse.
- Is the rectal examination abnormal? The rectal examination will be abnormal when there is an impacted feces or rectal carcinoma.
DIAGNOSTIC WORKUP
Referral to a gynecologist or urologist can obviate an expensive diagnostic workup in most cases. The primary care physician may wish to treat acute bartholinitis or vulvitis, however. A culture and sensitivity is the only procedure required in those cases.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Abnormal Uterine Bleeding:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Endometrial hyperplasia
–Endogenous estrogen excess (e.g., obesity,
tumor)
–Exogenous estrogen
–DUB is a diagnosis of exclusion (usually
not cyclic, occurs irregularly throughout the menstrual cycle)
-
Polycystic ovarian syndrome
-
Hypo- or hyperthyroidism
-
Endometrial atrophy
–Caused by long-term progestin or oral contraceptive use
-
Anatomic or structural lesions
–Uterine leiomyoma (fibroids)
–Foreign body (often intrauterine device)
–Cervical or uterine polyps
-
Pelvic infection (cervicitis, pelvic inflammatory disease)
-
Hypothalamic lesion
-
Hyperprolactinemia
-
Medications (e.g., exogenous estrogen, phenothiazines, reserpine)
-
Coagulation disorders
–Platelet dysfunction: Thrombocytopenia, leukemia, medications (e.g., aspirin, NSAIDs)
–Clotting factor abnormality: Von Willebrand's disease, hemophilia, hepatic or renal disease, anticoagulant use
-
Complications of pregnancy
–Spontaneous abortion (miscarriage)
–Ectopic pregnancy
–Placenta previa
–Placental abruption
-
Endometrial cancer
–Risk factors include older age, chronic anovulation, obesity, hypertension, DM, and unopposed estrogen
-
Systemic disease (e.g., HIV, hepatic disease, renal disease)
-
Nonuterine bleeding
–Vaginal (tear, trauma, or cancer)
–Cervical (trauma or cancer)
–Urinary (UTI or cancer)
–Rectal (bleeding, trauma, fissure, or cancer)
-
Other malignancy (ovarian or uterine tumor, sarcoma)
-
Endometrioma
Workup and Diagnosis
-
History, physical, pelvic, and rectal examinations
-
Pap smear
-
- Initial labs may include β-hCG (qualitative and, if positive, quantitative); CBC with differential; TSH, LH, FSH, estradiol, testosterone, prolactin, and DHEA-S levels
-
Consider PT/PTT, peripheral smear, clotting factor assays, liver function tests, serum progesterone, and BUN/creatinine to evaluate for coagulopathy, hepatic, or renal disease
-
Pelvic ultrasound may reveal adnexal or uterine masses or other pathology
-
Transvaginal ultrasound is more accurate than pelvic ultrasound in evaluating the endometrium
-
Endometrial biopsy and progesterone challenge test are helpful in the evaluation of estrogen excess
–Administration of medroxyprogesterone for 10 days results in withdrawal bleeding if adequate estrogen is present
-
CT scan may be helpful if malignancy is suspected
-
Hysteroscopy for evaluation of endometrium and uterine cavity
-
Diagnostic dilatation and curettage is more invasive but offers more information than endometrial biopsy
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
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