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Information about Gynecology

Published on October 15, 2008

Author: aSGuest1057


Gynecology : Gynecology Department of EMS Professions Temple College External Genitalia : External Genitalia External Genitalia (Vulva) : External Genitalia (Vulva) Mons Pubis Labia majora minora Perineum Prepuce Clitoris Uretheral opening (meatus) Vestibule Skene’s glands Bartholin’s glands Vaginal entrance (Introitus) Anus Female Reproductive System : Female Reproductive System Internal Reproductive Organs : Internal Reproductive Organs Vagina Cervix Uterus Corpus Fundus Fallopian Tubes Ovary Female Reproductive System : Female Reproductive System Female Reproductive Organs : Female Reproductive Organs Endometrium Mucosal Myometrium Circulation Smooth Muscles Perimetrium Serous Fundus & 1/2 Corpus Menstrual Cycle : Menstrual Cycle Menarche usually between 9 and 13 initially irregular Normal usually 28 day Hormones FSH LH Estrogen Progesterone Menopause 45 - 55 years old Menstrual Cycle : Menstrual Cycle Pituitary produces follicle stimulation hormone (FSH) FSH stimulates ovarian follicle maturation Follicles mature, release estrogen Estrogen stimulates thickening of endometrium Estrogen acts on pituitary to decrease FSH release FSH levels begin to fall, LH levels rise Menstrual Cycle : Menstrual Cycle After ovulation, luteinizing hormone (LH) acts on remains of follicle Promotes corpus luteum formation Corpus luteum produces progesterone Progesterone stabilizes, maintains uterine lining Menstrual Cycle : Menstrual Cycle If ovum is not fertilized Corpus luteum dies Progesterone levels drop Endometrium deteriorates, sloughs Menstrual period occurs Menstrual Cycle : Menstrual Cycle If ovum is fertilized Zygote implants in endometrium Human chorionic gonadotropin (HCG) released HCG sustains corpus luteum Corpus luteum produces progesterone Endometrium remains stable Pregnancy continues Menstrual Cycle : Menstrual Cycle Pelvic Inflammatory Disease : Pelvic Inflammatory Disease Pathophysiology Acute or chronic infection involving female reproductive tract, associated structures: Cervix (cervicitis) Uterus (endometritis) Fallopian tubes (salpingitis) Ovaries (oophoritis) Pelvic peritoneum PID : PID Pathophysiology Causative organisms include: Gonorrhea Chlamydia E. coli, other gram negative bacilli Gram positive cocci Mycoplasma Viruses PID : PID Most cases sexually transmitted Risk factors include: Previous infection Multiple partners Adolescence Presence of IUD PID : PID History Moderate to severe diffuse lower abdominal pain May localize to one quadrant or radiate to shoulders Gradual onset over 2-3 days beginning 1 -2 weeks after last period PID : PID History Pain worsened by intercourse (Dyspareunia) Associated symptoms Fever Chills Nausea, vomiting Vaginal discharge Erratic periods PID : PID Physical Exam Patient appears ill Fever usually present Tender abdomen Rebound tenderness Walks bent forward holding abdomen PID : PID Management Position of comfort General supportive care (oxygen, IV) Transport May be at risk for rupture of pyosalpinx or tubo-ovarian abscess Dysfunctional Uterine Bleeding : Dysfunctional Uterine Bleeding Pathophysiology Usually younger women Ovum not released from ovary regularly Without ovum release/corpus luteum formation, menstrual cycle is not completed Dysfunctional Uterine Bleeding : Dysfunctional Uterine Bleeding Pathophysiology Endometrium continues to thicken Outgrows blood supply, breaks down Massive vaginal bleeding results Dysfunctional Uterine Bleeding : Dysfunctional Uterine Bleeding History History of “missed”, irregular periods Continuous, profuse vaginal bleeding possibly persisting > 8 days Dysfunctional Uterine Bleeding : Dysfunctional Uterine Bleeding Physical Exam Signs/symptoms of hypovolemic shock Positive tilt test Passage of tissue with vaginal bleeding Dysfunctional Uterine Bleeding : Dysfunctional Uterine Bleeding Management Do not pack vagina to stop bleeding High concentration oxygen IV LR MAST if indicated Endometriosis : Endometriosis Presence of normal endometrium at ectopic locations Signs, symptoms Pelvic pain Dysmenorrhea Pain on intercourse Lower abdominal tenderness Endometriosis : Endometriosis History Painful intercourse Painful menstruation Painful bowel movements Endometriosis : Endometriosis Rupture of endometrial masses may cause severe pain, internal hemorrhage May require surgery Long term management is gynecologic issue Ruptured Ovarian Cyst : Ruptured Ovarian Cyst Ovarian cyst = Sac on ovary Causes include Growth of endometrial tissue in ovary Hemorrhaging into mature corpus luteum Over-distension of ovarian follicle Ruptured Ovarian Cyst : Ruptured Ovarian Cyst Cysts rupture into peritoneal cavity Peritonitis Hemorrhage, shock Ruptured Ovarian Cyst : Ruptured Ovarian Cyst Signs, symptoms History of menstrual irregularities, chronic pelvic pain Unilateral abdominal pain Unilateral tenderness Pallor, tachycardia, diaphoresis, hypotension Ruptured Ovarian Cyst : Ruptured Ovarian Cyst Management High concentration oxygen IV LR MAST if indicated Rapid transport Cystitis : Cystitis Inflammation of the bladder Usually bacterial Occurs frequently May lead to pyelonephritis Cystitis : Cystitis Assessment Suprapubic tenderness Frequent urination Dysuria Blood in urine Cystitis : Cystitis Management Supportive care Mittelschmertz : Mittelschmertz Pain at menstrual cycle midpoint Caused by ovulation Occurs on day 14 to 16 Unilateral, mild to moderate Lasts a day or less Possible light vaginal spotting Mittelschmertz : Mittelschmertz Management Rule out more serious causes of pain Analgesia may be required Self-limiting problem Can be confirmed by keeping calendar Sexual Assault : Sexual Assault Any sexual contact without consent Legal rather than medical diagnosis Seldom creates medical emergency If medical emergency exists, usually is from trauma secondary to assault Sexual Assault : Sexual Assault History Do not question patient regarding details of event. Do not question patient about sexual history or practices Avoid taking lengthy histories Do not ask questions which may lead to guilt feelings Anticipate reactions such as anxiety, withdrawal, denial, anger, fear Sexual Assault : Sexual Assault Physical Exam Examine genitalia only if severe injury present Avoid touching without permission Explain procedures before proceeding Maintain the patient’s modesty Sexual Assault : Sexual Assault Management Priority to immediate life threats Psychological support is important Limit intervention to that needed for immediate problems Protect patient’s privacy Sexual Assault : Sexual Assault Crime Scene Handle evidence as little as possible Ask patient not to change, bathe, or douche Do not allow patient to drink or brush their teeth Do not clean wounds unless absolutely necessary Sexual Assault : Sexual Assault Management May be preferable for female paramedic to attend patient Honor patient’s wishes Do not abandon patient at scene Complete trip report carefully Gynecological Assessment : Gynecological Assessment Abdominal Pain Bleeding Gynecological PA : Gynecological PA Abdominal Pain + Female Gender = Gynecologic Problem Until Proven Otherwise Gynecological PA : Gynecological PA Abdominal pain When was last period? Was it normal? Bleeding between periods? Regularity? Gynecological PA : Gynecological PA Abdominal pain Pregnant? Missed period? Urinary frequency? Breast enlargement or tenderness? N/V? Contraception? What kind? Vaginal discharge? Color, amount, odor Gynecological PA : Gynecological PA Abdominal Pain Aggravation/Alleviation OPQRST Tenderness/masses at pain’s location? Tilt test Gynecological PA : Gynecological PA Vaginal bleeding More, less heavy than normal period? Possibility of pregnancy? Associated pain/tenderness? Perform tilt test Gynecological PA : Gynecological PA Fever/Chills

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