Abnormal Uterine Bleeding for USMLE скачать в хорошем качестве

Abnormal Uterine Bleeding for USMLE

Abnomral Uterined Bleeding for USMLE, including Dysfunctional Uterine Bleeding. Handwritten tutorial lecture discussing pathophysiology, sign symptoms and treatment. Normal Uterine Bleeding is defined by frequency of 28 days plus or minus 7 days. So anywhere from 21-35 days. Duraiton of menses is 5 to 7 days and on average a woman loses 20-60mL of blood. So menses is measured relative or by the number of pads used. Abnormal can be menorrhagia which is high blood flow either becuase of high duration or high quantity. Metrorrhagia looks more at the frequency and the amount of blood will be normal. Menometrorrhagia will be a combination of the two. PREMENARCHAL BLEEDING Patients less than12 years old. Most common cause is foreign body insertion into vagina. Sexual abuse may also present as abnormal vaginal bleeding. Estrogen ingestion can lead to precosious pubery can lead to early bleeding. Vaginal and Cervical cancer more specifically sarcoma botyroides. Also adrenal and pituitary tumors releasing estrogen. Patient work up wil first consist of pelvic exam to look for foreign bodies, tumor or sexual abuse. Ensure it is coming from vagina and not urethra or rectum. Imaging consists of CT/MRI of pitutiary gland, abdomen and pelvis. POSTMENOPAUSAL Benign causes and malignant and exogenous causes. Benign cause atrophy because estrogen is real low and theis can lead to bleeding. Malignant causes are ovarian carcinoma and vulval vaginal and cervical cancer. Also HRT and anticoagulants. Evaluation you must assume cancer and rule it out. Physical examination to look for atrophy, urethral and rectal examination to confirm vaginal cause. Endometrium with Ultrasound and biopsy. Cytology of the cervix to rule out vervical cancer. Cytology for cervical cancer. REPRODUCTIVE AGE GROUP Must rule out pregnancy with hCG, also ectopic, molar and abortion. Abnormal growth such as leiomyoma (uterine artery emboli). Endometrial and endocervical polyps. External causes can be UID, OCP, HRT, Tamoxifen. Infectious causes such as endometritis (Gonorrhea, Trochamaotic) Bacterial vaginosis, (mycoplasma and PID) Systemic caues such as liver failure and thyroid, coagulopathy. THrombocytopenia. Dysfunctional uterine bleeding can be anvoulatory and ovulatory. Anovulatory is lack of estrogen. Ovulatory increases Prostaglanding and increases bleeding. Must first rule out pregnancy. Also check CBC to rule out anemia. PAP Smear to rule out cancer. Wet-Prep of cervical secretion. Endometrium with hysteroscopy, Dialtion and Curretage, pipelle device. Ultrasound to identify polyps, fibroids, Endometrial size is normally 5-8mm. Hyperplasia will 8-11m and cancer is usually greater than 11mm. Treatment is NSAIDS, Contraception, Anti-Fibrinolytics such as trexanemic Acid. Iron supplements. Surgical can be Dilation and curretage and hysterectomy