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yashikasingh37

PAP SMEAR TEST

Salud y medicina

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Definition Presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa is called endometriosis. It is a benign but it is locally invasive. Prevalence The real one is due to delayed marriage, postponement of first conception and adoption of small family norm. The apparent one is due to increased use of diagnostic laparoscopy as well as hightened awareness of this disease complex amongst the gynecologists Sites Abdominal: Usually confined to the abdominal structures below the level of umbilicus. Extra-abdominal: Common sites are abdominal scar of hysterotomy, cesarean section, tubectomy and myomectomy, umbilicus, episiotomy scar, vagina and cervix. Remote Pathology Naked Eye Appearance: The appearance of the lesion depends on the organs involved, extent of lesion and reaction of the surrounding tissues. Pelvic endometriosis: Small black dots, called ‘powder burns’ seen on the uterosacral ligaments and pouch of Douglas. Fibrosis and scarring Symptoms Dysmenorrhea (70%) Abnormal menstruation (20%) Infertility (40–60%) Dyspareunia (20–40%) Chronic Pelvic Pain Abdominal Pain Urinary— frequency, dysuria, back pain or even hematuria. Sigmoid colon and rectum—painful defecation (dyschezia), diarrhea, constipation, rectal bleeding or even melena. Chronic fatigue, perimenstrual symptoms (bowel, bladder). Hemoptysis (rarely), chest pain. Surgical scars—cyclical pain and bleeding. Examination Abdominal palpation A mass may be felt in the lower abdomen arising from the enlarged tubo-ovarian mass due to endometriotic adhesions. The mass is tender with restricted mobility. Pelvic Examination Pelvic tenderness, nodules in the pouch of Douglas, nodular feel of the uterosacral ligaments, fixed uterus or unilateral or bilateral adnexal mass of varying sizes Diagnosis Bichemical parameters: Serum CA 125 Monocyte Chemotactic Protein (MCP-1) Imaging: TVS - ovarian endometriomas Endorectal USG - Rectosigmoid endometriosis MRI - deep infiltrating endometriosis. Colonoscopy, rectosigmoidoscopy and cystoscopy Differential Diagnosis Chronic pelvic infection / symptomatic endometriosis. Laparoscopy is helpful in actual diagnosis. Ovarian endometrioma / benign ovarian tumor / malignant ovarian. Ultrasonography or Laparoscopy Rupture of the chocolate cyst / torsion or rupture of the ovarian tumour, disturbed ectopic pregnancy, appendicitis or diverticulitis. Complications Endocrinopathy Rupture of chocolate cyst Infection of chocolate cyst Obstructive features: Intestinal obstruction Ureteral obstruction → hydroureter hydronephrosis → renal infection Endocrinopathy in Endometriosis Corpus luteum insufficiency Luteolysis due to ↑ PGF. Luteinized unruptured follicle (LUF) Anovulation Elevated prolactin level Double LH peak. Staging Endometrios is should be staged appropriately. To predict prognosis. To choose therapy. To evaluate the treatment protocol. The stage is determined by adding specific points given to each.

endo.pptx

yashikasingh37

Contraception Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures. The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods. Need for contraception • To avoid unwanted pregnancies. • To regulate the timing of pregnancy. • To regulate the interval between pregnancy. Ideal Contraceptive • Safe • Effective • Acceptable • Reversible • Inexpensive • Long lasting • Requires little or no medical supervision Contraceptive methods Spacing methods Natural Barrier IUDs Emergency contraception Terminal methods Male fertilisation Female fertilisation Natural Methods Coitus inteyrruptus / withdrawal Rhythm Method Lactational Amenorrhoea Barrier Methods Mechanical Male : Condom Female : Condom, Diaphragm, Cervical cap Chemical Creams - Deleen Jelly – Koromex, Volpar paste Foam tablets – Aerosol foams, Chlorimin T or Contab Combination Combined use of Chemical and Mechanical methods. Male condom • Most commonly known and used contraceptive. • Better known in India as NIRODH. Female condom Femidom Diaphragm Spermicides Spermicides are surface active agents which attach themselves to spermatozoa and kill them. Available in various forms like Intrauterine Contraceptive Devices Cu T200 T shaped device Polyethylene frame. 215 mm2 surface area of Cu wire. Contains 124 mg of copper Cu is lost at the rate of 50 µg/day. Polyethylene monofilament tied at vertical stem. Cu is radio opaque so additionally barium is incorporated in the device. Supplied in a sterilised sealed packet. Lifetime 4 years. Cu T 380A 380 mm square surface area of copper wire. Replacement 10 years. Multiload Cu 250 60-100 ug/day Replacement 3 years Multiload - 375 Mode of action Biochemical and histological changes in endometrium. Increased tubal motility. Endometrial inflammatory response. Prevents implantation. Contraindication for insertion of IUCD Presence of pelvic infection Genital tract bleeding (undiagnosed) Suspected pregnancy Uterine fibroid Severe dysmenorrhoea Ectopic pregnancy history Caesarean section Cu allergy Time of insertion Interval 2-3 days after menstrual phase. During lactational amenorrhoea. Postabortal Done immediately following termination of pregnancy. Postpartum After 6 weeks of delivery. Postplacental delivery Post delivery of placenta. Method of Insertion Preliminary steps: History taking and examination Patient is informed and consent is obtained. Insertion is done in OPD aseptic conditions. Placement of device in inserter. Steps of operation The patient is asked to remain empty bladder. The patient is placed in lithotomy position. Local antiseptic cleaning is done. Posterior vaginal speculum is introduced. Anterior lip of cervix is grasped with Allis tissue forcep. The device is placed in the inserter and introduced through cervical

contraception.pptx

yashikasingh37

Bartholin’s Gland Function : The production of mucoid secretion that lubricates the distal end of the vagina during intercourse. The glands become active after menarche and are non palpable. Bartholinitis Causative agent: Gonococcus Streptococcus Staphylococcus E. coli End result : Complete resolution Recurrence Abscess Cyst formation Clinical features : Local pain discomfort. Difficulty in walking / sitting. Examination : Tenderness Induration of post half of vagina. Secretion coming out from the duct when pressed. Treatment Local : Systemic: Ampicillin 500 mg TDS Bartholin’s Abscess End result of acute Bartholinitis. Clinical features: Severe local pain and discomfort. Difficult / painful walking and sitting. On examination: Unilateral tender swelling. Oedomatous red overlying skin. Treatment: Rest. Sitz bath. Systemic antibiotic Ampicillin 500 mg. Drainage of abscess. Bartholin’s cyst The content is colourless glairy liquid. C/f : Small cyst : usually unnoticed. Larger cyst : Local discomfort and dyspareunia. Examination: Unilateral swelling on post half of labia majora. Projection on vulval cleft into S-shape. Overlying skin is shiny and thin. Cyst remains non tender and fluctuant. Treatment: Marsupilisation.

BARTHOLINS.pptx

yashikasingh37

Candida vaginitis Dr. Yashika Introduction: Causative agent: Candida albicans (Gram positive fungus) Clinical features: Intense vulvovaginal discharge Dyspareunia On examination: Thick, curdy white discharge. Cottage cheese type flakes discharge often adherent to the vaginal wall. Red swollen vulva. Tender PV examination. Diagnosis: Wet smear Treatment: Removal of predisposing factors. Local anti fungal prep. Creams, ointments, pessary. Single dose oral therapy Fluconazole/ itraconazole Thank you

Moniliasis(Candida vaginitis)

yashikasingh37

Lymphogranuloma Venereum Dr. Yashika Causative agent : Chlamydia trachomatis Incubation period: 3-30 days Clinical features : Initial phase: Painless papule, pustule or ulcer in vulva, urethra, rectum or cervix. Involved inguinal nodes feels rubbery. Acute lumphangitis and lymphadenitis. Necrosed glands and abscess formation. Rupture of abscess occurs within 7-15 days. Sinus and fistula formation. Intense fibrosis with lymphatic drainage. Secondary phase : Painful adenopathy. Classical clinical sign: Groove sign A depression between the groups of inflammed nodes. Complication: Vulval elephantiasis Perineal scarring Rectal stricture Sinus and fistula formation. Diagnosis Culture and isolation Detection of LGV Treatment: Doxycycline 100 mg BID x 21days. Azithromycin 1 gm PO weekly x 3 weeks Abscess aspiration

Lgv (Lymphogranuloma Venereum)

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Leucorrhoea Dr. Yashika Abnormal Vaginal Discharge Frequent complaint. Discharge may vary from excess to normal. Discharge may be blood-stained / contaminated with urine or stool. Characteristics of normal vaginal fluid Nature - watery Colour - white Odour - Odourless pH - 4.0 Microscopically - Squamous epithelial cells, Leucorrhoea Leucorrhoea is defined as excessive normal vaginal discharge. Features of vaginal discharge in leucorrhoea : Excess secretion. Non purulent Non offensive Non irritant Never causes pruritis. Etiology : Physiological excess Cervical causes Vaginal causes Physiologic excess Puberty Menstrual Cycle Pregnancy Sexual excitement Cervical causes: Cervicitis Cervical ectopy Cervical polyp Treatment General health improvement Surgical treatment of cervical factors Pill users are asked to stop pill immediately Local hygiene

Leucorrhoea

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HYSTERECTOMY Hysterectomy Hysterectomy Term origin: hyster + ectomy uterus surgical removal Definition: Hysterectomy is defined as the surgical removal of uterus. Routes for Hysterectomy Abdominal Hysterectomy Vaginal Hysterectomy Laparoscopic Hysterectomy Caesarean Hysterectomy Types of Hysterectomy Total Hysterectomy Removal of entire uterus. Subtotal Hysterectomy Removal of body or corpus leaves behind the cervix. Panhysterectomy / Hysterectomy with bilateral salpingo oophorectomy Removal of uterus along with tubes and ovaries of both sides. Indications

Hysterectomy

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Herpes Genitalis Dr. Yashika Introduction Causative organism : Herpes Simplex virus type 1 and 2 Transmission : Orogenital contact Incubation period : 2 – 14 days. Clinical features: First attack with 7 days of sexual contact. Red painful inflammatory area around clitoris, labia, vestibule, vagina, cervix and perineum. Appearance of multiple vesicles which progress into ulcers then heals up by crusting Lymphadenopathy Fever, malaise and headache. Diagnosis: Virus tissue culture and isolation ELISA Fluorescent method PCR test Treatment Specific treatment is yet to b explored. Acyclovir 200 mg 5 times x 5days. Saline water bath.

Hsv Herpes Genitalis

yashikasingh37

Hysterosalpingography Dr. Yashika Hysterosalpingography(HSG) Hystero + Salpingo + Graphy HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes. It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes. Indications: Assessment of tubal patency. Detection of uterine malformation. Diagnosis of cervical incompetence. Detection of translocated IUD. Diagnosis of uterine synechiae. Diagnosis of uterine fibroid , uterine polyp. Diagnosis of abdominal pregnancy. Uterine Malformation Steps of operation The patient is asked to remain empty bladder. Operation is done under general anaesthesia. The patient is placed in lithotomy position. Local antiseptic cleaning is done. Posterior vaginal speculum is introduced. Anterior lip of cervix is grasped with Allis tissue forcep. HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced. The passage of the dye is observed by using X-ray intensifier and a video display unit. Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure. Timing of procedure : HSG is done between D6 and D10 of cycle. Antibiotics are given one day prior the procedure up to 5 days. Contrast media Complications Peritoneal irritation. Pelvic pain. Vasovagal attack. Intravasation of dye into the venous or lymphatic channels. Flaring up of pelvic infections.

Hsg

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AIDS Dr. Yashika Introduction Causative agent : Human Immunodeficiency Viruses (HIV) HIV belongs to retrovirus family (double stranded RNA). Mode of transmission Sexual intercourse IV drug abusers Blood transfusion Use of contaminated needles Breastfeeding Perinatal transmission Immunopathogenesis Immunological Markers CD4 T lymphocyte count RT-PCR Raised P-24 antigen titre Raised serum β2 microglobulin Clinical Presentation Development of Ab marks the stage of seroconversion aka flu-like syndrome. Acute infection syndrome characterized by fever, skin rash, arthralgia, lymphadenopathy and diarrhoea. This is called seroconversion illness lasts upto 2-3 weeks and gets resolved itself spontaneously. Gynaecological Symptoms Infections of genital tract. Neoplasm of genital tract. Menstrual abnormalities. Fertility and pregnancy are not affected. Diagnosis Detection of IgG antibody. ELISA Western blot PCR Treatment

Human Immunodeficiency Virus - Acquired Immuno Deficiency Disease

yashikasingh37

GONORRHOEA Dr. Yashika Introduction Causative agent : Neisseria gonorrhoea (gram negative diplococcus). Incubation period : 3-7 days. Site of invasion : columnar and transitional epithelium of the genitourinary tract. Primary sites of infection : endocervix, urethra and Bartholins gland. Other sites of infection : Oropharynx, anorectal and conjuctiva. Clinical features : Local: Excessive irritant vaginal discharge Dysuria Acute unilateral pain Swelling over labia. Pharyngeal infection Intermenstrual bleeding. Rectal discomfort. Signs : Swollen labia and inflammed. Mucopurulent vaginal discharge. Speculum examination reveals congested endocervix. Distant symptoms : Perihepatitis Septicaemia Complications: PID Infertility Ectopic pregnancy Chronic pelvic pain Tubo ovarian mass Bartholins gland abscess. Diagnosis Nucleic acid amplification test (NAAT) urine culture Drug sensitivity test. Treatment Adequate therapy for gonococcal infection. To treat both the partner simultaneously. To avoid multiple sex partner. To use condom till free from disease.

Gonorrhoea

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Dilatation and Insufflation Dr. Yashika Dilatation and Insufflation(D&I) Also known as Rubin’s test. Operation for dilatation of cervix and insufflation of air (CO2) in to the uterine cavity to know the patency of fallopian tubes. Indications of D&I Investigation for fertility. Following tuboplasty. Contraindication : Pelvic infections. Steps of operation The patient is asked to remain empty bladder. Operation is done under general anaesthesia. The patient is placed in lithotomic position Local antiseptic cleaning is done. Posterior vaginal speculum is introduced. Anterior lip of cervix is grasped with Allis tissue forceps. 7. Uterine sound is introduced to confirm the position and to note the length of cervical canal. Cervical canal is dilated with graduated dilators. After the desired dilatation, the insufflation cannula is introduced into the cervical canal. 10. Air is introduced in the uterus and the hissing sound is auscultated over the flanks. Test Positive Test: An audible hissing sound on the flanks due to exit of air. Patient complains of shoulder painon sitting. Negative Test: No hissing sound over the flanks. Complications Complications

Dilatation and Insufflation

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Cervix Anatomy Lowermost part of uterus Cylindrical shape Diameter and length are 2.5 cm. Parts Supravaginal Infravaginal Extends from histological internal os to anatomical external os. Nulliparous - Pin hole cervix Parous - Bilateral slit Cervical Biopsy Punch Biopsy Wedge Biopsy Ring Biopsy Whole of squamo-columnar junction area of the cervix is excised with a special knife. The tissue is subjected to serial section to detect cervical intraepithelial neoplasia (CIN) or early invasive carcinoma. Cone Biopsy - Conization Complications Thank you

Cervical biopsy

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Bacterial Vaginosis Dr. Yashika Causative agent : Gardnerella vaginalis Clinical features: Malodorous vaginal discharge. (Homogenous, greyish white, adherent to vaginal wall) No vaginal inflammation. During pregnancy preterm membrane rupture, preterm labour, chorioamnionitis. Complications: Recurrent infection leads to PID. Development of PID following abortion. Vaginal cuff cellulitis following hysterectomy. Pregnancy complications. Diagnosis Amsel’s criteria : Homogenous vaginal discharge Vaginal discharge > 4.5 Positive whiff’s test Presence of clue cells > 20% of cells. Whiffs test: Appearance of fishy (amine) odour when a drop of discharge is mixed with 10% solution of KOH. Clue cells: Presence of stippled epithelial cells. Treatment: Metronidazole 200 mg TDS x 7 days. Clindamycin cream. Metronidazole gel.

Bacterial vaginosis

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Cervical Erosion Dr. Yashika Definition Cervical erosion is a condition where the squamous epithelium of the ectocervix is replaced by columnar epithelium which is continuous with endocervix. Aetiology Congenital Acquired Clinical features Symptoms : Vaginal discharge Contact bleeding Associated cervicitis SIGNS : Diagnosis Ectropion Early carcinoma Primary Lesion (Chancre) Tubercular ulcer Management Pregnancy Pill user Persistent ectopy

Cervical erosion

yashikasingh37

Menopause

yashikasingh37

Más de yashikasingh37 (16)

endo.pptx

contraception.pptx

BARTHOLINS.pptx

Moniliasis(Candida vaginitis)

Lgv (Lymphogranuloma Venereum)

Leucorrhoea

Hysterectomy

Hsv Herpes Genitalis

Hsg

Human Immunodeficiency Virus - Acquired Immuno Deficiency Disease

Gonorrhoea

Dilatation and Insufflation

Cervical biopsy

Bacterial vaginosis

Cervical erosion

Menopause

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papsmear.pptx