ginecologic examination.ppt

7/25/2019 GINECOLOGIC EXAMINATION.ppt

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GYNECOLOGICGYNECOLOGICEXAMINATIONEXAMINATION

Prof Hamonangan Hutapea SpOG.KProf Hamonangan Hutapea SpOG.K

Departement of Obtetr!" an# G$ne"o%og$Departement of Obtetr!" an# G$ne"o%og$

Me#!"a% S"&oo% 'S'Me#!"a% S"&oo% 'S'Me#an.Me#an.


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GYNECOLOGICGYNECOLOGIC

EXAMINATIONEXAMINATION

An a""urate an# "omp%ete &!tor$ ta(!ng ! of motAn a""urate an# "omp%ete &!tor$ ta(!ng ! of mot!mportant.!mportant.

A( )&at t&e ma!n prob%em !.A( )&at t&e ma!n prob%em !.

G!ne"o%og!"a% pat!ent ma$ be &$ or embarae# an#G!ne"o%og!"a% pat!ent ma$ be &$ or embarae# an#re*u!re +re*u!re +

, Pr!-a"$, Pr!-a"$

, T!me, T!me

, S$mpat&$ an#, S$mpat&$ an#

, Empat&$., Empat&$.


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GynecologicalGynecological

ExaminationExaminationGIO.GIO.

// 'n#ertan# an# ab%e to #o g!ne"o%og!"a%'n#ertan# an# ab%e to #o g!ne"o%og!"a%e0am!nat!on $temat!"a%%$ an# "an #ra) a r!g&te0am!nat!on $temat!"a%%$ an# "an #ra) a r!g&t

an# goo# "on"%ut!on t&ere after.an# goo# "on"%ut!on t&ere after.SIO.SIO.

// 1.Ta(e a re%e-ant &!tor$.1.Ta(e a re%e-ant &!tor$.

2.Do!ng Genera% E0am!nat!on "orre"t%$.2.Do!ng Genera% E0am!nat!on "orre"t%$.

3.E0p%a!n t&e re"ta% an# re"to-ag!na% e0am!nat!on.3.E0p%a!n t&e re"ta% an# re"to-ag!na% e0am!nat!on.

4.'n#ertan# t&e ne"e!t$ of upport!ng me54.'n#ertan# t&e ne"e!t$ of upport!ng me5

#!"a% e*u!pment an# %aborator$ !n-et!gat!on for#!"a% e*u!pment an# %aborator$ !n-et!gat!on for

a better #!agno!.a better #!agno!.


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History TakingHistory Taking

Previos gynecological or ot!er treatments"Previos gynecological or ot!er treatments" Menstral !istory# may vary very mc! $romMenstral !istory# may vary very mc! $rom%atient to %atient" Menarc!e is t!e age o$%atient to %atient" Menarc!e is t!e age o$onset o$ menstration&'( ) '*+ yrs"onset o$ menstration&'( ) '*+ yrs",!yt!m-reglarity o$ t!e cycle an. /loo.,!yt!m-reglarity o$ t!e cycle an. /loo.0o1&ex%resse. as#2-34+ t!e normal cycle#0o1&ex%resse. as#2-34+ t!e normal cycle#

&3'562+ .ays an. t!e /lee.ing lasts $or&657+&3'562+ .ays an. t!e /lee.ing lasts $or&657+.ays" 8olme o$ /loo. loss &6(5.ays" 8olme o$ /loo. loss &6(54(-3((+ml",emem/er t!at every 4(ml loss4(-3((+ml",emem/er t!at every 4(ml loss1ol. mean a loss o$ a/ot 9( mg iron"1ol. mean a loss o$ a/ot 9( mg iron"

Molmina# a secon.ary e:ects o$ menstralMolmina# a secon.ary e:ects o$ menstralcycle;1it! .iscom$ort;irrita/ility;.e%ression;cycle;1it! .iscom$ort;irrita/ility;.e%ression;

/reast .iscom$ort;/ackac!e;%elvic %ain/reast .iscom$ort;/ackac!e;%elvic %ain1!ic! is not severe enog! t!at t!e %atient1!ic! is not severe enog! t!at t!e %atientcan kee% !er normal activities an.;can kee% !er normal activities an.;

Last Menstral Perio.&LMP+"Last Menstral Perio.&LMP+"


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History TakingHistory Taking

Obtetr!" H!tor$+ par!t!epuerpera%Obtetr!" H!tor$+ par!t!epuerpera%!nfe"t!on!nfert!%!t$ an# abort!on.!nfe"t!on!nfert!%!t$ an# abort!on.

Genera% H!tor$+ &a t&e pat!ent e-erGenera% H!tor$+ &a t&e pat!ent e-eru6ere# from an$ #!eae+ "ar#!a"u6ere# from an$ #!eae+ "ar#!a"or en#o"r!ne #!eae#!abete%!-eror en#o"r!ne #!eae#!abete%!-er(!#ne$ or tuber(u%o! or(!#ne$ or tuber(u%o! or

p$"&!atr!" !%%ne. Pre-!ou urg!"a%p$"&!atr!" !%%ne. Pre-!ou urg!"a%proe#ure epe"!a%%$ g!ne"o%og!"a%proe#ure epe"!a%%$ g!ne"o%og!"a%&ou%# be note#.&ou%# be note#.


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Com%laint o$ %ainsCom%laint o$ %ains

Pa!n+ t&e %o"at!ont$pe!nterm!ttentre%ate#Pa!n+ t&e %o"at!ont$pe!nterm!ttentre%ate#to mentr."$"%e.T&e or#!nar$ pa!n %o"at!onto mentr."$"%e.T&e or#!nar$ pa!n %o"at!on

! fe%t !n t&e ba"(%o)er ab#omen an#! fe%t !n t&e ba"(%o)er ab#omen an##o)n to t&e t&!g& 7remember+#o)n to t&e t&!g& 7remember+appen#!"!t!8.appen#!"!t!8.

T&e e-er!t$ of pa!n "an be 9u#ge# toT&e e-er!t$ of pa!n "an be 9u#ge# to

ome e0tent b$ !t e6e"t on t&e pat!ent:ome e0tent b$ !t e6e"t on t&e pat!ent:be&a-!our. ;upture of t&e e"top!"be&a-!our. ;upture of t&e e"top!"pregnan"$tor!on of an o-ar!an "$tpregnan"$tor!on of an o-ar!an "$tpro#u"e !ntene"ont!nuou pa!n.pro#u"e !ntene"ont!nuou pa!n.


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Examination o$ t!eExamination o$ t!e

/reasts/reastsT&e pat!ent &ou%# be eate# or %$!ngT&e pat!ent &ou%# be eate# or %$!ngon &er ba"(.on &er ba"(.

T&e breat &ou%# be t&oroug&%$T&e breat &ou%# be t&oroug&%$

pa%pate#!n"%u#e# a0!%%a.pa%pate#!n"%u#e# a0!%%a. Note t&e "o%otrum or b%oo# e0pree#Note t&e "o%otrum or b%oo# e0pree#

from t&e n!pp%e.from t&e n!pp%e. A pa%pate# %ump ma$ uggetA pa%pate# %ump ma$ ugget

ma%!gnan"$.ma%!gnan"$. 7;out!ne mammograp&$ ! o6ere#7;out!ne mammograp&$ ! o6ere#

e-er$ 3$r !n )omen < $r of age8.e-er$ 3$r !n )omen < $r of age8.


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A/.ominalA/.ominal

ExaminationExamination Ab#om!na% pa%pat!on ! man#ator$.Ab#om!na% pa%pat!on ! man#ator$.

T&e te"n!*ue ofT&e te"n!*ue of

!npe"t!onpa%pat!on per"u!on!npe"t!onpa%pat!on per"u!onan# au"u%tat!on ! a#-!e#.an# au"u%tat!on ! a#-!e#.

Pa%pat!on &ou%# be #one gent%$ onPa%pat!on &ou%# be #one gent%$ on

a re%a0e# ab#omen )!t& t&e )&o%ea re%a0e# ab#omen )!t& t&e )&o%eurfa"e of $our pa%m to #ete"turfa"e of $our pa%m to #ete"t"$t!" or o%!# g$ne"o%og!" tumor."$t!" or o%!# g$ne"o%og!" tumor.


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A/.ominalA/.ominal

ExaminationExamination Inpe"t!on of a %arge o-ar!an "$tInpe"t!on of a %arge o-ar!an "$t

re-ea% a "&ara"ter!t!" of are-ea% a "&ara"ter!t!" of a

roun#e#$mmetr!"a% ab#omen)!t&roun#e#$mmetr!"a% ab#omen)!t&tre"&e# (!n an# a ?u!# t&r!%% ma$ betre"&e# (!n an# a ?u!# t&r!%% ma$ bee%!"!te#7no &!ft!ng #u%%ne8e%!"!te#7no &!ft!ng #u%%ne8

T&e a"!te or ma%!gnant o-ar!anT&e a"!te or ma%!gnant o-ar!an

tumor )!t& a"!te &o) t&e &!ft!ngtumor )!t& a"!te &o) t&e &!ft!ng#u%%ne on ab#om!na% per"u!on?at#u%%ne on ab#om!na% per"u!on?atab#omenan# an umb!%!"a% protrut!on.ab#omenan# an umb!%!"a% protrut!on.


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vlvavlva E0terna% an# !nterna% gen!ta%!a ofE0terna% an# !nterna% gen!ta%!a of

a )oman "an be e0am!ne#a )oman "an be e0am!ne#

t&oroug&%$ on a g$ne"o%og!"a%t&oroug&%$ on a g$ne"o%og!"a%"&a!r!n a fu%%$ %!g&te# "onfort"&a!r!n a fu%%$ %!g&te# "onfortan# u!tab%e room.an# u!tab%e room.

Dora% po!t!on ! "o-en!ent forDora% po!t!on ! "o-en!ent formot pat!ent an# #o"tor.mot pat!ent an# #o"tor.


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8lva8lva An !n#e0 @nger !nerte# !nto t&eAn !n#e0 @nger !nerte# !nto t&e

-ag!na.pa%pate t&e "on#!t!on of +-ag!na.pa%pate t&e "on#!t!on of +%ab!a"%!tor!anu an# t&e urroun#!ng (!n.%ab!a"%!tor!anu an# t&e urroun#!ng (!n.

S(!n "on#!t!on+!rr!tant #!"&arge an#S(!n "on#!t!on+!rr!tant #!"&arge an#prur!tupurp%!& #!"o%orat!onprur!tupurp%!& #!"o%orat!on#!abeteB#!abeteB

Ober-e+uret&ra% meatu*ueee an$ puOber-e+uret&ra% meatu*ueee an$ pufrom t&e per!uret&ra%5g%an# an# pa%patefrom t&e per!uret&ra%5g%an# an# pa%pate

t&e bart&o%!n g%an#.t&e bart&o%!n g%an#. If po!b%e !nert t)o @ngeran# pa%pate t&eIf po!b%e !nert t)o @ngeran# pa%pate t&e

per!nea% ?oor.per!nea% ?oor.


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=imanal Pelvic=imanal Pelvic

ExaminationExamination

A forma% "onent ! eent!a% beforeA forma% "onent ! eent!a% beforee0am!nat!on7b$ me#!"a% tu#ent8.e0am!nat!on7b$ me#!"a% tu#ent8.

Cutomar!%$ t)o @nger ! !nerte# !nto t&eCutomar!%$ t)o @nger ! !nerte# !nto t&e

-ag!naan# e0terna% &an# ! on t&e %o)er-ag!naan# e0terna% &an# ! on t&e %o)erab#omen to "o%%e"t an# upp%!e ena!ona%ab#omen to "o%%e"t an# upp%!e ena!ona%!nformat!on.er$ fe) !nformat!on ga!ne# !f!nformat!on.er$ fe) !nformat!on ga!ne# !ft&e pat!ent @n# t&e e0am!nat!on pa!nfu%.t&e pat!ent @n# t&e e0am!nat!on pa!nfu%.

In a -!rg!n or a "&!%# re"ta% e0am!nat!on !In a -!rg!n or a "&!%# re"ta% e0am!nat!on !a#-!e#.a#-!e#. !manua% E0am!nat!on nee# pra"t!"e.!manua% E0am!nat!on nee# pra"t!"e.


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=imanal Pelvic=imanal Pelvic

ExaminationExamination

Pa%pate t&e "er-!0note an$ &ar#ne.Pa%pate t&e "er-!0note an$ &ar#ne.T&e )&o%e uteru ! !#ent!@e#t&eT&e )&o%e uteru ! !#ent!@e#t&e

!e&apepo!t!onmob!%!t$ an#!e&apepo!t!onmob!%!t$ an#ten#erne are note#.ten#erne are note#.

T&e %atera% pe%-!" ! pa%pate# an# an$T&e %atera% pe%-!" ! pa%pate# an# an$)e%%!ng note#.)e%%!ng note#.

;e"to-ag!na% e0am!nat!on !;e"to-ag!na% e0am!nat!on !omet!me -er$ &e%pfu%.omet!me -er$ &e%pfu%.


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Materials and equipments

1. Surgical Gloves2. Bivalve speculum, Vergussons swpeculum and

Sims speculum

3 Sponge forcepsto clean cervi! and vagina"

#. Metal cat$eter and,%u&&er'plastic cat$eter

(. Su&limated cotton &all). *&+ect glass for citologic e!amination for

vaginal swap'smear.


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>"" Ayre s%atel an. et!yl alco!ol 72? $or>"" Ayre s%atel an. et!yl alco!ol 72? $orcervical an. vaginal cytology"cervical an. vaginal cytology"

4"" Cotton /all ti%%e. stra1 $or t!e exami54"" Cotton /all ti%%e. stra1 $or t!e exami5

nation o$ Gonor!oe;tric!omonas an.nation o$ Gonor!oe;tric!omonas an.

can.i.as"can.i.as"

7"" C!emical soltion#7"" C!emical soltion#&


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THAN YO@THAN YO@


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. -re spatula.

/. 0otton tipped stic to prepare fres$ vaginal preparation.

. Saline solution and otassium $dro!ide solution to test t$e presen4

ce of 5ric$omonas or 0andidas in a fres$ vaginal preparation.

16. 0ervi! 5enaculum

11. 7terine Sound

12. Biops forceps

13. Micro curet

1#. 8tc.

ginecologic examination.ppt

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