Gynecology Dr. Helen Albao

GynecologyDr. Helen AlbaoTypes of patients:Neonates-Vaginal discharges or bleeding-commonly due to physiologic withdrawal of maternal estrogen;- the anxious & justifiably apprehensive mother needs reassurance

12. Young child-Pruritus or discharge -MDs responsibility-to avoid creating fear or apprehension - Gentleness is mandatory - examination should never be compromised bec. Of the childs possible sensitivity.Sarcoma botryoides- on rare occasion this is a significant pathologyOvernight hospitalization & pelvic evaluation under anesthesia may be required. - less traumatic than examining a frightened child in the office. 3. AdolescentCommon complaints- be discussed openly & treated appropriately -Breast development - Vaginal discharge - irregularity of menses and -painful menstruation-Reassurance is important, regardless of the findingsMedical history-General data Name, Age, G/P, LMP, PNMP, AOG, ESG, Date & time of Admission, Name of hospital/ clinic-Chief complaint-HPI-Menstrual historyObstetrical historyPast medical/ surgical historyFamily HistoryNutritional HistoryG/P Gravidity/ ParityG- refers to the gravidity/ state of pregnancyP-refers to parity expressed in 4 digits (FPAL)1st digit- Full tem pregnancy (37 wks gestation and beyond)2nd Preterm preg. (21-36 weeks gestation)3rd- Abortion (20 weeks gestation & below)4th Living Children (total number of living children)G1P0- presently pregnant for the 1st timeG1P001- had 1 full term preg. 1 living child

LMP- 1st day of the last normal menstrual periodEDC- expected date of confinementEDD- espected date of delivery/ Naegeles ruleAOG- total no. of completed weeks of pregnancy from LMP

Chief Complaint-Primary reason for Patients admission, singular-Common gynecological complaints-Vaginal discharges -bleeding, Purulent discharges, foul smelling discharges-Pruritus vulva-Pelvico-abdominal mass-Dysuria-Dysmenorrhea-Dyspareunia -Profusion of mass in the vaginal outlet-Infertility

History of Present illnessHPI Detailed, narrative story of the reason for admission in chronological order until the time the patient decided to seek admission.Ex. The present condition started as vaginal bleeding which was noted 2 days PTA.-associated symptoms-Precipitating & Aggravating factors-Consultations/ Medications/ drugs taken/relief etc.

Menstrual HistoryMenarcheDays CycleNumber of daysAmount of FlowAssociated symptoms- Dysmenorrhea, painful defecation, dysuria, pruritusEx. 13x 28x 3-5, moderate flow, used 2-3 pads, pruritus associated with dysmenorrhea or premenstrual pains.Obstetrical historyNo.yearOutcome of preg.Place of delivery; handled by MD, mw, hilotBirth wgtCondition at birth APGAR scoreFetal sexMaternal complicationMedical RecordsPast medical/ surgical historyFamily historyNutritional historyPhysical ExaminationAdmitting DxDifferential DxDiagnostic work-upFinal Dx.

Physical ExaminationObjective findings-Examined conscious, coherent, cooperative, ambulatorywith the ff. vital signs -BP, Temp, PR, RR - HEENT-Neck-Chest & Lungs-Heart-Breast - Abdomen-GenitaliaPhysical examBreast/ Chest & Lungs/ abdomen-inspection, Palpation, percussion, Auscultation

Genitalia-Inspection-bimanual pelvic Exam (Digital exam) GenitaliaInspectionVulva (External)Gross AppearanceDischargesSpeculum exam - Vagina, cervixBimanual Pelvic examSpeculum examEmpty the Urinary bladderLithotomy position-the px. Lying supine on the examining table with her legs in stirrups

-Examining Gloves and Vaginal speculumSpeculum: 3 sizesSmall -Young children, virgins, tight perineal repair, menopauseMeduim used for most womenLarge- useful in large or obese women or those who are grand multiparasSpeculum examTransverse diameter of the blades inserted in the A-P position & Guiding the blades through the introitus in a downward motion with the tips pointing towards the rectum.-Because the Anterior wall of the Vagina is backed by the public symphysis, which is rigid, pressure upward causes the patient discomfort.-the resting state of the Vagina lies on the rectum and actually extends posteriorly from the introitus.May be facilitated by placing 2 fingers into the introitus & pressing down.

Speculum exam - Once the blades are inserted the speculum should be turned so that the transverse axis of the blades is in the transverse axis of the vagina.-The blades should be inserted to their full length,-Open to inspect the vaginal walls & cervix.

Inspection of the CervixPink, shiny, and clearNulliparous individual, the external os should be roundParous, the external os takes on a fish-mouth appearanceStellate Healed cervical lacerations

Speculum examNormally, the transofmation zone (i.e., the junction of squamous and columnar epithelium) is just barely visible inside the external os.Bimanual Pelvic examIndex & middle fingers of the dominant hand are placed within the vagina, and the thumb is folded under-so as not to cause the patient distress in the area of the mons pubis, clittoris, and pubic symphysis.

-The fingers are inserted deeply into the vagina so that they rest beneath the cervix in the posterior fornix.The 2 fingers of the vaginal hand are then moved into the right vaginal fornix as deeply as they can be inserted.The abdominal hand is placed just medial to the anterio superior iliac spine on the right.The 2 hands are brought as close together as possible.With a sliding motion from the area of the anterior superior iliac spine to the introitus, the fingers are swept downward, allowing for the adnexia to be palpated between them.

Rectovaginal ExamThe middle finger is relubricated w/ a water soluble lubricant and placed into the rectum.The index finger is reinserted into the vaginaPalpate the 1. Rectovaginal septum 2. Uteroscaral ligaments - Any thickening or beadiness of these structures may imply an inflammatory rxn or endometriosis.Preventive Medicine in Womens health