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Investigation methods of gynecological patients. General clinical symptoms of gynecological diseases 1. Rationale Professional motivation: The investigation methods in gynecology has a great value for studying subject. The basic and auxiliary methods of gynecological examination can enables to understand of gynecological diseases. These methods are used for verification of the diagnosis. 2. Objectives: 1. To analyze the main clinical symptoms of the gynecological diseases and gynecological anamnesis. -To explain The basic (objective) and auxiliary methods of gynecological examination and methods of functional diagnostics -To suggest tactics of management of patients in different diseases of reproductive system. -To classify the diseases of the cervix, endometrium, vulva according to current morphological and clinical classifications and ICD. -To interpret data of laboratory and instrumental examinations of the cervix, endometrium, vulva and endoscopic methods of examination gynecological patients -To draw a diagram of “patient route” and “plan of examination” in the background and precancerous pathology; indications of localization and PID To make the analysis of degrees of vagina cleanness. Cytology types. -To make up the models of clinical cases with various pathology in women of reproductive and premenopausal age. 3. The basic level of expertise, skills, abilities, required for learning the topic (interdisciplinary integration ) The name of the previous Acquired skills disciplines Normal Anatomy Structure of female genital organs. Topography of abdominal organs and pelvic organs. Histology Histological structure of the cervix, vulva and endometrium in normal and in pathological conditions. Notmal Physiology Physiological changes occurring in the hypothalamic- pituitary-ovarian system of women and target organs of the sex hormones action at different ages. Possession of the methodology for conducting functional diagnostics tests. Microbiology, Immunology Specific and nonspecific protective factors, antiviral immunity Pathological Anatomy Morphological structure of all types of benign tumors of the female genital organs. Pathological Physiology Hormonal changes in the body during the menstrual cycle and disorders of the microbiota of the female reproductive system. Operative Surgery The main types of surgery on the female genital organs. Mechanisms of therapeutic action of physical factors (electric current, refrigerants, laser radiation, phototherapy). Pharmacology Groups of medications that affect the function of the hypothalamus, pituitary gland, ovaries, adrenal glands; mechanism of pharmacological action of hormonal, hemostatic, anti-inflammatory, antiviral drugs. 4. Tasks for independent work in preparation for the lesson and in class. 4.1. The list of the major terms, parameters, characteristics to be acquired by a student to be prepared for the lesson The term Definition Gynecological pelvic Inspection of the external genitalia examination Inspection of the cervix and vagina using a speculum Bimanual examination Rectal, rectovaginal Clinical breast exam complaints A specific gynecological Меnstrual anamnesis, function: Sextual function Reproductive function: Gynecological diseases cytological (PAP-test) bacterioscopic laboratory tests in bacteriological gynecology virological (HPV-test) histological from the vagina, cervix, cervical canal and urethra and uterus functional diagnostics tests basal temperature Colposcopy Hysteroscopy Endoscopic Laparascopy research methods in gynecology Interpretation of the data of transabdominal and transvaginal ultrasound examination of Ultrasound examination of the the pelvic organs pelvic organs curettage of the cervical canal and uterine cavity Instrumental methods of examination gynecological patient. 4.2 Theoretical questions for the lesson: 1. General and specific methods of examination of gynecological patients. 2. Bimanual, vaginal and rectal examinations. Speculum examination. 3. Methods of diagnosing the functional state of the ovaries. 4. History taking, estimation of the laboratory investigations ( general and biochemical blood tests, urine blood coagulation, etc.) 5. Taking material from the vagina, urethra and cervical canal. 6. Evaluate the results of colpocytological study. 7. Evaluate the results of colposcopy. 8. Evaluate the diagnostic tests of the ovaries function. 9. Evaluate the results of the cytological, histological and bacteriological investigation. 10. Evaluate results of X-ray of female genitalia. 11.Estimate results of pelvic sonography. 12. Plan the investigations of patiens with various gynecological diseases. 4.3 Practical activities (tasks) to be performed on the lesson: To perform gynecological examination (bivalve vaginal speculum, bimanual, rectal, rectovaginal). To collect a specific gynecological anamnesis, to evaluate the findings of laboratory tests. To collect material from the vagina, cervix, cervical canal and urethra for cytological, and bacterioscopic studies. To evaluate the findings of cytological, histological, virological and bacteriological studies. To evaluate the findings of the ultrasonography of organs of the small pelvis. To estimate the protocol of the colposcopy of the cervix and vulva. To make a plan of examination of a patient in various nosological forms of background and precancerous pathology. 4.4 Topic content Investigation methods of gynecological patients. General clinical symptoms of gynecological diseases Examination of the patient, who had been admitted to the gynecological department, consists of anamnesis, objective (general and special) examination, and auxiliary methods. 1.1. Gynecological Anamnesis First, the doctor makes inquiries about the patient’s complaints, then about the development of the given disease (case history, anamnesis morbi), special gynecological history (certificates of the menstrual, sexual, reproductive, and secretory functions, antifertility agent application) (gynecological history, anamnesis gynaecology), and after that about living conditions, the history of diseases, allergic reactions (anamnesis vitae). The questioning is conducted according to a certain plan. 1. Passport data: the surname, name, patronymic name, age of the woman. 2. The patient’s complaints. Most often patients appeal to the doctor with complaints of pain, leucorrhoea, menstrual irregularities, bleeding, and also dysfunction of the adjacent organs (urinary incontinence, frequent urination, constipations, pain in defecating). 3. Case history. The doctor should find out how the disease began – acutely or gradually, what might have promoted disease development, whether there have been any examinations or treatment. 4. Gynecological history includes information about the menstrual, sexual, reproductive, and secretory functions of the woman. Menstrual function: the age of the first menstruation (menarche), the presence or absence of pain, menstruation duration, its regularity, menstrual cycle change after deliveries and abortions, the presence and duration of menopause, the date of the last menstruation. Sexual function: at what age the woman began sexual life, if there were any signs of the disease when she began sexual life or changed partner, how many sexual partners the woman has at the same time, what contraception method is preferred. Reproductive function: in what time interval after beginning sexual life without contraception the woman became pregnant for the first time, how many pregnancies the woman has had (deliveries, abortions), if there have been any complications after deliveries or abortions. Secretory function: the information about the quantity, smell, appearance, and periodicity of the vaginal discharge. Correctly collected gynecological anamnesis allows giving a provisional diagnosis with satisfactory accuracy. However, the doctor can draw the final conclusion about the disease only after an objective examination of the patient. 5. Life history: under what conditions the woman used to live and develop, what diseases she has had, allergic anamnesis, the presence of any pernicious habits (smoking, alcoholism, drug addiction). 6. Objective examination methods. 1.2. The basic methods of gynecological examination Gynecological examination is carried out on a gynecological chair. The woman is lying on her back with her legs half-bent in the knee and hip joints. Before examination the woman must necessarily evacuate the urinary bladder; if it is necessary, a cleansing enema is given. The doctor examines the woman in sterile gloves. Examination of the external genitals: pubis (its form, the state of the hypoderm, the pattern of hair distribution – adult woman, adult male, or mixed), perineum, large and small lips of pudendum (size, presence of edemas, ulcers, tumors, condylomatous excrescences, the degree of pudendal fissure closure); examination of the external urethral orifice, clitoris, internal surface of the large and small lips of pudendum (color, the state of the mucous tunic, pigmentation, ulcers), detecting the size of the Bartholin’s glands (location of their excretory ducts, the character of the secret, the presence of swelling and reddening around the orifice), posterior labial commissure (ruptures, scars), detecting falling and prolapse of the vaginal walls and uterus. The doctor obligatorily assesses the state of the hymen (intact, ruptured, acute ruptures). Simultaneously the doctor finds signs of infantilism (a narrow pudendal fissure, the large lips of pudendum
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