ICD-9-CM and ICD-10-CM Codes for Gynecology and Obstetrics
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Vaginitis and Abnormal Vaginal Bleeding
UCSF Family Medicine Board Review 2013 Vaginitis and Abnormal • There are no relevant financial relationships with any commercial Vaginal Bleeding interests to disclose Michael Policar, MD, MPH Professor of Ob, Gyn, and Repro Sciences UCSF School of Medicine [email protected] Vulvovaginal Symptoms: CDC 2010: Trichomoniasis Differential Diagnosis Screening and Testing Category Condition • Screening indications – Infections Vaginal trichomoniasis (VT) HIV positive women: annually – Bacterial vaginosis (BV) Consider if “at risk”: new/multiple sex partners, history of STI, inconsistent condom use, sex work, IDU Vulvovaginal candidiasis (VVC) • Newer assays Skin Conditions Fungal vulvitis (candida, tinea) – Rapid antigen test: sensitivity, specificity vs. wet mount Contact dermatitis (irritant, allergic) – Aptima TMA T. vaginalis Analyte Specific Reagent (ASR) Vulvar dermatoses (LS, LP, LSC) • Other testing situations – Vulvar intraepithelial neoplasia (VIN) Suspect trich but NaCl slide neg culture or newer assays – Psychogenic Physiologic, psychogenic Pap with trich confirm if low risk • Consider retesting 3 months after treatment Trichomoniasis: Laboratory Tests CDC 2010: Vaginal Trichomoniasis Treatment Test Sensitivity Specificity Cost Comment Aptima TMA +4 (98%) +3 (98%) $$$ NAAT (like GC/Ct) • Recommended regimen Culture +3 (83%) +4 (100%) $$$ Not in most labs – Metronidazole 2 grams PO single dose Point of care – Tinidazole 2 grams PO single dose •Affirm VP III +3 +4 $$$ DNA probe • Alternative regimen (preferred for HIV infected -
Cervical Polypectomy
Cervical Polypectomy Author: Consultant Department: Gynaecology/ Colposcopy Document Number: STHK1225 Version: 4 Review date: 01/10/2022 What is a polyp? Your doctor/nurse has advised you to have a polypectomy, which is the removal of a polyp. A polyp is a flesh-like structure (often described as looking like a cherry on a stalk or a skin tag), which can develop in many places in the body, including the cervix and uterus. It may have blood vessels running through it, which can often be the cause of bleeding. If it is thought the polyp is in your uterus, you will need to have a hysteroscopy (a procedure that uses a narrow camera to look inside the cavity of the uterus). This procedure is carried out as a gynaecology outpatient appointment at the Women’s Centre, and is performed in a special clinic in the Diagnostic Suite. You will receive a further appointment for this treatment and be given a different leaflet to explain the hysteroscopy procedure. If for any reason the polyp cannot be removed or fully removed during either of these treatments, the doctor will advise you of other options. Reasons for the procedure As you know you have been referred to the Colposcopy Clinic because you have a polyp on the cervix. Sometimes the cervical polyp is broad based, where it does not have a stalk but sits on the cervix. Often they cause no symptoms and are found as a result of other examinations. Polyps are usually benign (non-cancerous). Less than 1 % (1 in 100) may have pre-cancerous or cancerous changes within them; it is therefore advisable to have them removed. -
How to Evaluate Vaginal Bleeding and Discharge
How to Evaluate Vaginal Bleeding and Discharge Is the bleeding normal or abnormal? When does vaginal discharge reflect something as innocuous as irritation caused by a new soap? And when does it signal something more serious? The authors’ discussion of eight actual patient presentations will help you through the next differential diagnosis for a woman with vulvovaginal complaints. By Vincent Ball, MD, MAJ, USA, Diane Devita, MD, FACEP, LTC, USA, and Warren Johnson, MD, CPT, USA bnormal vaginal bleeding or discharge is typically due to either inadequate levels of estrogen one of the most common reasons women or a persistent corpus luteum. Structural causes of come to the emergency department.1,2 bleeding include leiomyomas, endometrial polyps, or Because the possible underlying causes malignancy. Infectious etiologies include pelvic in- Aare diverse, the patient’s age, key historical factors, flammatory disease (PID). Additionally, a variety of and a directed physical examination are instrumental bleeding dyscrasias involving platelet or clotting fac- in deciding on diagnosis and treatment. This article tors can complicate the normal menstrual period. Iat- will review some common case presentations of rogenic causes of vaginal bleeding include hormone nonpregnant female patients with abnormal vaginal replacement therapy, steroid hormone contraception, bleeding, inflammation, or discharge. and contraceptive intrauterine devices.3-5 Anovulatory bleeding is common in perimenar- ABNORMAL VAGINAL BLEEDING chal girls as a result of an immature hypothalamic- To ensure appropriate patient management, “Is she pituitary axis and in perimenopausal women due to pregnant?” should be the first question addressed, declining levels of estrogen. During reproductive since some vulvovaginal signs and symptoms will years, dysfunctional uterine differ in significance and urgency depending on the bleeding (DUB) is the most >>FAST TRACK<< answer. -
Having a Cervical Polypectomy
Gynaecology information Having a cervical polypectomy Introduction This leaflet gives you advice and information about having a cervical polypectomy (removal of polyps from the neck of the womb). Please read it before you go home so that you can have your questions answered before you leave. Feel free to discuss any questions or concerns with your nurse or telephone the Colposcopy Clinic on 0118 322 7197 or Sonning Ward on: 0118 322 7181. What is a cervical polypectomy and why do I need one? A cervical polyp is a small piece of tissue, usually on a stalk, that grows on the cervix (neck of the womb). Sometimes the cervical polyp is broad-based, where it does not have a stalk but sits on the cervix. Often they cause no symptoms and are found as a result of other examinations. Polyps are usually benign (non-cancerous). Less than 1% may have pre- cancerous or cancerous changes within them; it is therefore advisable to have them removed. A polypectomy is the removal of polyps. What are the risks of a cervical polypectomy? The procedure is very low risk, but may cause an infection or heavier bleeding. Before being sent for a polypectomy your doctor will have carried out a full pelvic examination, including an examination of your cervix using a speculum and you may have had an ultrasound or scan. What happens during a cervical polypectomy? This is normally done in the outpatient clinic. You will be asked to undress from the waist down and lie down on an examination couch. A speculum (the instrument used to open up the vagina) is passed into the vagina to expose the cervix. -
Menstrual Disorder
Menstrual Disorder N.SmidtN.Smidt--AfekAfek MD MHPE Lake Placid January 2011 The Menstrual Cycle two phases: follicular and luteal Normal Menstruation Regular menstruation 28+/28+/--7days;7days; Flow 4 --7d. 40ml loss Menstrual Disorders Abnormal Beleding –– Menorrhagia ,Metrorrhagia, Polymenorrhagia, Oligomenorrhea, Amenorrhea -- Dysmenorrhea –– Primary Dysmenorrhea, secondary Dysmenorrhea Pre Menstrual Tension –– PMD, PMDD Abnormal Uterine Beleeding Abnormal Bleeding Patterns Menorrhagia --bleedingbleeding more than 80ml or lasting >7days Metrorrhagia --bleedingbleeding between periods Polymenorrhagia -- menses less than 21d apart Oligomenorrhea --mensesmenses greater than 35 dasy apart. (in majority is anovulatory) Amenorrhea --NoNo menses for at least 6months Dysfunctional Uterine Bleeding Clinical term referring to abnormal bleeding that is not caused by identifiable gynecological pathology "Anovulatory Uterine Bleeding“ is usually the cause Diagnosis of exclusion Anovulatory Bleeding Most common at either end of reproductive life Chronic spotting Intermittent heavy bleeding Post Coital Bleeding Cervical ectropion ( most common in pregnancy) Cervicitis Vaginal or cervical malignancy Polyp Common Causes by age Neonatal Premenarchal ––EstrogenEstrogen withdrawal ––ForeignForeign body ––Trauma,Trauma, including sexual abuse Infection ––UrethralUrethral prolapse ––Sarcoma botryoides ––Ovarian tumor ––PrecociousPrecocious puberty Common Causes by age Early postmenarche Anovulation (hypothalamic immaturity) Bleeding -
A Giant, Deceptive Cervical Polyp
Interventions in Gynaecology & Women’s Healthcare DOI: 10.32474/IGWHC.2020.04.000183 ISSN: 2637-4544 Case Report A Giant, Deceptive Cervical Polyp Mounia Bennani*, Hanane Baybay, Jihane Ziani, Sara Elloudi, Zakia Douhi and Fatima Zahra Mernissi Department of dermatology and venerology, Hassan II hospital university, Morocco *Corresponding author: Mounia Bennani Department of dermatology and venerology, Hassan II Hospital University, FES Received: February 29,2020 Published: March 05, 2020 Case Report This is the case of a 48-year-old patient, no Medical or pink-reddish, with a smooth surface (Figure 2), the vaginal touch pharmacological history referred in Our dermatology consultation protruding through the vagina (Figure1). The mass was firm, the tumor was in continuity with the cervix, while the vulva was for management of a lesion evolving for 6 years, increasing in intact. A dermoscopic examination was carried out objectifying size, becoming bleeding on contact, the patient did not complain the presence of a polymorphic vascularization made of vessels in of pain, but rather an unpleasant feeling of heaviness. On local points, irregular linear, and hairpins in place, associated with the examination, a multi-lobed tumor of approximately 10 cm was presence of bright white areas without structures (Figure 3). Figure 1: Image showing a 10cm Multilobed tumor protruding through the vagina. Copyright © All rights are reserved by Mounia Bennani. 384 Int Gyn & Women’s Health Volume 4 - Issue 2 Copyrights @ Mounia Bennani. Figure 2: Image showing a firm, pinkish-reddish, multiloped mass with a smooth surface. Figure 3: Dermoscopic image showing polymorphic vascularity and bright white structures. -
Vaginal Atrophy (VVA)
Information Sheet Vulvovaginal symptoms after menopause Key points • Vulvovaginal symptoms are numerous and varied and result from declining oestrogen levels. • Investigate any post- menopausal bleeding or malodorous discharge. • Management includes lifestyle changes as well as prescription and non- prescription medications. • As women age they will experience changes to their vagina and urinary system largely due to decreasing levels of the hormone oestrogen. • The changes, which may cause dryness, irritation, itching and pain with intercourse1-3 are known as the genito-urinary syndrome of menopause (GSM) and can affect up to 50% of postmenopausal women4. GSM was previously known as atrophic vaginitis or vulvovaginal atrophy (VVA). • Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; genito-urinary problems often persist and may progress with time. Genito-urinary symptoms are associated both with menopause and with ageing4. • Changes in vaginal and urethral health occur with natural and surgical menopause, as well as after treatments for certain medical conditions (Please refer to AMS Information Sheet Vaginal health after breast cancer: A guide for patients). Why is oestrogen important for vaginal health? • The vaginal area needs adequate levels of oestrogen to maintain tissue integrity. • The vaginal epithelium contains oestrogen receptors which, when stimulated by the hormone, keep the walls thick and elastic. • When the amount of oestrogen in the body decreases this is commonly associated with dryness of the vulva and vagina. • A normal pre-menopausal vagina is naturally acidic, but with menopause it may become more alkaline, increasing susceptibility to urinary tract infections. A number of factors, including low oestrogen levels, have been implicated in the development of UTIs4-7 and vaginitis8-9 in postmenopausal women. -
The Woman with Postmenopausal Bleeding
THEME Gynaecological malignancies The woman with postmenopausal bleeding Alison H Brand MD, FRCS(C), FRANZCOG, CGO, BACKGROUND is a certified gynaecological Postmenopausal bleeding is a common complaint from women seen in general practice. oncologist, Westmead Hospital, New South Wales. OBJECTIVE [email protected]. This article outlines a general approach to such patients and discusses the diagnostic possibilities and their edu.au management. DISCUSSION The most common cause of postmenopausal bleeding is atrophic vaginitis or endometritis. However, as 10% of women with postmenopausal bleeding will be found to have endometrial cancer, all patients must be properly assessed to rule out the diagnosis of malignancy. Most women with endometrial cancer will be diagnosed with early stage disease when the prognosis is excellent as postmenopausal bleeding is an early warning sign that leads women to seek medical advice. Postmenopausal bleeding (PMB) is defined as bleeding • cancer of the uterus, cervix, or vagina (Table 1). that occurs after 1 year of amenorrhea in a woman Endometrial or vaginal atrophy is the most common cause who is not receiving hormone therapy (HT). Women of PMB but more sinister causes of the bleeding such on continuous progesterone and oestrogen hormone as carcinoma must first be ruled out. Patients at risk for therapy can expect to have irregular vaginal bleeding, endometrial cancer are those who are obese, diabetic and/ especially for the first 6 months. This bleeding should or hypertensive, nulliparous, on exogenous oestrogens cease after 1 year. Women on oestrogen and cyclical (including tamoxifen) or those who experience late progesterone should have a regular withdrawal bleeding menopause1 (Table 2). -
Vulvovaginal Atrophy: a Common—And Commonly Overlooked— Problem Mary H
The Warren Alpert Medical School of Brown University GERI A TRI C S FOR THE Division of Geriatrics PR ac TI C ING PHYSICIAN Quality Partners of RI Department of Medicine EDITED B Y AN A Tuya FU LTON , MD Vulvovaginal Atrophy: A Common—and Commonly Overlooked— Problem Mary H. Hohenhaus, MD, FACP Mrs. K is a 67-year-old woman presenting for a brief All postmenopausal women are at risk for vaginal atrophy. follow-up visit. You treated her for an E. coli urinary Smokers are more estrogen deficient compared with nonsmok- tract infection last month, but she feels well today and ers and may be at higher risk. Engaging in regular sexual activ- offers no complaints. Her blood pressure and lipids ity, whether through intercourse or masturbation, appears to are well controlled on low doses of a single antihyper- decrease risk, possibly through increased blood flow. Women tensive and a lipid lowering agent. She still struggles using anti-estrogen medications, such as aromatase inhibitors with smoking, but has cut down to a few cigarettes a for adjuvant treatment of breast cancer, are more likely to experi- day. She also reports her husband has finally turned ence severe symptoms. over the family business to their children, and they Women may not volunteer symptoms related to vulvovagi- are enjoying spending more time together. When you nal atrophy. The symptomatic woman can experience vaginal ask if there is anything else she needs, she hesitates dryness, burning, and pruritus; yellow, malodorous discharge; for a moment before asking, “Is there anything I can urinary frequency and urgency; and pain during intercourse and do to make sex more comfortable?” bloody spotting afterward. -
Common Causes of Chronic Pelvic Pain Diagnoses Description Dysmenorrhea • Dysmenorrhea Is Pain During Menstruation That Is Not Associated with Well-Defined Pathology
Common Causes of Chronic Pelvic Pain Diagnoses Description Dysmenorrhea • Dysmenorrhea is pain during menstruation that is not associated with well-defined pathology. • Primary dysmenorrhea: cramping pain in the lower abdomen, originating in the uterus • Secondary dysmenorrhea: painful menstruation resulting from pelvic pathology such as endometriosis • Dysmenorrhea is considered a chronic pain syndrome if it is persistent and associated with negative cognitive, behavioral, sexual or emotional consequences. Dyspareunia • Dyspareunia is characterized as pain before, during, or after sexual activity. It is not solely caused by lack of lubrication. • Dyspareunia may present as superficial, deep, or both. • Superficial: discomfort at entry of vaginal introitus • Deep: complaint of pain or discomfort on deeper penetration • Causes of dyspareunia include atrophic vaginitis, vulvar vestibulitis, lichen sclerosis, endometriosis, scar adhesions, and trauma. Endometriosis • Endometriosis is when endometrial tissue typically found in the uterus is found outside of the uterus. • Most women with endometriosis experience pelvic pain during their menstrual cycles but many also have pain that is unrelated to their period. Fibromyalgia syndrome • Fibromyalgia affects the muscles, tendons, ligaments, and soft tissues of the body. • Fibromyalgia causes pain throughout entire body, including the vulvar and pelvic/hip region. • Symptoms of fibromyalgia include extreme fatigue, sleep disturbances, burning sensations throughout body. Interstitial cystitis/ • Interstitial cystitis is characterized by: painful bladder syndrome o Urinary urgency: feeling the need to urinate o Urinary frequency: urinating up to every 5-10 minutes o Pelvic Pain: in the vulva, pain with intercourse, or pain in the lower back and hips. • Many foods and drinks may trigger interstitial cystitis. Fruit juices such as oranges, cranberry and tomato are bladder irritants. -
Pregnancy Complicated with a Giant Endocervical Polyp
Pregnancy complicated with a giant endocervical polyp Kirbas A, Biberoglu E, Timur H, Uygur D, Danisman N Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey Objective We report the case of a giant cervical polyp in a primigravid young women that was associated cervical funneling. Methods Case report. Results A 21 year old primigravid woman admitted to our clinic with suspicion of cervical incompetence at 22 weeks of gestation. She complained of light vaginal bleeding and a vaginal mass. She did not have any pain. Her past medical history was uneventful. A detailed abdominal 2D ultrasound scan was performed to verify the presence of the pregnancy and research for associated anomalies. The US scan showed a 22 week viable fetus. Additionally, there was funneling of the cervical canal and the cervical length was 22 mm (Figure 1). On vaginal examination, there was light bleeding and a large fragile mass protruding from the vagina (Figure 2). We detected that the mass originated from the anterior lip of the cervix and it was extending into the cervical canal (Figure 3). We performed simple polypectomy. The funneling of the cervical canal disappeared after the operation and cervical canal length was 31 mm. The final histopathological findings confirmed a benign giant cervical polyp. The pregnancy is progressing well with a normal cervical length and she is currently 34 weeks of gestation. There has been no recurrence. We have planned endometrial and cervical canal evaluation after delivery. Conclusion Cervical polyps less than 2cm are quite common in the female adult population. -
The Uterus and the Endometrium Common and Unusual Pathologies
The uterus and the endometrium Common and unusual pathologies Dr Anne Marie Coady Consultant Radiologist Head of Obstetric and Gynaecological Ultrasound HEY WACH Lecture outline Normal • Unusual Pathologies • Definitions – Asherman’s – Flexion – Osseous metaplasia – Version – Post ablation syndrome • Normal appearances – Uterus • Not covering congenital uterine – Cervix malformations • Dimensions Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer To be avoided at all costs • Do not describe every uterus with two endometrial cavities as a bicornuate uterus • Do not use “malignancy cannot be excluded” as a blanket term to describe a mass that you cannot categorize • Do not use “ectopic cannot be excluded” just because you cannot determine the site of the pregnancy 2 Endometrial cavities Lecture outline • Definitions • Unusual Pathologies – Flexion – Asherman’s – Version – Osseous metaplasia • Normal appearances – Post ablation syndrome – Uterus – Cervix • Not covering congenital uterine • Dimensions malformations • Pathologies • Uterine – Adenomyosis – Fibroids • Endometrial – Polyps – Hyperplasia – Cancer Anteflexed Definitions 2 terms are described to the orientation of the uterus in the pelvis Flexion Version Flexion is the bending of the uterus on itself and the angle that the uterus makes in the mid sagittal plane with the cervix i.e. the angle between the isthmus: cervix/lower segment and the fundus Anteflexed < 180 degrees Retroflexed > 180 degrees Retroflexed Definitions 2 terms are described