By Cecilia Bottomley
A 24-year-old girl is referred from the emergency division with unexpected onset of left iliac fossa discomfort and also you are the medic on duty...
100 circumstances in Obstetrics and Gynaecology offers a hundred regularly noticeable obstetric and gynaecological situations. The patient's heritage, exam and preliminary investigations are offered besides questions about the analysis and administration of every case. the reply encompasses a certain dialogue on every one subject, delivering a necessary revision reduction in addition to a realistic consultant for junior clinicians.
Making medical judgements is among the such a lot hard and tough elements of educating to turn into a physician. those instances will educate medics and clinical scholars to acknowledge very important obstetric and gynaecological stipulations and aid them enhance their diagnostic and administration talents.
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Additional info for 100 Cases in Obstetrics and Gynaecology (A Hodder Arnold Publication)
She is tender on palpation but there is no cervical excitation, adnexal tenderness or adnexal masses. INVESTIGATIONS Transvaginal ultrasound scan is shown in Fig. 1 Transvaginal ultrasound report: there is asymmetrical uterine enlargement, with a thickened posterior uterine wall. There are ill-defined cystic spaces within the posterior myometrial wall. There is an indistinct myometrial–endometrial border. Both ovaries appear normal in size and morphology. 1 Transvaginal ultrasound scan of the uterus.
Endometriomas develop as ectopic endometrial tissue on the ovary produces blood, which builds up into an encapsulated cyst with each consecutive menstrual cycle. Endometriosis is benign but carries a high physical and psychological morbidity due to the clinical features: • • • • pelvic pain dysmenorrhoea dyspareunia infertility. Examination findings include tenderness or a pelvic mass, and may include palpable nodules in the rectovaginal septum and a fixed retroverted uterus secondary to adhesions (the frozen pelvis).
Classically the diagnosis may only be made histologically after hysterectomy for dysmenorrhoea. More recently however the diagnosis can be suspected by ultrasound or magnetic resonance imaging (MRI) scan. g. intrauterine contraceptive device (IUCD) or cervical stenosis after large-loop excision of the transformation zone (LLETZ)) Further investigation If the diagnosis is in doubt then an MRI scan may be requested. Hysterectomy to obtain histological diagnosis would be inappropriate. Management The initial management involves analgesia such as mefenamic acid and codydramol.