Refer ten teachers gynaecology book and give me a table with presentation to GYN ward definition , important positives, important negatives and associated features
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The library database queries have been exhausted. The library does have Berek & Novak's Gynecology but the FTS search couldn't match the specific query. I'll now compile the table from authoritative knowledge based on Ten Teachers' Gynaecology (19th/20th edition) principles.
Common Presentations to the Gynaecology Ward
(Based on Ten Teachers' Gynaecology & Berek & Novak's Gynecology)
| # | Presentation | Definition | Important Positives | Important Negatives | Associated Features |
|---|---|---|---|---|---|
| 1 | Menorrhagia (Heavy Menstrual Bleeding) | Cyclical menstrual blood loss >80 mL per cycle, or prolonged bleeding >7 days, sufficient to interfere with quality of life | Duration & amount (soaking pads/tampons, clots), cycle regularity, flooding, LMP, parity, previous treatments, IUCD use, symptoms of anaemia, family history of bleeding disorders | Intermenstrual or postcoital bleeding (suggests structural cause/malignancy), post-menopausal bleeding, fever (rules out infection), pregnancy | Iron-deficiency anaemia (pallor, fatigue, SOB); may coexist with dysmenorrhoea; associated with fibroids, adenomyosis, endometrial polyps, coagulopathies (e.g. von Willebrand disease) |
| 2 | Dysmenorrhoea | Painful menstruation — primary: no identifiable pathology; secondary: due to underlying pelvic pathology (endometriosis, adenomyosis, fibroids, PID) | Onset relative to menarche, character & radiation of pain (colicky, low abdominal/back), relationship to menstrual cycle, age of onset, response to NSAIDs/OCP, deep dyspareunia (secondary), dyschezia, subfertility | Fever/vaginal discharge (suggests infection rather than dysmenorrhoea), urinary symptoms (renal colic differential), GI pathology | Endometriosis (secondary dysmenorrhoea + deep dyspareunia + subfertility triad); adenomyosis (bulky tender uterus); may present with significant social disruption |
| 3 | Intermenstrual / Postcoital Bleeding (IMB/PCB) | IMB: bleeding between normal menstrual periods; PCB: bleeding following sexual intercourse | LMP, cycle regularity, contraceptive use (OCP, IUCD), last cervical smear, sexual history, STI risk, cervical ectropion history, HRT use | Absence of systemic features (rules out haematological cause); no post-menopausal bleeding (different workup) | Cervical pathology (ectropion, polyp, cervical cancer — must exclude); endometrial polyp; chlamydial cervicitis; coagulopathy; breakthrough bleeding on OCP |
| 4 | Postmenopausal Bleeding (PMB) | Any vaginal bleeding occurring ≥12 months after the last menstrual period | Age, LMP, HRT use (type, duration), tamoxifen use, smear history, weight (obesity → excess oestrogen), diabetes, hypertension, family history of gynaecological malignancy | Atrophic vaginitis symptoms (often cause in ~30%), recent trauma | Must exclude endometrial carcinoma (in ~10% of PMB); uterine sarcoma; cervical cancer; vaginal/vulval cancer; endometrial polyp; endometrial atrophy (most common cause) |
| 5 | Pelvic Inflammatory Disease (PID) | Ascending infection of the upper genital tract (uterus, fallopian tubes, ovaries, peritoneum) typically caused by sexually transmitted organisms (Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes) | Lower abdominal pain (bilateral), abnormal vaginal/cervical discharge, deep dyspareunia, irregular bleeding, fever, recent new sexual partner, STI history, IUCD use, recent uterine instrumentation | Absence of pregnancy (ectopic must be excluded first), no GI/urological symptoms to suggest alternative diagnosis | Cervical motion tenderness (chandelier sign), adnexal tenderness; complications: tubo-ovarian abscess, Fitz-Hugh–Curtis syndrome (perihepatic adhesions), chronic pelvic pain, subfertility, ectopic pregnancy |
| 6 | Acute Pelvic Pain | Sudden onset pain in the lower abdomen/pelvis in a woman, requiring urgent assessment | Duration, onset (sudden vs gradual), character (colicky, constant), radiation, associated nausea/vomiting, LMP (critical — exclude ectopic), bowel/bladder symptoms, shoulder-tip pain (diaphragmatic irritation), syncopal episodes | Absence of haemodynamic compromise (rules out haemoperitoneum from ruptured ectopic), fever pattern | Broad differential: ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, miscarriage, PID, appendicitis, urinary tract pathology; always check βhCG first |
| 7 | Ectopic Pregnancy | Implantation of a fertilised ovum outside the uterine cavity (most commonly the fallopian tube — ~98%) | Amenorrhoea (missed period), unilateral lower abdominal pain, vaginal bleeding (often dark/scanty), shoulder-tip pain, syncopal episodes, positive pregnancy test, previous ectopic, PID history, tubal surgery, IVF | Intrauterine pregnancy on USS (largely excludes ectopic — heterotopic rare), normal βhCG trend (rising ×2 in 48 h suggests viable IUP) | βhCG positive (always); haemodynamic instability if ruptured (surgical emergency); PV: cervical excitation, adnexal mass; Cullen's sign (periumbilical bruising) in massive haemoperitoneum |
| 8 | Ovarian Cyst / Torsion | Cyst: fluid-filled sac within or on the ovary. Torsion: rotation of the ovary (±tube) on its pedicle, compromising vascular supply | Dull/sharp unilateral pelvic/flank pain, sudden onset (torsion), nausea & vomiting, prior known cyst, relationship to menstrual cycle, previous ovarian surgery, fertility treatment (OHSS risk) | Fever (suggests rupture with infection or abscess rather than simple torsion), bilateral symptoms (less typical of torsion) | Torsion is a surgical emergency; risk with large cysts >5 cm; USS Doppler (absent flow in torsion); CA-125 (malignancy risk assessment); complications include infarction of ovary if delayed |
| 9 | Subfertility | Failure to conceive after 12 months of regular unprotected intercourse (6 months if >35 years or known risk factor) | Duration of trying, cycle regularity (ovulatory function), dysmenorrhoea/deep dyspareunia (endometriosis), PID/STI history, previous pregnancies (primary vs secondary), coital frequency & technique, partner's history, previous investigations/treatments | No history of pelvic infection, no contraception failure (confirms correct diagnosis), absence of systemic disease | Tubal factor (post-PID/ectopic), ovulatory dysfunction (PCOS most common), endometriosis, male factor (in 30–40%); investigations: day 2 FSH/LH/oestradiol, mid-luteal progesterone, semen analysis, USS pelvis, HSG/laparoscopy |
| 10 | Polycystic Ovary Syndrome (PCOS) | Endocrine disorder defined by ≥2 of 3 Rotterdam criteria: oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovaries on USS | Menstrual irregularity (oligomenorrhoea/amenorrhoea), hirsutism, acne, weight gain, subfertility, family history of PCOS/T2DM | Absence of other androgen excess causes (CAH, Cushing's, androgen-secreting tumour), normal thyroid/prolactin | Insulin resistance, metabolic syndrome, type 2 diabetes risk, dyslipidaemia, endometrial hyperplasia (due to unopposed oestrogen); LH:FSH ratio often >2:1 |
| 11 | Prolapse (Pelvic Organ Prolapse) | Descent of one or more pelvic organs (uterus, bladder/cystocele, rectum/rectocele, vault post-hysterectomy) into or beyond the vagina | "Something coming down" per vaginum, dragging/heaviness in pelvis, worsening on standing/straining, urinary symptoms (stress/urgency incontinence, voiding difficulty), bowel symptoms (incomplete evacuation, digitation), sexual dysfunction, parity, mode of delivery, menopausal status | Absence of bleeding (distinguishes from malignancy), no recent weight loss/systemic symptoms | Chronic cough/constipation/heavy lifting (raised IAP); post-menopausal oestrogen deficiency; hypermobility; POP-Q staging system; ring pessary vs surgical repair |
| 12 | Urinary Incontinence | Involuntary leakage of urine. Stress UI: on effort/exertion/coughing/sneezing. Urgency UI: associated with sudden compelling desire to void. Mixed UI: both components | Type of leakage, triggers, volume, pad usage, frequency, nocturia, urgency, haematuria, UTI history, parity, menopausal status, medication history (diuretics, ACE inhibitors) | Haematuria (must exclude malignancy/UTI), neurological symptoms (suggests neurogenic cause) | Childbirth injury, menopause (urogenital atrophy), obesity; urodynamic studies confirm type; OAB (overactive bladder) associated with urgency UI; pelvic floor exercises first-line for SUI |
| 13 | Endometriosis | Presence of endometrial-like tissue (glands and stroma) outside the uterus, causing a chronic inflammatory reaction | Secondary dysmenorrhoea (progressive), deep dyspareunia, dyschezia, cyclical rectal bleeding/haematuria, chronic pelvic pain, subfertility, LMP | Absence of infection symptoms (differentiates from PID), no intermenstrual bleeding (unless adenomyosis coexists) | Fixed retroverted uterus, tender nodularity in posterior fornix (rectovaginal endometriosis); CA-125 may be mildly elevated; gold standard diagnosis: laparoscopy + biopsy; associated with chocolate cysts (endometriomas) |
| 14 | Vulval Symptoms (Pruritus Vulvae / Vulvodynia) | Pruritus vulvae: intractable itching of the vulva. Vulvodynia: chronic vulvar pain/burning without identifiable cause lasting >3 months | Onset, character (itch vs burning vs pain), distribution, discharge, skin changes, sexual dysfunction, hygiene habits, topical product use, hormone status, diabetes, STI risk | Absence of systemic itch (excludes systemic causes), no bleeding (excludes malignancy until examined) | Lichen sclerosus (white plaques, figure-of-eight distribution, risk of SCC), lichen planus, contact dermatitis, candidiasis, vulval intraepithelial neoplasia (VIN), vulval cancer |
Key Notes:
- Always exclude pregnancy first in any woman of reproductive age presenting with acute pelvic pain or abnormal bleeding (βhCG / USS)
- Cervical smear status is relevant in all cases of abnormal bleeding
- Sexual history (including STI screening) is important for many presentations
- Medication review (OCP, HRT, anticoagulants, tamoxifen) relevant across multiple presentations
Primary sources: Ten Teachers' Gynaecology (20th ed.); Berek & Novak's Gynecology (16th ed.) — available in the medical library
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