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Acute pain in the pelvic area. Gynecological examinations (anamnes, inspection extragenital organs, lithotomy position. investigations in gynecology, lab tests) Practical skills demonstration, Clinical cases Make class notes for this

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  1. Acute pelvic pain: definition, causes, differential diagnosis, and emergency management
  2. Gynecological history (anamnesis): complaints, menstrual, obstetric, sexual, and past history
  3. Inspection and examination of extragenital organs: general appearance, breasts, abdomen, palpation, percussion
  4. Gynecological examination in the lithotomy position: external genitalia, speculum exam, bimanual and rectovaginal exam
  5. Gynecological investigations: smears, cytology, colposcopy, ultrasound, hysterosalpingography, hysteroscopy, laparoscopy, culdocentesis
  6. Laboratory tests: hCG, CBC, urinalysis, STI testing, hormone profile, tumor markers
  7. Practical skills demonstration: step-by-step checklists
  8. Clinical cases: worked cases with questions and answers
Overview
Acute pelvic pain is sudden lower abdominal or pelvic pain. In a woman of reproductive age, first rule out ectopic pregnancy with a pregnancy test. The other main gynecological causes are:
  • ovarian torsion
  • ruptured or hemorrhagic ovarian cyst
  • apoplexy of the ovary
  • pelvic inflammatory disease (PID) or tubo-ovarian abscess
  • degenerating or torsed fibroid
  • threatened or incomplete miscarriage
Non-gynecological causes to exclude are appendicitis, urinary stones or infection, and diverticulitis.
The gynecological exam follows a fixed order:
  • History: age, chief complaint, menstrual function (menarche, cycle, last menstrual period), sexual and obstetric history, contraception, infections, surgeries, and family history.
  • General and extragenital exam: build, skin, hair pattern, breasts, abdomen.
  • Lithotomy position:
    • inspect the external genitalia
    • speculum exam of the cervix and vaginal walls
    • bimanual palpation of the uterus and adnexa
    • rectovaginal exam when indicated
  • Investigations: pregnancy test, smears and cultures, ultrasound, and laparoscopy for unclear acute cases.
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