妇科阴道流血.ppt

Anovulatory dysfunctional uterine bleeding Irregular uterus bleeding Characteristic of bleeding: （1）irregular cycle and duration （2）not stop by oneself （3）irregular amount （4）no menalgia (痛经) （5）anaemia Endometrial cancer 1. Irregular bleeding： Post-menopause bleeding: middle or less amount, durative(持续性) or intermittence(间歇性)； Child-bearing age women: prolonged and heavy menses or intermenstrual bleeding 2. Vaginal apocenosis (排液) 3. pain 4. General symptom 5. Enlarged uterus, tender, tissue emersion in advanced stage( 组织物脱出)。 6. Segmenting diagnosis curettage(分段诊刮) help to diagnose lesions whether involve cervix canal. 7. Hysteroscope, ultrasound, CT、MRI help to diagnosis. 3. Last and durative uterine bleeding(长期持续阴道流血 ) Often happen in reproductive malignant tumor Need exclude carcinoma of cervix uteri and corpus uteri Cervix cancer 1. Contact bleeding (接触性出血): after sex intercross or pelvic examination young： prolonged and heavy menses, short cycle old：post-menopause irregular bleeding 2. Vagina apocenosis (流液)：white or uprightness(血性)、smell of fish(腥臭) or foul smell (恶臭) 3. Often early onset of sexual activity or marriage and child bear, multiple sexual partner(多个性伙伴). 4. Pelvic examination 5. Special examination: cervical cytology, HPV testing, iodine test, colposcopy(阴道镜), biopsy, endocervical curettage, cone biopsy(宫颈锥切) 4. Bleeding after menelipsis(停经后阴道流血) Child-bearing age: first consider pregnancy-related disease Abortion Ectopic pregnancy Gestational trophoblastic disease (GTD) Peri-menopause period: Anovulatory dysfunctional uterine bleeding Exclude genital malignant tumor Abortion Bleeding and pelvic pain after menelipsis (停经). Clinic types and feature： amount pelvic pain tissue discharge cervix uterus zise Threatened ~ less no or light no close match Inevitable ~ middle to heavy severe no