Professional Documents
Culture Documents
EMERGENCIES
FARHAD TAKHTI M.D.
SENIOR CONSULTANT
LANDESKLINIKUM NEUNKIRCHEN
AUSTRIA
CARCINOMA BLEEDING
VAGINAL BLEEDING:
ADVANCED CERVIX OR ENDOMETRIUM
CARCINOMA.
INTRAABDOMINAL BLEEDING:
CAPSULE RUPTURE OF AN OVARIAN
CARCINOMA
CLINICAL PICTURE
VAGINAL BLEEDING
I.SPECULUM EXAMINATION:
THE VAGINA IS FULL WITH CLOTS,
PORTIO EXOPHYTIC OR SHOWS
CARCINOMA CRATER
SURFACE BLEEDING STRONGER AFTER
TOUCHING
II.PALPATION:
OFTEN LARGE TUMOR THAT FILLS THE
SMALL
PELVIS
CLINICAL PICTURE
INTRAABDOMINAL BLEEDING
I.ABDOMINAL PAIN(localised then
generalised)
ABDOMINAL RIGIDITY
NAUSEA , VOMITING
PALOR , CYANOSIS, WEAK PULSE
II.SONOGRAPHY:
SPACE OCCUPYING LESION
FREE LIQUID IN DOUGLAS SPACE
ACUTE MANAGEMENT
LOCAL THERAPY:
1. COVER THE CERVIX TUMOR WITH A
HEMOSTYPTICAL PATCH (TACHOCOMB)
2. TAMPONADE THE CERVIX FIRMLY
3. URINARY CATHETER
DO NOT TRY TO ELECTROCOAGULATE
DO NOT TRY TO MAKE SUTURES
ACUTE MANAGEMENT
GENERAL MEASURES:
AT LEAST 2 IV LINES
TYPE & CROSSMATCH
VOLUME SUBSTITUTION:
PACKED RBC,s-CRYSTALLOIDS
OXYGEN(6 Lit / minute)
SEDATE THE PATIENT ( DIAZEPAM)
DIAGNOSIS
KNOWN INOPERABLE TUMOR IN
MOST CASES
BIOPSY & HISTOLOGY
RECTOSCOPY
CYSTOSCOPY
COMPUTER TOMOGRAPHY
MAGNET RESONANCE IMAGING
LAPARATOMY
THERAPY
INOPERABLE TUMOR OF UTERUS:
RADIATION
LAPARATOMY
Simple perforation:
Perforation with small Hegar or
uterine sound
without heavy Bleeding.
Complex perforation:
Perforation of uterus with a large
defect by an
Abortion forceps.
UTERINE PERFORATION
Etiology:
hysteroscopy, curettage, IUD
insertion.
Manifestaions:
A. feel no resistance against the
instruments.
B. if a large perforation you see the
intestine
or appendices epiploicae
C.with heavy bleeding the clinical
MANAGEMENT
STOP THE OPERATIVE PROCEDURE
IF NO ACTIVE OR REMARKABLE BLEEDING
DO HYSTEROSCOPY;IF NO BLEEDING
SOURCE THEN :OBSERVE THE PATIENT
FOR 24 HOURS
IF REMARKABLE BLEEDING :GIVE
UTEROTONICS(METHERGIN-SULPROSTON)
AND DO LAPARASCOPY
IN HEAVY BLEEDING-HYDATIFORM MOLE
AND ENDOMETRIUM CA :HYSTRECTOMY
GENITAL TRAUMA
DEFINITION:
CONTUSION,SCRATCH,LABIAL TEAR,
PENETRATING INJURY THROUGH
PERINEUM OR ABDOMINAL WALL
ETIOLOGY:
FALL ON THE FENCE OR BYCYCLE
FRAME,PENETRATING TRAUMA,CAR
ACCIDENTS
SIGNS & SYMPTOMS
EXCORIATION, CONTUSION AND
HEMATOMA OF THE VULVA AND
MONS PUBIS
PAIN
HEMATURIA
FECAL MATERIAL THROUGH
PENETRATION CANAL
BLEEDING(EXTERNAL-INTERNAL)
DIAGNOSTIC
EXACT EXAMINATION OF GENITALIA
SONOGRAPHY
COMPUTER TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
CYSTOSCOPY
COLOSCOPY
INTERDISCIPLINARY COOPERATION
BETWEEN GYNECOLOGIST, SURGEON
UROLOGIST, RADIOLOGIST
COHABITATION INJURY
DEFLORATION
OPERATIVE THERAPY:
LAPARASCOPY:
A. LINEAR SALPINGOSTOMY
B. SALPINGECTOMY
LAPARATOMY:
A. SEGMENTAL SALPINGECTOMY AND
REANASTOMOSIS
B. SALPINGECTOMY
METHOTREXATE
DOSIS :50 mg /sq m
ABSOLUTE CONTRAINDICATIONS:
ACTIVE HEPATIC OR RENAL DISEASE
IMMUNDEFICIENCY
BLOOD DYSCRASIAS
BREAST FEEDING
RELATIVE CONTRAINDICATIONS:
GESTATIONAL SAC >3.5 cm
ß –hCG >5000 m IU /ml
FETAL CARDIAC ACTIVITY
QUESTIONABLE COMPLIANCE WITH FOLLOW-UP
METHOTREXATE PROTOCOL
DAY 0 : CBC +BUN +CREATININE
+ LIVER ENZYMES
METHOTREXATE : 50 mg /sq m
DAY 4 : ß-hCG LEVEL
EXTRAUTERINE PREGNANCY
ENDOMETRIOSIS
COLLITIS ULCEROSA
DIVERTICULITIS
MANAGEMENTOF PID
ACCORDING TO CDC
OUTPATIENT TREATMENT:
REGIMEN A
CEFOXITIN 2 G IM +DOXYCYCLINE 100 MG
ORALLY TWO TIMES DAILY FOR 14 DAYS +/-
METRONIDAZOL 500 MG TWO TIMES DAILY FOR
14 DAYS
REGIMEN B
OFLOXACIN 400 MG ORALLY TWO TIMES DAILY
FOR 14 DAYS +/-METRONIDAZOL 500 MG ORALLY
TWO TIMES DAILY FOR 14 DAYS
PID MANAGEMANT
INPATIENT TREATMENT
REGIMEN A
CEFOXITIN 2 G EVERY 6 HOURS INTRAVENOUSLY
+/- DOXYCYCLINE 100 MG EVERY 12 HOURS IV
REGIMEN B
CLINDAMYCIN 900 MG INTRAVENOUSLY EVERY 8
HOURS +
GENTAMYCIN LOADING DOSIS OF 2 MG/KG OF
BODY WEIGHT AND THEN 1.5 MG/KG EVERY 8
HOURS
PIONIERS OF
GYNECOLOGY
HERMANN JOHANESS
PFANNENSTIEL
1862-1909
Was born June 28,
1862 in Berlin,
receiving his
medical degree in
1885.
He introduced in
1900 the
transverse
suprapubic incision
of the skin for
PIONIERS OF
GYNECOLOGY
CARL GUSTAV CARUS
1789-1869
Was born January 3,
1789 in Leipzig.
He described the
pelvic inclination
curve.
PIONIERS OF
GYNECOLOGY
HUGH LENOX HODGE
1796 – 1873
Was born, June 27,
1796 in
Philadelphia.
1860 he introduced
the Hodge pessary
for the
management of
uterine prolapse.
THANK YOU
FRIENDS ARE GENERALLY OF
THE SAME SEX, FOR WHEN
MEN AND WOMEN AGREE, IT
IS ONLY IN THE
CONCLUSIONS, THEIR
REASONS ARE ALWAYS
DIFFERENT.
George Santayana