APPROACH TO THE PATIENT . . . CONT.
Imaging ultrasound • transvaginal ultrasound provides enhanced details of structures located near the apex of the vagina; i.e. intrauterine and adnexal structures • may be used for • acute or chronic pelvic pain • rule in or out ectopic pregnancy, intrauterine pregnancy • assess uterine, adnexal, ovarian masses (i.e. solid or cystic) • uterine thickness • follicle monitoring during assisted reproduction hysterosalpingography • an x-ray is taken after contrast is introduced through the cervix into the uterus • contrast flows through the tubes and into the peritoneal cavity if the tubes are patent • used for evaluation of size, shape, configuration of uterus, tubal patency or obstruction sonohystography • saline infusion into endometrial cavity under ultrasound visualization expands endometrium, allowing visualization of uterus and fallopian tubes • useful for investigation of abnormal uterine bleeding, uncertain endometrial findings on vaginal U/S, infertility, congenital/acquired uterine abnormalities (i.e. uterus didelphys, uni/bicornate, arcuate uterus) • easily done, minimal cost, extremely well-tolerated, sensitive and specific • more accurate than hysterosalpingography and frequently avoids need for hysteroscopy
Genital Tract Biopsy vulvar biopsy • under local anesthetic • Keye’s biopsy or punch biopsy • hemostasis achieved with local pressure, Monsel solution or silver nitrate vaginal and cervical biopsy • punch biopsy or biopsy forceps • generally no anesthetic used • hemostasis with Monsel solution endometrial biopsy • in the office using an endometrial suction curette (Pipelle) • hollow tube guided through the cervix used to aspirate fragments of endometrium (well-tolerated) • a more invasive procedure using cervical dilatation and curettage may be done in the office
Colposcopy diagnostic use • provides a magnified view of the surface structures of the vulva, vagina and cervix • special green filters allow better visualization of vessels • application of 1% acetic acid wash dehydrates cells and reveals white areas of increased nuclear density (abnormal) or areas with epithelial changes • biopsy of visible lesions or those revealed with the acetic acid wash allows early identification of dysplasia and neoplasia therapeutic use • cryotherapy • tissue destruction by freezing • for dysplastic changes, genital warts • laser • cervical conization • encompasses the cervical transformation zone and into the endocervical canal • methods include cold knife, laser excision, or electrocautery
MCCQE 2000 Review Notes and Lecture Series