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Basic gynecological examination
3rd Medical Faculty, Charles University
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Gynecological examination

• Non invasive history, aspection, palpation,
  ultrasound, etc
• Pre-bioptic examination kolposcopy
• Mikrobiological examination
• Endoscopic methods cystoscopy, hysteroscopy,
  laparoscopy, etc

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History

• Family / genetic factors
• Personal - blood pressure, BMI, etc
• gynecological - obstetric
• Menstruation cycle
• Delivery spontaneus / S.C.
• Gynecologicla disease
• Contraception / hormonal therapy
• Status present
• Sexual life

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Gynecological examination

• palpation
• cervix, uterus, adnexis, cavum Douglasi,
  abdominal wall, small pelvis, urinary bladder -
  pain, resistence, peritoneal irritation
• In speculam
• Pathology of introitus, vulva, cervix
  (speculae Simpsons, Scherbacks, Cuzks)
• examination per rectum
• Pediatric gynecology
• cervix, uterus, adnexis, cavum Douglasi
• Examination in anestasia / analgesia

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• Breast examination
• shape, density, skin and nipple of the breast
• palpation 4 quadrants, nipple discharge
• recommandation
• self examination once a months
• Mamograph screening programme from 45 years
  every 24 months event. ultrasound

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Pre-bioptic examination methods

• Kolposcopy
• Screening examination
• 6 - 40x (magnification)
• native kolposcopy
• Cervical and vulvar patholgy
• Change of the epithelium,
• inflammation
• angiogenesis
• Pre-cancerosis, tumor proscess

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Pre-bioptic examination methods

• Expanded colposcopy
• Acetic acid diferentiation of squamous and
  cylindric epithelium change of the colour
  andtransparence
• Schillers examination Lugols dilution
  squamous epithelium is brown, cylindric
  epithelium or erosion are non-colured

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Pre-bioptic examination methods

• Expanded colposcopy
• physiological status squamous epithelium,
  ektopium, ektropium, trnasformative zone
• non-physiological status angiogenesis, glands,
  leukoplakia, white epithelium, mozaik,
  pre-carcinoma, carcinoma.
• kondylomatas, papiloms etc

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Pre-bioptic examination methods

• Function cytology
• changes of the epithelium during the menstruation
  cycle
• diagnaotic of the mestrual cycle disorders
• Oncological cytology
• The most important screening methods for ca
  cervicis
• Cytological critiria of the smear from the cervix
  exocervix / endocervix

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Pre-bioptic examination methods

• Classification of the oncological cytology
• Bethesda
• SIL - dlaždicobunecná intraeiteliální léze
• LSIL
• HSIL
• ASCUS
• HPV infection

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Ultrasound

• The most important diagnostic method
• Abdominal ultrasound
• Pediatric gynecology
• Abdominal tumors, ascites
• Vaginal ultrasound
• Small pelvis pathology
• GEU
• Tumonrs ot the vary and uterus
• doppler

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Urogynecology

• cystoskopy
• urodynamics
• uroflowmetry
• Uretral pressure profile
• uretrocystografy

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Endoskopic methods

• Vaginoscopy
• Hysteroscopy
• Rektoscopy
• Laparoscopy

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laparoscopy
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Invasive diagnostic and treatment methods

• Dilatation of the cervix
• curretage
• Punction of the cavi Douglasi
• Biopsia of the cervix
• Biopsia of the vulva