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1- ACUTE
1.1. Gynecological:
*ectopic pregnancy
*acute pelvic inflammatory disease
*rupture of an ovarian cyst
*adnexal torsion
*threatened,inevitable,or incomplete abortion
*degenerating fibroids or ovarian tumors
1.2. Non-gynecological
* Appendicitis
* diverticulitis
* urinary tract disorders
* mesenteric lymphadenitis
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2- Non-dysfunctional abnormal uterine bleeding
1-Iatrogenic:
* exogenous estrogen, OCP
* Progesterone-only contraceptive
* Hormone replacement therapy
* aspirin
* heparin\coumadin
* tamoxifen
* steroids
* intrauterine device
4-trauma
* laceration
* abrasion
* foreign body
5- complications of pregnancy
* Miscarriage
* Ectopic pregnancy
* Gestational trophoblastic disease
6- Neoplasm
* Cervical dysplasia / carcinoma
* endometrial hyperplasia / polyp / carcinoma
* uterine leiomyomas
* Estrogen-producing ovarian tumors
* adenomyosis
7- Infections
* endometritis
* cervicitis
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3- Dysfunctional uterine bleeding (anovulation)
Physiological
- Adolescence
- Perimenopause
- Lactation
- Pregnancy
Pathologic
- Hyperandrogenic state
- Hyperprolactinemia
- Hypothyroidism
- Low estrogen status (estrogen withdrawal)
- Premature ovarian failure
- Bilateral oophorectomy
- Radiation of mature follicles
- Cessation of exogenous estrogen therapy
- Very high estrogen level (estrogen breakthrough)
- Polycystic ovary syndrome
- Obesity
- Progesterone breakthrough
- long-acting progesterone-only contraceptive
- Progesterone withdrawal
- After stop progesterone such as contraceptive
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5- DD OF UTERUS SMALLER THAN EXPECTED
- wrong calculation
- oligohydramnions
- single dead fetus
- IUGR
- anencephaly
- shoulder presentation
- missed abortion
4
8- DD OF ABDOMINAL PAIN DURING PRGNANCY
A- due to pregnancy
Early - ruptured ectopic
- Septic abortion with perotonitis
Late
- Labor pain
- Red degeneration of fibroid
- Torsion of pedunculated fibroid
- Ruptured uterus
- Abrupto placenta
- Polyhydramnions
- Chorioamnitis
- HELLP syndrome
5
9- DD OF Vaginal discharge
A- Blood
- pregnant
*1st trimester
> Normal pregnancy: implantation bleed, abortion
> abnormal pregnancy:
!! Intrauterine> molar
!! extrautrine: ectopic
* 2nd & 3rd trimester
APH due to the causes of APH or PPH due to causes of PPH
- non-pregnant
1st of all u should put in mind the normal menses or variation of menses like menorrhagia, mid
cycle spotting or obviously menarche!!!
*according to age groups:
> adolescents
Anovulatory, Exogenous hormone use, coagulopathy, Trauma, Breakthrough bleeding of OCP
> Perimenopause -around menopause
Anovulatory, Fibroid, endocervical & endometrial polyp, Thyroid dysfunction, Trauma, HRT
incorrect use
* Or according to:
>reproductive:
anovulatory, Exogenous hormone use , Fibroid, endocervical & endometrial polyp,
Thyroid dysfunction , Trauma , Breakthrough bleeding of OCP
> Post menopausal:
Endometrial cancer, endometrial hyperplasia, endometrial cervical polyp, DUB, exogenous
hormone
use, atrophic vaginitis (most common), other tumor (vulvar, vaginal, cervical), trauma
B- Non blood
- physiologic discharge & cervical mucus production.
Many women will have a consistent, slightly clear, non-odor-producing discharge, either
midcycle or premenstrually, particularly if they are on oral contraceptives
A change in odor, consistency, or color of discharge may signify that evaluation is
necessary increased discharge is associated with pregnancy
-non physiologic:
*genital tract infection
> vulvovaginitis with it's causes, chlamydia/ gonorrhea, pyosalpinx, salpingitis
*non-infectious genital tract inflammation
> Local: chemical irritants, douches, sprays, forign body, trauma, atrophic vaginitis,
desquamative inflammatory vaginitis, focal valvitis.
> neoplasia: vulvar, vaginal, cervical, endometrial >>> consider esp with blood
>systemic: toxic shock syndrome, collagen disease, dermatologic (e.g. lichen sclerosis).
>Drugs: IUD (Mirena), OCP.
C- Urine
Fistula like in IBD esp. crhon's & diverticulosis.
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10- DD OF PELVIC- ABDOMINAL MASS
GYNECOLOGICAL CAUSES
Uterus
- pregnancy
- fibroid
- carcinoma
- adenomyosis
Lower quadrants:
- ovarian cyst
- ovarian neoplasm
- ectopic pregnancy
- hydroslpinx
- tubo-ovarian abscess
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12- DDx of loss or decreased fetal movements:
- Normal sleep phase
- Physiological (toward the end of pregnancy)
- decrease maternal perception (idiopathic or distraction)
- Sedative drugs given to mother (barbiturates)
- Intrauterine asphyxia (fetal distress)
- abrptio placenta
- Ruptured uterus
- Fetal death
13- Postpartum fever:
1- endometritis (most common cause)
2- pyelonephritis
3- mastitis
4- breast engorgement
5- respiratory complications
6- wound infections
7- infection of CS incision
8- infection of episiotomy repair
9- infection of spontaneous obstetric lacerations
10- thrombophlebitis
11- septic pelvic thrombophlebitis
12- thrombophlebitis of the lower limb
13- bacterial endocarditis
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15- DDx of fever during pregnancy:
- Cystitis
- Acute pyelonephritis
- Septic abortion
- Amnionitis
- Pneumonia
- Infections: malaria
Typhoid
Hepatitis