妇产科学ppt课件：功能失调性子宫出血(英文版)

,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Dysfunctional uterine bleeding(DUB),Dysfunctional uterine bleedin,Patterns,Menorrhagia(hypermenorrhea),月经过多,Hypomenorrhea(cryptomenorrhea),月经过少,Metrorrhagia(intermenstrual bleeding),子宫不规则出血,Polymenorrhea,月经频发（月经过频）,Oligomenorrhea,月经稀发,Menometrorrhagia,子宫不规则出血过多,Contact bleeding(postcoital bleeding),接触性出血、性交后出血,Patterns Menorrhagia(hypermeno,Definition,Irregular bleeding,unrelated to anatomic lesions of the uterus,exclusion of pathologic causes of abnormal bleeding,is referred to as dysfunctional uterine bleeding.,Disturbance of endocrine,Most common at the reproductive age,Review the normal menstruation,cycle 21-35,period 2-8,amount 20-60ml,DefinitionIrregular bleeding,妇产科学ppt课件：功能失调性子宫出血(英文版),Pathogenesis,Pathogenesis,Classification,Anovulatory:,85%,Ovulatory:,15%,Incidence,Incidence,Classification,Classification IncidenceClassi,Introduction,Breakthrough bleeding:,only estrogen stimulate endometrium,no progesterone,Low,plasma concentrations of estrogens infrequent and light bleeding,Chronic stimulation of endometrium from,increased,plasma concentrations of estrogens frequent and heavy bleeding,Withdrawal bleeding:,single estrogen influent endometrium,atresia of follicles estrogen bleeding,Anovulatory dysfunctional bleeding,Introduction Anovulatory dysf,Pathological changes of endometrium,Hyperplasia of endometrium,simple hyperplasia,complex hyperplasia,atypical hyperplasia:,not belong to DUB,glandular epithelium hyperplasia,polarity of cell disappear,size enlarged,dark and large nucleus,karyokinesis,Proliferative phase of endometrium,Atrophic endometrium,Pathological changes of endome,Clinical findings,Irregular uterine bleeding,Patterns:,Menorrhagia,（月经过多）,Metrorrhagia(,子宫不规则出血,),Menometrorrhagia,（子宫不规则出血过多）,Polymenorrhea,（月经过频）,No abdominal pain and discomfortable,Anemia,Pelvic exam:,uterine size is normal,Clinical findings Irregular ut,Diagnosis,Exclude anatomic causes of abnormal uterine bleeding,History,Age,menses,marital,contraceptive,treatment,Physical exam:,General:,exclude systemic diseases,Pelvic:,exclude genital disease,Lab exam,Ultrasound:,uterine size,shape,endometrium,Urine or serum HCG,Diagnosis Exclude anatomic cau,Cytologic exam of cervix:,cervical cancer,Determination of ovarian function,BBT,:monophase,Serum hormones:,progesterone is lower,Hysteroscope:,pathologic changes of cavity,Cytologic smear of vaginal shed cell:,anovulatory periodic changes,Cervical mucosa:,1-2 days before,uterine bleeding,fernlike pattern,(,羊齿状结晶,),(picture,),Coagulation function,blood cell count,Cytologic exam of cervix:cerv,Sampling of endometrium,D&C(,诊刮,),hemostasis and finding causes,before menses or within 6 hours of menstrual onset,Fractional D&C:different cervix and corpus,proliferative or hyperplasia,no secretory changes,Biopsy of endometrium,Sampling of endometrium,Differential diagnosis,Abnormal pregnancy or complications of pregnancy:,abortion,ectopic pregnancy,retained placenta,Systemic disease:,hematopathy,failure of liver or kidney,hyperthyroidism or hypothyroidism,rectal or urologic disorders,Differential diagnosisAbnormal,Genital tumors:,carcinoma of endometrium,cervix,myomas,ovarian tumor,Genital infection:,endometritis,salpingitis,cervical and endometrial polyps,Misuse of sexual hormone,IUD,Genital tumors:carcinoma of e,In different age,the differential diagnosis is different,Puberty hemologic system disease,Reproductive age pregnancy induced disease,Premenopause tumor,In different age,the differen,Treatments,General treatment,Iron,vitamine C,protein,antibiotic,rest,Medicine,:the first-line therapy,Surgery,Hysterectomy:,medicine is no effect,Endometrial ablation:,laser,roller ball,necrosis of endometrium,premenopause,no desire of reproduction in young women,Use danazol,gestrinone or GnRHa before operation,Treatments General treatment,Notice some key points,In diagnosis,must exclude pathologic causes,In hemostasis,rapidly stop hemorrhage and regulate cycles,choice the most suitable drugs and usage,To young women,the cured indications are recovering ovulation,Notice some key points,Ovulatory menstrual dysfunction,Ovulation,abnormal of corpus luteum,Two types,Luteal phase defect(LPD),Irregular shedding of endometrium,Ovulatory menstrual dysfunctio,Luteal phase defect(LPD),Pathology,Secretory reaction of endometrium but luteal phase defect,corpus luteum secrete inadequate progesterone,derangement of gland and interstitium,less edema of interstitium,Clinical manifestation,Shortening of cycles,luteal phase7d,Diagnosis,Symptoms,BBT,:double phase,decrease slowly,D&C:,the 5,th,of menses,mixed endometrium,Treatment,Progesterone,12days after ovulation or 1014 days before next menses,MPA 10mg for 10 days,HCG,COC,Clinical findings,Summary of diagnosis and therapy,history,PE,lab,no systemic and genital disease,35 y,biopsy of endometrium,proliferative,atypical,hyperplasia,hysterectomy,medicine,desire of,fertility,no de