Friday, April 18, 2014

Dysfunctional Uterine Bleeding

Im rewriting the answers for my sessional exams. Urgh, i know it was a disaster.
Definition of DUB : It is a state of abnormal uterine bleeding w/o clinically detectable organic,systemic pathology and iatrogenic causes.
It a diagnosis done by ruling  out :
  • pregnancy  related complications
  • tumours of uterus -Benign (Cervical polyp, endometrial polyp, fibroids)
  • Infections
  • foreign body- IUD
  • Systemic -Hepatic,Renal,
  • Blood disorders
  • idiopathic
  • endocrinal disorders
Types of DUB
  • Anovulatory (80%) -Threshold bleeding of puberty menorhagia,Metropathia Hemorhagica,Premenopausal DUB
  • Ovulatory(20%) - Irregular ripening,Irregular shedding, IUCD insertion,following sterilization operation.
Signs and symptoms
.Abnormal bleeding are associated with  or without ovulation and are grouped into:
  • Ovuular bleeding (polymenorrhea/polymenorhagia/oligomenorrhea/menorhagia of irregular shedding and ripening)
  • Anovular bleeding (usually excessive bleeding due to anovulation causing endometrium growth is under unopposed action of oestrogen in absence of progesterone).
Investigations of anovulatory DUB
  • Detailed history of menstruation ( no of pads used, passage of clots size & nomober, and duration of bleeding)
  • History of IUCD or  steroidal contraception
  • History of abnormal bleeding from gums, injury site, epistaxis.
  • Bimanual (per vagina, per rectal) examination done to exclude pelvic pathology.(  PV done  for all except virgins)
  • Blood haemoglobin estimation,platelet,PT,prothrombin time,
  • TSH,T3,T4 estimation done is suspected thyroid cases.
  • D&C ( Diagnostic uterine curretage)
  • USG and colour Doppler (endometrial hyperplasia : ET> 12mm,hyperechoic,and regular outline)
  • Hysteroscopy
  • Laparoscopy
  • Hysterography
Plan of investigations : Blood values->USG->D&C->Hysteroscopy/hysterography->laparoscopy

Management of anovulatory DUB
DUB treatment includes a general,medical and surgical treatment.
General treatment - Rest, correct anemia,
Medical treatment - Hormones,Prostaglandins synthethase inhibitors,Antifibrinolytics
Surgical treatment - Uterine curettage,endometrial ablation/resection,hysterectomy







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