Medicine

Methodological Instructions to Lesson 5 for - 7 hours

METHODICAL INSTRUCTIONS

TO PRACTICAL LESSON FOR STUDENTS

FACULTY OF FOREING STUDENTS

MODULE 3: Diseases of the female reproductive system. Family planning.

LESSON № 5 (practical  -  6 hours)

 

Themes: 1. INFLAMMATION DISEASES OF FEMALE GENITAL ORGANS

               2. “Acute abdomen” in gynecology

Aim: To study the methods of examining and treating patients with acute, sub acute and chronic processes of external and internal sexual organs;

to be able to recognize the main disease caused the symptoms of “acute abdomen”, to make the correct diagnosis, to learn the methods of treatment and surgical correction of this pathology.

Professional motivation: Inflammatory processes of women sex organs occur at 50-60% of cases with patients having gynecological pathology. They may cause labor activity lowering, menstrual and generative function disorders in women There are some diseases which have clinic called the “acute abdomen”: ectopic pregnancy, ovarian apoplexy, torsion of the tumor’ pedicle. Extraordinary important is the correct diagnostics and differential diagnostics with surgical pathology. In this cases operation is the only way for the patient’s convalescence, and sometimes for saving her life.

 

1.     Methodology of Practical Class

Practical work from 9.00 till 12.00.

Practical work #1.

 student collects anamnesis, performs general and gynecological examination of woman, and prescribes additional methods of diagnostics. Formulates preliminary diagnosis, prescribes treatment.

Practical work #2

Motivates treatment of woman with Gonorrhea,  Tuberculosis,  Chlamidiosis, Trichomoniasis and Ureaplasmosis

Practical work #3

Student collects an anamnesis, conducts general and gynecological examination of woman, prescribes additional examination methods.

Practical work #4

 Formulates preliminary diagnosis, conducts differential diagnostics with appendicitis, inevitable abortion, ectopic pregnancy, non-malignant and malignant uterine and its adnexa diseases. Motivates the women with acute and chronic inflammatory processes of genital organs.

2. Individual Students Program.

You should prepare for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:

THEME 1:

1.     Ways of spreading of infection and the sense of organism reactivity in developing of inflammatory processes of women sex organs.

2.     Classification of genital inflammatory deceases.

3.     Vulvitis – etiology, clinics, diagnostics, treatment.

4.     Acute bartholinitis – etiology, clinics, diagnostics, treatment.

5.     Vaginitis – etiology, clinics, diagnostics, treatment.

6.     Cervicitis, endocervicitis – etiology, clinics, diagnostics, treatment.

7.     Endometritis – etiology, clinics, diagnostics, treatment.

8.     Acute salpingooophritis – etiology, clinics, diagnostics, treatment.

9.     Pelvioperitonitis – etiology, clinics, diagnostics, treatment.

10.                                                         Parametritis – etiology, clinics, diagnostics, treatment.

11.                                                         Difdiagnosis of acute adnexitis and acute appendicitis.

12.                                                         Difdiagnosis of piosalphinx, parametritis and the abscess of Douglas’s pouch.

13.                                                         Principles of acute genital inflammatory process treatment.

14.                                                         Principles of subacute inflammatory processes treatment.

15.                                                         Symptoms of chronic inflammatory diseases of uterine adnexa. 

16.                                                         Differential diagnostics of inflammatory processes of uterus and it’s appendices with chronic appendicitis, vaginitis, inevitable abortion, malignant processes of ovary and uterine tubes.

17.                                                                                                                                                                                                                                                                                                                  Characteristics of pathogens of specific inflammatory processes of female sexual organs.

18.                                                                                                                                                                                                                                                                                                                  Ways of spreading the gonococcus, mucobacillus of tuberculosis, chlamydias, ureaplasms and importance of organisms reactivity in appearance of specific etiology inflammatory diseases of women sex organs.

19.                                                                                                                                                                                                                                                                                                                  Classification of inflammatory diseases of external and internal women sex organs of gonorrhea etiology.

20.                                                                                                                                                                                                                                                                                                                  Clinics of gonorrhea of women sex organs.

21.                                                                                                                                                                                                                                                                                                                  Bacterioscopic bacteriologic methods of diagnostics of gonorrhea of women sex organs.

22.                                                                                                                                                                                                                                                                                                                  Methods of treatment and prophylactics of gonorrhea of women sex organs.

23.                                                                                                                                                                                                                                                                                                                  Tuberculosis of women sex organs. Classification, clinics, methods of diagnostics and treatment.

THEME 2:

1.     Ectopic pregnancy. Classification, etiology, clinical symptoms.

2.     Outcome of ectopic pregnancy: tubal rupture and tubal abortion.

3.     Clinic of tubal rupture.

4.     Clinic of tubal abortion.

5.     Making diagnosis of ectopic pregnancy. Algorithm of diagnostics (ultrasonography, pregnancy test, culdocentesis, laparoscopy).

6.     Clinical symptoms of ectopic pregnancy.

7.     Surgical treatment of ectopic pregnancy.

8.     Ovarian, cervical, abdominal pregnancy. Pregnancy in rudimentary horn.

9.     Ovarian apoplexy. Etiology, clinical symptoms.

10.                      Torsion of the tumor’ pedicle. Clinical symptoms, algorithm of diagnostics, surgical treatment.

3. Seminar discussion of theoretical questions 12.30-14.00

Seminars’ discussion of the theoretical material from 12.30-14.00 (90 minutes).

1.     Classification of genital inflammatory deceases.

2.     Vulvitis – etiology, clinics, diagnostics, treatment.

3.     Acute bartholinitis – etiology, clinics, diagnostics, treatment.

4.     Vaginitis – etiology, clinics, diagnostics, treatment.

5.     Cervicitis, endocervicitis – etiology, clinics, diagnostics, treatment.

6.     Endometritis – etiology, clinics, diagnostics, treatment.

7.     Acute salpingooophritis – etiology, clinics, diagnostics, treatment.

8.     Pelvioperitonitis – etiology, clinics, diagnostics, treatment.

9.     Parametritis – etiology, clinics, diagnostics, treatment.

10.                                                   Difdiagnosis of acute adnexitis and acute appendicitis.

11.                                                   Difdiagnosis of piosalphinx, parametritis and the abscess of Douglas’s pouch.

12.                                                   Principles of acute genital inflammatory process treatment.

13.                                                   Principles of subacute inflammatory processes treatment.

14.                                                   Symptoms of chronic inflammatory diseases of uterine adnexa. 

 

4. Tests and Assignments for Self – assessment.

Multiple Choice.

Choose the correct answer / statement:

1. Which of the following is characteristic of bacterial vaginosis?

A – Thin filaments found on microscopic examination;

B – Intense itching;

C – Thick, lumpy discharge

D – All of the above

        2.What is the commonest site of ectopic pregnancy:

A - Ovarian pregnancy;

B - Cervical pregnancy;

C - Abdominal pregnancy;

D - Tubal pregnancy;

E - Pregnancy in rudimentary horn.

         3.What are  the symptoms of ectopic pregnancy?

A - Morning sickness;

B - Pain;

C - Short amenorrhea;

D - Vaginal bleeding;

        4.What is the most important sign of ectopic pregnancy on ultrasonography investigation?

A - An empty uterine cavity and a gestation sac on the side of the body of the uterus;

B - Gestation sac in uterine cavity;

C - Thickened endometrium;

D - Enlarged adnexa.

        5.What are the clinical signs of torsion of the tumor’ pedicle?

A - Hypomenstrual syndrome;

B - Pain;

C - Hypermenorrhea;

D - Great deal of follicular cysts in ovaries.

Real-life situation to be solved:

6.  L., 26 years old complains of the acute pains in the left side of lower abdomen and the little vaginal bleeding. The last menses was 7 weeks ago. On vaginal examination: the uterus is increase as in 5 weeks of pregnancy, left adnexa are increased and very painful. The posterior vaginal fornix is painful. Diagnosis? What doctor must to do?

.

 

5. Student's individual work from 14.15 till 15.00 hrs.

Students, who have not passed control in «MOODLE» system, should stay for individual work and write test control. Students work with thematic training tables, train in computer class, work with license examination test "KROK" and the department database tests, in-depth study of topics according to an individual study program, etc.

 

6. Students must know:

1.     Etiology and path of inflammatory processes of women sex organs of non specific etiology.

2.     Clinical forms of non specific inflammatory processes.

3.     Principles of conservative and operational treatment of non specific etiology inflammatory processes of women sex organs.

4.     Principles of dispensary monitoring and methods of rehabilitation of patients with inflammatory processes of female genital  organs.

5.     Etiology and pathogenesis of specific (Gonorrhea, Tuberculosis, Chlamidiasis,  Trichomoniasis, Ureaplasmosis) diseases of female sexual organs.

6.     Clinical forms of special genital infection processes.

7.     Principles of treatment of women sex organs infection diseases of specific etiology.

8.     Principles of monitoring and methods of patients rehabilitation with specific infection diseases of women sex organs.

9.     The classification, etiology, clinical symptoms of ectopic pregnancy.

10.                Etiology, clinical symptoms of ovarian apoplexy.

7. Students should be able to:

1.     Collect an anamnesis and conduct general gynecological examination of woman.

2.     Evaluate results of additional methods of examination.

3.     Formulate a diagnosis.

4.     Conduct differential diagnostics with other deseases that have similar clinics.

5.     Make a plan of examination and treatment of woman with non specific acute and chronic inflammatory processes.

6.     Make a plan of examination and treatment of woman with genital inflammatory processes.

7.     To take material for finding pathogens of special diseases of women sex organs.

8.     To make the diagnosis of ectopic pregnancy.

9.     To make the diagnosis of ovarian apoplexy.

8. Answers to the Self- Assessment.

1.D.2.D. 3. A, B, C, D. 4. A, D. 5 B. 6. Ectopic pregnancy. Leftside tubal rupture. Doctor must perform culdocentesis with the following salpingectomy

9. References:

A – Main: 1. Gynecology  – Edited by Ventskivska. – Kyiv “Medicine” – 2008. – 340p

2. S. Khmil, Z. Kuchma. L. Romanchuk. Gynecology. – Ternopil. Ukrmedkniga, 2006 – P. 131 – 145. P. 153 - 194.

3. Inflammatory diseases of the female sexual organs

B – Additional:

1. Essentials of obstetrics and gynecology. – W.B.Saunders Company. – Third edition – Neville F.Hacker, M.D., J.George More, M.D. – P. 196-212.

2. Danforth’s  Obstetrics and gynecology. Seventh edition. – 1994 . – P. 641 – 664.

3. Obstetrics and gynaecology. – Third Edition. – Charles R.B.Beckmann, Frank W. Ling, William N.P. Herbert.  – Williams & Wilkins Waverly Company, 1998. – P. 289-291. P. 324 - 351

 

 

Prepared by Stelmakh O.Y.

Methodical instruction was discussed and adopted at the Department sitting

27.05.2011. Minute № 13

Methodical instruction was reviewed and adopted at the Department sitting

24.05.2012. Minute № 13

Methodical instruction was discussed and adopted at the Department sitting

23.05.2013. Minute № 10

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute № __