生殖系統(tǒng)機制圖

1、Vaginal bleeding cycle or caused bbleeding sites1) Uterus:Endom2) Adnexa: Ovan3) Vagina: VaginiendocrinetumourinflamimechanismmapofreproductivesystemfromGroup3Generaldata:female27Chiefcomplaint:Excessivemenstrualflowwithpassageofclotsfor3daysHistoryofpresentillness:dizzinessandlowfeverfor1dayOvarian

2、 function disorder1) anovulatory dysfunctional uterine bleeding2) ovulatory menstrual dysfunctionLeucorrhea Increase painUterine fibroid:Intramural fibroids Submucosal fibroids malignant tumorGermiculturInfection 一Less blooddiagnosis of exclusiondizziness low feverMassive Haemorrhageanoxiaimmunesupp

3、ression，infectionmenstrualhistory:menarche:18blood coagulation system:- exclusion:hematopathyirregularmenstruation(bloodclots)一LMP:2011-6-15PMP:2011-3-21maritalhistory:marriedchildbearinghistory:0-0-1-0(pregnancyfortwomonths,abortion8monthsago)PasthistoryNo pregnancyNohypertensionNohemopathyNocardia

4、cdiseaseNohepatopathyNonephropathyinflammationPeritonitis :Tumour：renal function：Hyperthyroidism：-dysfunction of liver :- exclusion:hepatic dysfunctionMassive Haemorrhagephysicalexaminations:Height:165cmWeight:70kgtemperature:37.5Cpulse:103/minHR:103/minBP:95/70mmHgRespiration:25/minAcneinfaceAnemic

5、facies:+Stainedyellow:-Hepatosplenomegaly:-Breathsoundsclearmuscleguarding:-reboundtenderness:-mass:-Abdominaltenderness:-tendernessofbladderregion:-edemainbothlowerlimbsexclusion:drugorIUDinduceduterinebleeding:ERT/oralcontraceptiveshypopituitarism:-gynecologialexaminationsVulva:marriedtypeVaginais

6、unblockedbutwithbloodclotunusualsmell:-cervicalerosion:+cervicalliftingpain:-uterusisalittlelargerIndication:mildinflammationexclusion:cervicalmyoma/cervicitis/ectopicpregnancyexclusion:malignanttumorPatterns of bleeding1) Withdrawal bleeding Decrease in estrogen2) Breakthrough bleeding Low level of

7、 estrogen High level of estrogen1) InadolescentsImmaturityofthehypothalamic-pituitary-ovarianaxis.Especially,lowresponseofhypothalamusandpituitaryglandtopositivefeedbackfromestrogen.2) premenopausalLowresponseoftheremainingfolliclestogonadotropins.3) WomenofreproductiveageStress,fear,erferesw

8、ithovulationtreatmentPrincipleoftreatment1) generaltreatmentanemicpatient:Fe2+,vitaminCandproteinsevereanemicpatient:bloodtransfusionpatientwithlongtimebleeding:anti-infection2) thetreatmentofanovulatoryDUBa) adolescentageandchild-bearingagepatienti. haemostasis1. massivebleedinga) benzestrofolb) i.

9、v.conjugatedestrogenc) oralapplicationofconjugatedestrogen2. littlebleedinglowdoseofhormone3. Ifmedicaltreatmentfails,diagnosticD&Corablationoftheendometriumorhysterectomyhastobeconsidered.ii. adjustmentofmenstrualcycle1. therapyofprogestogenwithinsecondhalfofmenstrualcycle:applywithpatientwhowi

10、thnormallevelofendogenousestrogen2. Artificialmenstrualcycle:applywithpatientwithlowlevelofendogenousestrogen3. oralcontraceptivemedicationb) critiqueagepatient(>40yearsold)i. haemostasisprogestogen,sometimesandrogenaddedii. adjustmentofmenstrualcycleoralapplicationofanorethisterone3) adjunctivetherapy1) AntiiCefurox axetil2) CorrFerric c3) Haeia) h b)