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Gynaecology

6 modules8 presentations17 studies

Two ways in. Start from the organ on the sourced pelvis and find the presentations that begin there, or start from the way the patient arrives and work back to the anatomy. The ultrasound is real and the answer is held back.

The female pelvis opened in the midline: bladder in front, uterus, cervix and vagina in the middle, rectum behind, the ovary and tube to the side, the pelvic floor below
The non-pregnant pelvis in section. Open the 3D labFemale Reproductive System, Stanford EdTech, CC BY 4.0

Start from the organ

Each structure on the model, and the presentations that begin there.

  1. Uterus

  2. Cervix, vagina and vulva

  3. Adnexa

  4. Pelvis and neighbours

Start from the presentation

The way patients arrive. A first question, a workflow, and a differential with what favours and what argues against each.

  1. 01Gynaecology or family practice clinicHeavy menstrual bleedingIs she anaemic, and is the cause structural?7 differentials
  2. 02Emergency departmentAcute pelvic painIs she pregnant, and could this be torsion?7 differentials
  3. 03Gynaecology clinicChronic pelvic painWhat pattern does the pain follow, and which systems are involved?7 differentials
  4. 04ClinicAbsent or infrequent periodsPrimary or secondary, and is she pregnant?9 differentials
  5. 05Clinic, or an incidental findingAdnexal massIs it likely benign, and does it need surgery or surveillance?8 differentials
  6. 06ClinicVaginal dischargeIs it physiological, vaginal, or cervical?8 differentials
  7. 07Clinic, referred promptlyPostmenopausal bleedingIs this endometrial cancer, until proven otherwise?6 differentials
  8. 08ClinicA request for contraceptionWhat does she want from a method, and what is she eligible for?0 differentials

Real pelvic ultrasound

Describe the uterus, the endometrium and each adnexa before naming anything. The images are real; the diagnosis waits until you commit.

GYN ultrasound
Moving pictures

24 bedside loops of the uterus and adnexa from The POCUS Atlas, among 63 obstetric and gynaecological clips. CC BY-NC 4.0, each credited and linked.

  • Uterus with Leiomyomas (fibroids)
  • Uterine Perforation
  • Transabdominal Uterus Transverse
  • Hematocolpos
  • Bicornuate Uterus with IUP
POCUS clips

Labs

Lab Menstrual cycle labHormones, the ovary and the endometrium on one day scrub, with the histology that matches, and the loop broken four ways.Lab Contraception labMethods, eligibility and counselling: choose for a patient and see what the criteria say.

Gynaecology modules

Presentation-first: bleeding, pain, masses, discharge, menopause.

  1. 01Abnormal uterine bleeding: PALM-COEINHeavy, irregular, intermenstrual or postmenopausal: describe the bleeding, then sort the cause into structural (PALM) or not (COEIN).Gynaecology · condition
  2. 02Fibroids and adenomyosisBenign myometrial disease that bleeds, presses, and sometimes hurts. Location decides the symptoms and the surgery.Gynaecology · condition
  3. 03Pelvic pain: acute and chronicAcute pain is a race against torsion, ectopic and rupture. Chronic pain is a longer conversation with endometriosis at its centre.Gynaecology · condition
  4. 04EndometriosisEndometrium outside the uterus; pain, subfertility and a diagnosis that has moved from the laparoscope to the clinic.Gynaecology · condition
  5. 05Vaginal discharge, vaginitis and pelvic inflammatory diseaseThree common causes of discharge with three different treatments, and the infection above the cervix that scars the tubes.Gynaecology · condition
  6. 06Menopause and its managementTwelve months without a period, on average at 51. The symptoms are treatable, the risks of treatment are specific, and the conversation is individual.Gynaecology · condition