Gynaecology
6 modules11 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.
Start from the organ
Each structure on the model, and the presentations that begin there.
Uterus
- Fundus and cornuaThe dome of the uterus above the tubal openings.
- Body and myometriumHeavy menstrual bleeding
- EndometriumHeavy menstrual bleedingAbsent or infrequent periodsPostmenopausal bleedingA request for contraceptionHot flushes, sleep and the years around the menopause
- Isthmus and lower segmentThe narrow waist between body and cervix, which pregnancy stretches into the lower uterine segment.
Cervix, vagina and vulva
Adnexa
Pelvis and neighbours
- BladderChronic pelvic painUrinary incontinence and prolapse
- Rectum and pouch of DouglasAcute pelvic painChronic pelvic painUrinary incontinence and prolapse
- Pelvic floorUrinary incontinence and prolapse
- Bony pelvisSacrum and the two hip bones: inlet, mid-pelvis and outlet, each with its own diameters.
Start from the presentation
The way patients arrive. A first question, a workflow, and a differential with what favours and what argues against each.
- 01Gynaecology or family practice clinicHeavy menstrual bleedingIs she anaemic, and is the cause structural?7 differentials
- 02Emergency departmentAcute pelvic painIs she pregnant, and could this be torsion?7 differentials
- 03Gynaecology clinicChronic pelvic painWhat pattern does the pain follow, and which systems are involved?7 differentials
- 04ClinicAbsent or infrequent periodsPrimary or secondary, and is she pregnant?9 differentials
- 05Clinic, or an incidental findingAdnexal massIs it likely benign, and does it need surgery or surveillance?8 differentials
- 06ClinicVaginal dischargeIs it physiological, vaginal, or cervical?8 differentials
- 07Clinic, referred promptlyPostmenopausal bleedingIs this endometrial cancer, until proven otherwise?6 differentials
- 08ClinicA request for contraceptionWhat does she want from a method, and what is she eligible for?0 differentials
- 09Family practice or gynaecology clinic, at any ageVulval itch, pain and skin changeIs this an infection, a skin disease, or a lesion that needs a biopsy?7 differentials
- 10Family practice or urogynaecology clinicUrinary incontinence and prolapseIs the leak with urgency, with effort, or both, and is there something coming down?7 differentials
- 11Family practice or menopause clinic, usually between 45 and 55Hot flushes, sleep and the years around the menopauseIs this the menopause, what is bothering her most, and is there a reason not to offer hormone therapy?6 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.
- Pelvic mass, heavy periods and pressure
- Chronic pelvic pain, right adnexal cyst
- Postmenopausal bleeding at eighty-eight
- Small intramural fibroid (labelled)
- Subserosal fibroid (labelled)
- Heavy painful periods, bulky uterus
- Adnexal cyst with uniform internal echoes
- Sudden unilateral pelvic pain mid-cycle
- Incidental adnexal mass in a young woman
- Adnexal mass with bright content
- Oligomenorrhoea and hirsutism, ovarian scan
- Ovary with peripheral follicles
- Subfertility, left adnexal cystic structure
- Irregular bleeding, IUD threads not seen
- IUD not found in the cavity
- Two uterine bodies
- Duplicated uterine body (labelled)
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.
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.
- 01Abnormal uterine bleeding: PALM-COEINHeavy, irregular, intermenstrual or postmenopausal: describe the bleeding, then sort the cause into structural (PALM) or not (COEIN).Gynaecology · condition
- 02Fibroids and adenomyosisBenign myometrial disease that bleeds, presses, and sometimes hurts. Location decides the symptoms and the surgery.Gynaecology · condition
- 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
- 04EndometriosisEndometrium outside the uterus; pain, subfertility and a diagnosis that has moved from the laparoscope to the clinic.Gynaecology · condition
- 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
- 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