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Pediatric Gynecology PowerPoint Presentation

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Description : its about the gynecology of newborn, pedia and teenagers by rajat

Tags : gynecology

Published on : Jul 25, 2021 | Views : 33906 | Downloads : 33

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RAJAT KUMAR VISHWAKARMA Pediatric and Adolescent Gynecology
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GYNECOLOGIC VISIT AND EXAMINATION OF A CHILD Gain The Childs Confidence. They Should Be Participating And Not Forced. Visits Are Preventive In Nature And Problem Oriented. Problems Are Treated By Medical Means. Most Common Condition Is Vulvovaginitis. Mostly Examination Is Done To Get The Etiology.
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PERFORMANCE OF THE GYNECOLOGIC EXAM IN A CHILD Complete Pediatric Examination Includes History; Inspection With Visualization Of The External Genitalia, Visualization Of The Vagina, And Cervix, If Necessary, A Rectal Examination. HSTORY: Ask Parent/caretaker Address current signs and symptoms Duration of the problem Past treatment and diagnoses can ask direct questions
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PERFORMANCE OF THE GYNECOLOGIC EXAM IN A CHILD P.E : Reassure Child And Parent Give A Sense Of Control. “I Will Just Look” (Do Not Proceed Immediately To Touching The Patient) Explain Step By Step Keep Talking While Examining The Child Allow The Girl To Handle And Visualize Instruments Do Not Restrain The Child
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FOCUS ON Growth Development Tanner stage Routine PE genital examination
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Sitting on mom’s lap. Frog leg position Knee chest position. Prone position. D Evaluation of the Pediatric external genitalia
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GYNECOLOGIC EXAM Many Gynecologic Conditions In Children May Be Diagnosed By Inspection. Examination Involves Evaluation Of The Vagina. Oto/Ophthalmoscope Is Used As A Magnifying Instrument And Light Source But Is Not Inserted Into The Vagina. Evaluate The Vaginal Walls And Visualize The Cervix As A Transverse Ridge. A foreign object and the cervix may be visualized using this technique.
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Rectal examination Little finger is used and placed in the rectum and the other hand place on the abdomen. Ask the patient to breathe through her mouth for anal dilation. Ratio of Uterus to Cervix is 2:1 Non palpable ****IE not done in Pediatric, only Rectal Exam ****
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NORMAL FINDINGS: HYMEN AND VAGINA OF A PREPUBERTAL CHILD CHILD ADOLESENCE HYMEN : Crescent, annular or ringlike Thin, non-elastic pH : Basic Acidic VAGINA : Narrow Wider VAGINAL EPITHELIUM Redder, thinner Lighter Crescent/ redundant Thicker, elastic
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Gentle gripping of the labia and pulling anteriorly Examination of the vulva, hymen, and anterior vagina by gentle lateral retraction Evaluation of the Adolescence external genitalia Lithotomy position
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PROBLEMS IN PREPUBERTAL CHILDREN VULVOVAGINITIS Most common problem in prepubertal (PP) girls 80-90% SS: introital irritation discharges PP low estrogen: basic pH Adolescent: acidic pH Pathophysiology Primary irritation with secondary irritation of lower 1/3 of vagina.
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VULVOVAGINITIS Etiology Normal rectal flora Poor hygiene Back to front wiping (proper way is FRONT TO BACK) Chemical irritants (talc, soaps), further irritation by normal rectal flora URTI, auto inoculation (grp A or B beta hemolytic) Parasite (pinworm 20%)- Pruritus Mycotic Not common Immunocompromised (HIV) Purulent/bloody discharge suspect for a foreign body- Foul smelling discharge
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VULVOVAGINITIS Diagnostic Vaginal discharge culture Positive identification of gonorrhea, or chlamydia in premenarcheal vulvovaginitis, is considered diagnostic of sexual abuse. Improvement of perineal hygiene Parent education Topical creams Antibiotics (only if first line treatment fails)
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Labial Adhesions Labial adhesions literally mean the labia minora have adhered or agglutinated together at the midline. Partial Common: 2-6 years old Reason: estrogen nadir Spontaneous separation in 6-18 months Treatment offered only if patient is symptomatic Topical estrogen for 2 weeks Scarred posterior fourchette and new onset labial adhesion after 6yo = SEXUAL ABUSE
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Urethral Prolapse most common presentation is prepubertal bleeding. Increase in abdominal pressure Treatment: Conservative Antibiotics Surgery only for necrosis
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Lichen Sclerosus skin dystrophy Usually seen in menopausal women 10-15% of prepubertal girls Pruritus and vulvar discomfort Figure of eight appearance Diagnostic: Small punch biopsy may be done Treatment: Avoiding irritation or trauma Avoid straddle activities Clean perineum and do hot sitz bath Clobetasol for 2 weeks
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Foreign Body 4% of OPD consults Girls 3-9 year old No witness Tissue paper, buttons, hairpins, parts of a toy, coins SS: foul, bloody vaginal discharge Diagnostic: Vaginoscopy
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Sarcoma Botryoides  Rare malignancy  Prior to 6 years old  Arises from embryonic muscle cells  SS: vaginal bleeding, dysuria, difficult urination  Diagnostic: Vaginoscopy
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Accidental Genital Trauma Usual cause: Fall Straddle injuries straddle injuries from a variety of common objects such as the arms of chairs, countertops, ledges of pools and bathtubs, bicycle crossbars, and ladder rings. Diagnostic: Vaginoscopy to rule out internal hematomas Treatment: Conservative or Surgical Presence of hymenal transection= SEXUAL ABUSE
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Vulvar Hematomas vulva strikes a blunt object a young child to bleeding from trauma sexual abuse, automobile and bicycle accidents, kicks sustained in a fight, and self-inflicted wounds. extend is determined by visualization and palpation. serial examinations and the use of an ice pack or cool sitz bath and pain medications
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Genital Warts Human papillomavirus (HPV), prior to 3 years of age, maternal-child transmission. half of lesions, regress over 5 years laser and/or ultrasonic treatment under anesthesia,
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Prenatal Ovarian Cysts female fetus frequently demonstrates a simple ovarian cyst (up to 80% of fetuses). large cysts (probably greater than 9 cm) may require a cesarean section.
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Neonatal Ovarian Cysts common and can be followed expectantly ovarian torsion warnings, presents with acute vomiting or abdominal pain. Repeat serial ultrasonography Almost all will resolve Aspiration for large cyst.
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Ovarian Cysts in Children and Adolescents expectant management unless they are extremely large (>10 cm) abdominal ultrasound for complaints such as abdominal pain. ovarian torsion warning prevented combined oral contraceptives in adolescents.
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Ovarian Tumors in Children and Adolescents benign and malignant usually unilateral. consider the possibility of a malignancy, patients with solid ovarian masses or cystic and solid. Germ cell tumors : most common gynecologic neoplasm most common malignant germ cell tumor is a dysgerminoma. several issues are especially pertinent to children and adolescents. The most common lower abdominal pain or the presence of a mass Ovarian tumors constitute approximately 1%. Ultrasound, MRI, CT scan. mass may appear toothlike: ovarian teratoma. tumor markers such as α-fetoprotein, both alpha and beta human chorionic gonadotropin, inhibin (A and B), lactate dehydrogenase, estradiol, and testosterone;
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Ovarian Tumors in Children and Adolescents Routine biopsy of the normal-appearing contralateral ovary should be avoided. 75% to 85% of ovarian neoplasms necessitating surgery are benign. the appropriate surgical removal of the neoplasm and the preservation of future fertility. Evaluation of lymph nodes and Appropriate staging.
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Ovarian Torsion Twisting of ovaries on its attachments. secondary to a pelvic mass or due to mechanical factors . Ovarian torsion should be managed conservatively with untwisting and preservation of the adnexa, regardless of the appearance.
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