Primary dysmenorrhea onset of painful menses without

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primary dysmenorrhea onset of painful menses without pelvic pathology secondary dysmenorrhea painful menses secondary to pelvic pathology normal uterus size (nonpregnant) no larger than 8 wks in size, size of clenched fist. may be midly tender on exam just prior or during menses. should be smooth. should be mobile (may be immobile due to endometriosis implants along ligaments) normal ovaries -normally 2 x 3 centimeters in size-roughly the size of an oyster. -In an obese woman the ovaries may be nonpalpable. -During ovulation the ovaries may be slightly larger secondary to physiologic cysts. -Caution should be taken while palpating the ovaries since the patient may have a mild sickening feeling. -Mild tenderness on palpation of the ovaries is normal. Nabothian cysts -physiologically normal on the cervix. -formed during the process of metaplasia where normal columnar glands are covered by squamous epithelium. -inclusion cysts that may come and go and are of no clinical significance. vaginal discharge on exam Normal vaginal discharge is termed physiologic leukorrhea. It is normal for women to have physiologic clear to white vaginal discharge. The volume of discharge may get so heavy a woman will wear a pad for comfort; the volume may change during the course of a menstrual cycle. -While looking at the cervix white discharge can also normally be seen coming from the os or in the vagina. If there are endometrial growths on the cervix or vagina these may be blueish. Menorrhagia -absolute criterion for menorrhagia is blood loss of more than 80 milliliters. -Anything longer than seven days is most likely menorrhagia. Some providers try to use pad or tampon count. However there is variability in the absorption of different pads and how much blood a woman has on the pad prior to changing. Asking about clots may help, but again not easy to quantify. In fact, many women either over- or under-estimate the blood loss. Metorrhagia Irregular frequent bleeding but it doesn't have to be heavy. Menometrorrhagia irregular frequent and heavy bleeding. Premenstrual dysphoric disorder -Complex disorder that occurs at a specific time in a woman's cycle during multiple menstrual cycles in a year. A minimum of five symptoms need to begin the week prior to menses, start to improve during menses and then become minimal the week after menses. The patient must have one of the following: marked mood lability, irritability or anger, depressed mood or feeling hopeless, or anxiety and edginess.
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