Abnormal uterine bleeding: Difference between revisions

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! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Beta-HCG
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
Labs
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasound
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Miscarriage
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Miscarriage
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! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
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! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-  
|-  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal uterine bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal uterine bleeding
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! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PTT/INR
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Coagulation factors
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
Time
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Von willebrand disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Von willebrand disease
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| colspan="2" style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Factors deficiencies
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Factors deficiencies
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Platelet dysfunction
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Platelet dysfunction
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| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal uterine bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal uterine bleeding
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! colspan="2" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |TSH/T4/T3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |FSH/LH
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hyperthyroidism
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hyperthyroidism
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
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| colspan="2" style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Wet skin/hair thinning
| style="background: #F5F5F5; padding: 5px;" |
 
* Palpitation
 
* [[Insomnia]]
* [[Anxiety]]
* [[Weight loss]]
* Heat intolerance
* [[Diarrhea]]
 
| style="background: #F5F5F5; padding: 5px;" |Enlarged thyroid (Goiter)
 
Exophthalmous
 
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypothyroidism
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypothyroidism
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
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| colspan="2" style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Fatigue]]
* Cold intolerance
* Decreased [[sweating]]
* [[Hypothermia]]
* Coarse skin
* [[Weight gain]]
* Constipation
* Dry skin/hair loss
| style="background: #F5F5F5; padding: 5px;" |
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adrenal hyperplasia
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adrenal hyperplasia
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
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| colspan="2" style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Cushing's disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Cushing's disease
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
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| colspan="2" style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Polycystic ovarian syndrome
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Polycystic ovarian syndrome
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
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| colspan="2" style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hepatic disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hepatic disease
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
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| colspan="2" style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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|-
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-  
|-  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal uterine bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal uterine bleeding
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Coagulation studies
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other lab values
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Anticoagulants
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Anticoagulants

Revision as of 19:15, 30 January 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Farman Khan, MD, MRCP [2]

Causes

Common Causes


Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Blood thinners, breakthrough bleeding in women using hormonal birth control, copper intrauterine device , depo-Provera

hormone replacement therapy, tamoxifen, corticosteroids, chemotherapy, clomiphene, dilantin, antipsychotic drugs , antibiotics ( due to toxic epidermal necrolysis or Stevens-Johnson syndrome )

Ear Nose Throat No underlying causes
Endocrine Diabetes, hyperthyroidism, hypothyroidism, Cushing's syndrome, Hormone secreting adrenal and ovarian tumors
Environmental No underlying causes
Gastroenterologic Liver disease
Genetic No underlying causes
Hematologic Clotting disorders, Von Willebrand disease, thrombocytopenia or platelet dysfunction,

acute leukemia ,Some factor deficiencies, Advanced liver disease

Iatrogenic Radiation therapy
Infectious Disease Chlamydia, gonorrhea, uterine infection, genitourinary tract infection, bacterial vaginosis

sexually transmitted diseases, atrophic vaginitis

Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Adenomyosis, atrophy of the tissue lining the vagina and uterus, cervicitis, ectopic pregnancy, endometrial hyperplasia, endometritis, uterine sarcoma, first few months after the first menstrual period, first few weeks after abortion, first few weeks after delivery, intrauterine device, miscarriage, ovarian cysts, placenta previa, polycystic ovarian syndrome, retained products of conception, uterine fibroids, uterine polyps, diseases involving the vulva for example Crohn's disease, Behcet's syndrome , pemphigoid , pemphigus , erosive lichen planus , lymphoma, skin tags, sebaceous cysts, condylomata, angiokerataoma
Oncologic Cancer or precancer of the cervix , cancer or precancer of the endometrium, ovarian cancer, uterine cancer, uterine sarcoma
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte Chronic renal disease
Rheum / Immune / Allergy No underlying causes
Sexual Sexual abuse
Trauma Sexual intercourse , sexual abuse , foreign bodies (including IUD) , pelvic trauma, Straddle injuries
Urologic Genitourinary tract infection
Dental No underlying causes
Miscellaneous Foreign body, irritation of the genital area due to bubble baths, soaps, lotions or infection, smoking,

Excessive exercise

Causes in Alphabetical Order


Treatment

Contraindicated medications


Template:Abnormal uterine bleeding Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[4]

Overview

Abnormal uterine bleeding differential diagnosis

  • Abnormal uterine bleeding differential diagnosis include:
  • Endometrial hyperplasia
  • Cervical polyp
  • Cervical leiomyoma
  • Cervical lymphoma
  • Cervical sarcoma
  • Metastases to the cervix
  • Cervical ectopic pregnancy
  • Cervicitis
  • Cervical erosion ( Ectropion )
  • IUD use
  • Pelvic inflammatory disease
  • Endometriosis
  • Adenomyosis
  • Postcoital bleeding
  • Clear cell adenocarcinoma
  • Hematologic causes:
    • Von willebrand disease
    • Thrombocytopenia
    • Clotting disorder
    • Platelet dysfunction
    • Factors deficiency
Abnormal Uterine bleeidng differential diagnosis
Ob-Gyn neoplasm and diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Abnormal vaginal dyscharge Pelvic

pain

Itching or

burning of the vulva

Other Genitourinary/ Gastrointestinal symptoms B symptoms Abdominal pain Gynecological examinations Abdominal

mass

HPV

Pap smear

STI panel

Other labs Ultrasound Other

imagings

Cervical cancer[1][2][3][4][5][6]
  • Postmenopausal
  • Intermenstrual
  • Postcoital
  • Bleeding after pelvic exam
+ + +
  • Burning during urination
  • Difficulty urinating
  • Pain during sex
+

+

  • Cervical mass on exam
+ ± HPV
  • Atypical cells on Pap smear
  • STI: ±Chlamydia
  • Large cervical cancer
  • Angiogenesis on Doppler sonography
  • Bladder involvement
  • Lymph node involvement
T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. PET/CT scan:
    • Detect tumor size
    • Lymph node involvement,
    • Metastases to bladder or rectum
  • CIN1: mild dysplasia
  • CIN2: moderate dysplasia
  • CIN3: high degree of dysplasia/metastases
  • Colposcopy/biopsy
Cervical polyp[7]
  • Postcoital
  • Intermenstrual
  • Postmenopausal
  • Bleeding after exam
+
  • Mass on exam
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
  • Epithelial cells with no nuclear atypia/mitoses
  • Hysteroscopy /Biopsy
Cervical leiomyoma[8][9][10][11][12][13][14][15]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
+ +
  • Urinary retention
  • Constipation
  • Infertility
  • Bowel obstruction
  • Increase in pregnancy/labor complications
+
  • Large,irregular pelvic mass
±
  • Well circumscribed hyperechoic mass
T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
  • Spindle shaped smooth muscle cells
  • Mature adipocytes
  • Extracellular matrix consist of collagen,fibronectin.
  • Clinical diagnosis/ and
  • Ultrasound
Cervical lymphoma[16][17]
  • Postmenopausal bleeding
+
  • Difficulty urinating
  • Post-coital pain
+ +
  • Larrge uterine/cervix mass
  • Irregularity
+
  • Well-defined, solid, concentric, hypoechoic mass
  • Small tumor cells with large nuclei
  • High mitoses and proliferation
  • Biopsy
Cervical sarcoma[18]
  • Intermentrual
  • Postmenopausal
± +
  • Post-coital pain
  • Fullness in pelvic
± +
  • Cervical mass
  • Lump protruding from vagina/vulva
+
  • Biopsy
Cervical erosion(Ectropion)[19][20][21]
  • Light bleeding after pelvic exam
  • Spotting
+ + ±
  • Post-coital pain
  • Painful cramps
  • Pain after sex
+
Cervicitis[22][23]
  • Intermenstrual bleeding
  • Postcoital
  • Bleeding after pelvic exam
+ +
  • Itching
  • Pain during urination
  • Pain during sex
  • Painful menstruation
  • May have fever only
  • Red,inflammed swollen cervix
  • Inflammation/irritation of vulva/vagina
STI panel:
  • Chlamydia
  • Gonorrhea
  • Herpes simplex
  • Trichomonas vaginalis
Endometrial carcinoma
  • Postmenopausal bleeding
  • Intermesntrual

bleeding

Endometrial hyperplasia
Endometriosis[24][25][26][27]
  • Heavy mentrual bleeding
±
  • Pelvic pain
  • Back pain
  • Painful menstruation
  • Burning/painful urination
  • Painful bowel movement
  • Pain during or after sex
  • Infertility
+
  • Tender uterosacral nodularity
  • Immobile uterus
  • Cervical motion tenderness
  • Retroverted uterus
  • Visual inspection by laparascopy
IUD use[28]
  • Heavy bleeidng
± +
  • Itching
  • Painful menstruation
Pelvic inflammatory diseases[29]
  • Bleeding after sex
  • Intermenstrual bleeding
+ +
  • Itching/burning
  • Pain during sex
  • Painful menstruation
  • Burning sensation during urination
  • Pain during bowel movement
  • Fever
±Abdominal

pain

  • Pelvic pain
  • Vaginal/vulvar tender lesion depending on microbial cause
STI panel:
  • Chlamydia
  • Gonorrhea
Adnemyosis[30]
  • Abnormal uterine bleeding
+
  • Painful menstruation
  • Polypoid mass protruding into the endocervical canal.
Cervical ectopic pregnancy[31]
  • Amennorhea
  • Bleeding after pelvic exam
  • Pelvic pain
+
  • Soft and disporportionally enlarged uterus.
  • Empty uterine
  • Thickened endometrium
T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
  • Necrotic hemorrhagic mass with chorionic villus
  • Hysterectomy and biopsy
DES exposure (Clear cell adenocarcinoma)[32]
  • Postcoital bleeding
+
Paget's disease of vulva to cervix[33][34][35]
  • Bleeding from lesion
  • Oozing
±
  • Itching/burning
  • Pain in vulva
  • Scaly eczematoid lesion in vulva.
  • Erythematous plaques with white scaling.
  • Inguinal lymphadenopathy in case of metastases.
  • Intraepidermal adenocarcinoma which involves epidermis
  • Biopsy of lesion
Vaginal cancer[36]
  • Postcoital bleeding

+

  • Tenesmus
  • Dysuria
  • Urinary frequency
  • Constipation
  • Pelvic pain
  • Vaginal lump
  • Inguinal lymphadenopathy
Nabothian cyst[37][38][39]
  • Postcoital bleeding
+
  • Pain during sex
  • Cystic mass on exam
T1-weighted
  • Intermediate or slightly high signal intensity T2-weighted
  • High signal intensity on T2-weighted images
Pregnancy and pregnancy related conditions Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abnormal uterine bleeding Physical exam 1 Physical exam 2 Physical exam 3 Beta-HCG CBC Other

Labs

Ultrasound
Miscarriage
Abruptio placenta
Placenta previa
Ectopic pregnancy
Molar pregnancy
Hematologic conditions Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings
Abnormal uterine bleeding Physical exam 1 Physical exam 2 Physical exam 3 CBC PT PTT/INR Coagulation factors Bleeding

Time

Von willebrand disease
Factors deficiencies
Platelet dysfunction
Metabolic conditions Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Signs
Lab Findings Imaging Histopathology
Abnormal uterine bleeding Other symptoms TSH/T4/T3 FSH/LH Imaging 1 Imaging 2 Imaging 3
Hyperthyroidism +
  • Wet skin/hair thinning
  • Palpitation
Enlarged thyroid (Goiter)

Exophthalmous

Hypothyroidism +
Adrenal hyperplasia +
Cushing's disease +
Polycystic ovarian syndrome +
Hepatic disease +
Medication side effects/ Iatrogenic Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Signs
Lab Findings
Abnormal uterine bleeding CBC Coagulation studies Other lab values
Anticoagulants
Antipsychotics
Corticosteroids
Oral contraceptive pills
Herbal supplements

References

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