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Table of contents
- Vaginal Bleeding
- Rapala Shad Rap 07 Fishing Lure - Bleeding Pearl
- International landing - Kmart
- Objectives
- Post navigation
When performing the pelvic exam, always start by visualizing the external genitalia and anus for lesions.
Vaginal Bleeding
Carefully examine the vagina and cervix, especially in the bleeding patient, to assess for lacerations or lesions that may be causing bleeding. Look for signs of products of conception protruding from the cervix or in the vaginal canal. Collect cervical specimens and send them to the lab even if you do not initially intend on testing, as you do not want to have to repeat an invasive exam unnecessarily.
Common tests performed on the specimens look for bacterial vaginosis, yeast and trichomonas wet mount as well as chlamydia and gonorrhea. Wet mount specimens are typically collected from the posterior fornix while either endocervical or vaginal swabs are appropriate for the gonorrhea and chlamydia Nucleic Acid Amplification Test NAAT. The wet mount typically results while the patient is still in the ED, while chlamydia and gonorrhea take up to three days to result.
If you suspect that your patient is at a high risk for these infections, you may recommend and provide empiric antibiotic treatment. Following the speculum examination, a bimanual exam is performed to assess the adnexa, cervix and uterus.
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Your patient's body habitus may limit this part of gynecologic examination, particularly if they are obese. Note that the bimanual exam is contraindicated in pregnant patients with placenta previa. If you suspect the patient is pregnant and possibly in their second trimester with unknown placental location possible previa , defer this portion of the exam to the obstetrician or until an ultrasound is complete and the location of the placenta is known. Treatment recommendations listed should always be checked with updated management guidelines and hospital susceptibility data.
Consider both gonorrhea and chlamydia in patients with pelvic complaints and high risk sexual behavior. With gonorrheal infection, symptoms may not be limited to the urogenital tract. Pharyngeal, rectal and ocular infections are also possible. In women, urogenital infections cervicitis, urethritis present with abnormal vaginal discharge, intermenstrual bleeding, dysuria, dyspareunia or lower abdominal pain. There may be mucopurulent discharge from the cervical os in gonococcal cervicitis. When treating empirically in the ED, provide coverage for both organisms.
Acute infection presents with purulent, foul, thin discharge with burning, itching lower abdominal pain and dyspareunia. Patients may also have postcoital bleeding.
Rapala Shad Rap 07 Fishing Lure - Bleeding Pearl
Vulva and vaginal mucosa appear erythematous. Greenish, frothy, malodorous discharge is sometimes present. Motile trichomonads are seen on wet mount and diagnosis can also be made by a positive culture, NAAT or rapid antigen probe test. Trichomoniasis is treated with 5-nitroimidazole drugs only metronidazole or tinidazole :. Patients present with vaginitis symptoms pruritis, burning, soreness, dysuria or dyspareunia. Higher risk patients are those with diabetes, antibiotic use, oral contraceptive use, pregnancy and immunosuppression. Candida is seen on wet mount.
Vaginal pH is typically normal. Treatment is targeted at symptom relief. Patients present with vaginal discharge, acute bilateral lower abdominal pain, dyspareunia and post-coital bleeding. On exam, there is cervical motion and adnexal tenderness as well as mucopurulent cervical discharge.
WBCs are seen on wet mount. Some also have leukocytosis on CBC. Patients may present with dysuria, urinary urgency, frequency, pelvic pain and hematuria. Urinalysis and urine culture should be obtained.
International landing - Kmart
An adnexal mass may be palpated on examination. Labs may show leukocytosis. Do not delay consultation if suspicion is high as definitive diagnosis is made in the OR; ultrasonography cannot rule out ovarian torsion. Obtain a pregnancy test to exclude an ectopic pregnancy.
Also consider tubo-ovarian abscess and appendicitis in the differential. Definitive treatment is surgical. Patients present with amenorrhea, irregular spotting, pelvic pain, missed period, history of PID, prior ectopic pregnancy. Pain becomes acutely worse with a ruptured ectopic and may lead to syncope.
Objectives
Patients may complain of shoulder pain due to blood irritating the diaphragm. On exam, evaluate for abdominal or adnexal tenderness. Sometimes an adnexal mass can be palpated.
Obtain beta hCG level and pelvic ultrasound to locate the fetus. Pregnancy of undetermined location on US with a beta hCG in this range is concerning for ectopic pregnancy. We're committed to providing low prices every day, on everything. So if you find a current lower price from an online retailer on an identical, in-stock product, tell us and we'll match it. See more details at Online Price Match.
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In The Spotlight. Shop Our Brands. All Rights Reserved. Cancel Submit. Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it. Vaginal Bleeding Is this your child's symptom? Vaginal bleeding before puberty OR abnormal bleeding after puberty Heavy menstrual bleeding after puberty Light breakthrough bleeding or spotting in between menstrual cycles after puberty.
When to Call for Vaginal Bleeding Call Now Passed out fainted Very weak can't stand You think your child has a life-threatening emergency Call Doctor or Seek Care Now Could have been caused by sexual abuse Moderate vaginal bleeding soaking 1 pad or tampon per hour for 6 or more hours Pale skin and new onset Skin bruises, nosebleed, or other bleeding not caused by an injury Vaginal bleeding of unknown cause before puberty.