Abnormal Uterine Bleeding for USMLE

Abnomral Uterined Bleeding for USMLE, including Dysfunctional Uterine Bleeding. Handwritten tutorial lecture discussing pathophysiology, sign symptoms and treatment.
Normal Uterine Bleeding is defined by frequency of 28 days plus or minus 7 days. So anywhere from 21-35 days. Duraiton of menses is 5 to 7 days and on average a woman loses 20-60mL of blood. So menses is measured relative or by the number of pads used. Abnormal can be menorrhagia which is high blood flow either becuase of high duration or high quantity. Metrorrhagia looks more at the frequency and the amount of blood will be normal. Menometrorrhagia will be a combination of the two.
PREMENARCHAL BLEEDING
Patients less than12 years old. Most common cause is foreign body insertion into vagina. Sexual abuse may also present as abnormal vaginal bleeding. Estrogen ingestion can lead to precosious pubery can lead to early bleeding. Vaginal and Cervical cancer more specifically sarcoma botyroides. Also adrenal and pituitary tumors releasing estrogen.
Patient work up wil first consist of pelvic exam to look for foreign bodies, tumor or sexual abuse. Ensure it is coming from vagina and not urethra or rectum. Imaging consists of CT/MRI of pitutiary gland, abdomen and pelvis.
POSTMENOPAUSAL
Benign causes and malignant and exogenous causes. Benign cause atrophy because estrogen is real low and theis can lead to bleeding. Malignant causes are ovarian carcinoma and vulval vaginal and cervical cancer. Also HRT and anticoagulants. Evaluation you must assume cancer and rule it out. Physical examination to look for atrophy, urethral and rectal examination to confirm vaginal cause. Endometrium with Ultrasound and biopsy. Cytology of the cervix to rule out vervical cancer. Cytology for cervical cancer.
REPRODUCTIVE AGE GROUP
Must rule out pregnancy with hCG, also ectopic, molar and abortion. Abnormal growth such as leiomyoma (uterine artery emboli). Endometrial and endocervical polyps. External causes can be UID, OCP, HRT, Tamoxifen. Infectious causes such as endometritis (Gonorrhea, Trochamaotic) Bacterial vaginosis, (mycoplasma and PID) Systemic caues such as liver failure and thyroid, coagulopathy. THrombocytopenia.
Dysfunctional uterine bleeding can be anvoulatory and ovulatory. Anovulatory is lack of estrogen. Ovulatory increases Prostaglanding and increases bleeding. Must first rule out pregnancy. Also check CBC to rule out anemia. PAP Smear to rule out cancer. Wet-Prep of cervical secretion. Endometrium with hysteroscopy, Dialtion and Curretage, pipelle device. Ultrasound to identify polyps, fibroids, Endometrial size is normally 5-8mm. Hyperplasia will 8-11m and cancer is usually greater than 11mm.
Treatment is NSAIDS, Contraception, Anti-Fibrinolytics such as trexanemic Acid. Iron supplements. Surgical can be Dilation and curretage and hysterectomy

[@SajoOo92]

Thank you .. your videos made my studying of OB.GYN easier !
advice to those struggling to get through the course: watch the videos first, make notes, then read the book.. it will feel less complicated and faster to flip through !

[@fibckf]

Hi, how does low oestrogen cause atrophy please? Also I am deaf and for other deaf people as well, it would mean so much if you could make your videos with subtitles! :)) I know you have the transcript and I am so grateful, but it would just add that much more extra to your videos! Thank you

[@thestudyspot]

Estrogen acts on the endometrium to cause proliferation. So without the stimulation of estrogen the endometrium will atrophy. Also I have typed up a transcript in the description section. It follows pretty closely with the video. I will see if I can figure out how to get subtitles and then put it up.

[@brad4908]

Thanks for clarifying that we're looking at abnormal uterine bleeding _for a female_ so I don't think that male uterine bleeding might be abnormal.

[@jjetson403]

Beware the man-period...

[@n_92alharbi71]

Hahahaha

[@charlenec.6166]

Thank you!!!! You're the best!

[@research9983]

Thank you so much, really you’re best than my doctor 👍🏻👍🏻👍🏻👍🏻

[@honeybee7090]

i think ovulatory DUB is due to decrease in PG instead of increase?

[@evahbopape6141]

Is it not the ratio that is disturbed? Vasoconstrictve vs dilation? E2 and F2?

[@gerradterray9124]

Imbalance of PGs cause uterine angina and ovulatory DUB results from endometrium epithelial shedding in lack of PROGESTERONE

[@sansanismeee]

Sorry.. just wanna ask isn't it hemophilia is X-linked disorder? so the cause is kinda invalid for reproductive cause of abnormal uterine bleeding here?

[@HafizahHoshni]

Excellent and concise presentation. Thanks you so much! 26/7/2018 :D

[@imeneimaya1960]

great lecture great channel thank you

[@BrutalHeadHunter]

Thank you so much,this is so good.

[@thestudyspot]

You're welcome 😊

[@rubimalik4878]

Does the mirena coil work.

[@chetanchetan23]

simply superb.Thanks

[@anonymoussingh4561]

Cancers in premenarchal (

[@yashvendrasingh234]

thanks for the great lecture....

[@allalover]

you are the best!

[@sergeabegaabega2679]

please i'm looking for the new classification of figo 2018 for myomas. please need help

[@nawafhussain7451]

thank you so much.

[@Ardka]

Thank you so much

[@raveeshbannihatti8731]

What is the difference between Dub and Breakthrough bleeding?

[@Guidemaster11B]

Imaging? Why would you do CT/MRI before doing US? thanks

[@mrfesoj]

thank you !
helped me :)

[@thestudyspot]

+joseph.elizarov Your Welcome. Glad I could Help!

[@rubimalik4878]

Bleeding four months non stop.

[@benardlinga3045]

Thank you

[@imperiusss]

hey great lectures.
which hardware and software do you use for your teachings?

[@thestudyspot]

Thanks. I use Microsoft Surface and Microsoft OneNote.

[@alinawani2507]

Is oligomennorhea included in aub???

[@musiary]

Thank you so muchhh

[@kolfol11]

thanks ,nice info

[@thestudyspot]

+Joseph Saby Your welcome, glad you enjoyed

[@GEO-rm4wp]

Thank u

[@Natalia-zp6tb]

pretty much helpful. . Thank you

[@rinadelyan8334]

Thanks alot😊

[@thestudyspot]

Rinad Elyan Your Welcome!