《婦科陰道流血》ppt課件-全文預(yù)覽
【正文】 e 6. Bleeding due to systemic diseases 1. Ovarian endocrine dysfunction Due to dysfunction of the hypothalamicpituitaryovarian axis (HPOA). ? anovulatory dysfunctional uterine bleeding (無(wú)排卵性功能失調(diào)性子宮出血 ) ? ovulatory menstrual dysfunction (排卵性月經(jīng)失調(diào) ) ? intermenstrual bleeding (經(jīng)間期出血 ) (1) Anovulatory dysfunctional uterine bleeding ? Puberty（ 20%）： unstable HPOA regulation with growing follicle but no LH peak and ovulation does not occur. ? Perimenopause （ 50%）： ovary bees low responsive to Gn and its function declines. ? Child bearing period （ 30%）： inside/ outside interference, such as psychologic factor, environment,stress,etc. (2) Ovulatory menstrual dysfunction ? Luteal phase defect (LPD) (黃體功能不全 ) Abnormal FSH/LH or ratio, low LH peak or following pulse defect. ? Irregular shedding of endometrium(子宮內(nèi)膜不規(guī)則脫落 ） HPOA dysfuction and corpus luteum degenerate unpletely (3) intermenstrual bleeding ? With the rupture of dominant follicle, estrogens declines in a short time and endometrium breakthrough bleeding. 2. Bleeding due to pregnancy ? Abortion 流產(chǎn) ? Ectopic pregnancy異位妊娠 ? Gestational trophoblastic disease (GTD) 妊娠滋養(yǎng)細(xì)胞疾病 ? Anomaly of placenta 胎盤異常 placenta praevia(前置 )、 abruption(早剝 )、adherence(粘連 )、 implantation(植入 ) ? Postpartum part placenta remain胎盤部分殘留 ? Involution of uterus unhealthy 子宮復(fù)舊不良 Abortion ? Morphologic and geic abnormalities: Abnormal chromosome is the main factor. ? Maternal factors: 1. Systemic diseases： infections, cardiovascular disorders, severe anaemia, etc. 2. Endocrine disorder： hypothyroidism, poorly controlled diabetes mellitus. 3. Immunologic disorders 4. Uterine defects： congenital anomalies, submucous or intramural myomas, intrauterine adhensious. 5. Trauma (創(chuàng)傷刺激 ) ? Toxic factors： unhealthy life style, radiation, uncontrolled drugs Ectopic pregnancy More than 95% occur in the fallopian tube. ? 50% had salpingitis. ? History of fallopian operation. ? Intrauterine Device (IUD) ? Fallopian dysplasia or dysfunction, affect the transmigration of fertilized ovum. ? Others： surrounding oncothlipsis, EMs Gestational Trophoblastic Disease Trophohyper plasiacyte, erosin and destroy surrounding blood vessel. ? Hydatidiform mole (葡萄胎 ) ? Invasive hydatidiform mole(侵蝕性葡萄胎 ) ? Chorionic carcinoma(絨毛膜癌 ) 3. Genitals inflammation ? Vulvovaginitis(外陰陰道炎 )： disorder of vaginal ecological balance or exogenous pathogen invasion ? Cervicitis(宮頸炎 ) ? Cervical polyp(宮頸息肉 ): longterm chronic inflammation stimulation ? Endometritis (子宮內(nèi)膜炎 )： mon in after abortion, parturition, postmenopause women and IUD 4. Genitals tumor （ 1） Tumor erosion the vessel wall, cause cellular necrosis, ulcer. （ 2） Tumor cause steroid hormone disorder. （ 3） Myoma enlarged endometrial area, interfere uterine contraction and blood sinus shut. ? Vulovaginal tumor, cervix cancer, myoma, endometrial carcinoma, sara of uterus, ovarian cancer, oviduct cancer 5.
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