Block G: Calma, Capili, Coruna, Dagang, Datukon, Dayrit, de Castro, de la Llana, Gayeta, Golepang

General Data  MP  34 years old  G3P3 (3003)  Married, housewife  Roman Catholic  Cabuyao, Laguna

Chief Complaint  menorrhagia

Past Medical History  No previous illnesses (-) HPN, DM, PTB, BA, goiter  No previous surgeries  No known allergies to food or drugs

Family Medical History  (-) HPN, DM, PTB, BA, goiter  No relative with similar symptoms as the patient

Personal/Social History  High school graduate  Currently a housewife  Non-smoker, non-alcoholic beverage drinker, does not use illegal drugs

Sexual History  First coitus at 17 years of age  1 non-promiscuous sexual partner  (+) OCP use from  (-) previous IUD use  (-) previous STD’s

Menstrual History  Menarche at 13 years old  Regular monthly intervals  3-4 days’ duration  Consuming 3-4 pads/day  (+) occasional mild dysmenorrhea  LMP: 1/20/2010  PMP: 12/22/2009  No previous Pap smear

Obstetric History  G3P3 (3003)  G11986, FT via SVD at home c/o hilot, M, AGA, (-) FMC, alive  G21991, FT via SVD at home c/o hilot, F, AGA, (-) FMC, alive  G31997, FT via SVD at home c/o hilot, M, AGA, (-) FMC, alive\

History of Present Illness  3 months PTC Increase in amount and duration of menses (3-4 pads per day  5-6 pads per, 3-4 days duration  10 days, with flow decreasing to 1-2 pads later) (-) intermenstrual bleeding, hypogastric pain, bowel/urinary changes (-) post-coital bleeding, dyspareunia, vaginal discharge, weight loss, anorexia and pallor (-) consults done / medications taken

History of Present Illness  1 month PTC Persistence of symptoms Duration increasing to 12 days Flow decreasing to 1 pad/day later in the period Consulted an Ob-Gyn in Laguna ○ TV UTZ done – unrecalled findings ○ Patient lost to follow up  persistence of symptoms prompted this consult

Review of Systems  (-) fever  (-) malaise  (-) cough  (-) DOB  (-) hemoptysis  (-) chest pain  (-) orthopnea  (-) PND  (-) easy fatigability  (-) dizziness  (-) nape pain  (-) weakness  (-) polydipsia  (-) polyuria  (-) polyphagia  (-) palpitations  (-) abdominal pain  (-) bowel changes  (-) dysuria  (-) decreasing urine output  Tea-colored urine

Physical Examination  Awake, coherent, ambulatory, NICRD  BP 120/80HR 84RR 18  Weight: 55kgHeight: 152cmBMI: 23  HEENT: pink conjunctivae, anicteric sclerae, (-) CLAD/TPC/ANM  Lungs: equal chest expansion, clear breath sounds, (-) crackles/wheezes  Heart: (-) heaves/thrills, distinct heart sounds, normal rate, regular rhythm, (-) murmurs

Physical Examination  Abdomen: flabby, soft, normoactive bowel sounds, nontender, (-) masses/organomegaly  Extremities: pink nail beds, full equal pulses, (-) cyanosis/clubbing/edema

Physical Examination  Internal Examination:  Normal external genitalia; smooth, parous vagina; cervix smooth, closed, firm; corpus small; (-) adnexal masses/tenderness  Rectovaginal Examination: Good sphincter tone, intact rectovaginal septum, smooth and pliable parametria, (-) fullness in the cul de sac, (-) intraluminal masses, (-) blood per examining finger

Assessment  Abnormal uterine bleeding probably secondary to adenomyosis, r/o endometrial pathology

Plan  Diagnostics CBC, Pap smear, Transvaginal ultrasound  Therapeutics FeSO4 325 mg/tab OD  Others Increase OFI, full body bath + perineal hygiene daily Menstrual calendar For endometrial biopsy with endocervical curettage once with ultrasound results

Results  CBC: WBC 9.7, Hgb 117, Hct 0.379, Plt 359, Neut 0.76, Lym 0.23  Transvaginal Ultrasound The uterus is anteverted with smooth contour and homogeneous echopattern, measuring 8.1x5x4.5cm, the cervix measures 3.4x3.2x2.8cm, the left ovary measures 1.9x2x1.6cm. There is no free fluid in the cul de sac IMPRESSION: thickened endometrium, r/o endometrial pathology, normal ovaries

Results  Endometrial Biopsy and Endocervical Curettage was done Final Histopathologic Diagnosis: ○ Endometrial polyp ○ Secretory phase endometrium ○ Chronic endocervicitis

Guide Questions  What is abnormal uterine bleeding (AUB)? How is this different from dysfunctional uterine bleeding?  Differentiate menorrhagia, metrorrhagia, polymenorrhea, and menometrorrhagia.  How is this diagnosed?  What are the possible causes of AUB?  What other diagnostics may be ordered for the patient?

Guide Questions  What are the possible methods of medical management for AUB?  What are the possible methods of surgical management of AUB?  What is an endometrial polyp?  What is endocervicitis?  How should this patient be managed?