1. Welcome to Weakly seminar Dr. Shubha Prasad Das Intern Doctor Dept. of Gynaecology and Obstetrics

2. Particulars of the patient Name: Marjina Registratio no: Age:45 years Bed No: Husband’s Name: Md. Akkas Address: Village: Makorpara, P.O:Sakrail, Village: Makorpara, P.O:Sakrail, Thana : Modhukhali, District: Faridpur Thana : Modhukhali, District: Faridpur Date of admission: 17 th April,2011 Date of examination: 17 th April,2011

3. Chief complaints: - Irregular menstruation with excessive bleeding for 2 years. - Weakness

4. History of present illness According to the patient statement she was well 2 years back. Thereafter she developed irregular menstrual cycle which persist for 15-16 days. Menstrual period persist for 2-3 days. There is excessive bleeding during menstruation with passage of blood clots. She also complains generalized weakness with these symptoms. There is no associated dysmenorrhoea. According to the patient statement she was well 2 years back. Thereafter she developed irregular menstrual cycle which persist for 15-16 days. Menstrual period persist for 2-3 days. There is excessive bleeding during menstruation with passage of blood clots. She also complains generalized weakness with these symptoms. There is no associated dysmenorrhoea.

5. History of past illness She has no history of liver disease, thyroid disease, renal disease or bleeding disorders. She has no history of liver disease, thyroid disease, renal disease or bleeding disorders.

6. Menstrual History Menarche: At the age of 13 years Menstrual period:3-4 days Menstural cycle: 28 days Since last 2 years : Menstrual period:2-2 days Menstural cycle: 15-20 days Menstrual flow: excessive LMP: 14/04/11 Dysmenorrhoea: Absent

7. Obstetrics History Married for: 32 years Para: 5(NVD)+2( IUD) ALC: 13 years

8. Family History: Nothing contributory Drug History: Nothing contributory Socio-economic History: Poor Contraceptive History: She don’t use any type of contraception.

9. General Examination Appearance- Ill Looking Respiratory rate- 14 breath/min Body Built- Average BP- 110/70 mmhg Anaemia- Moderate Heart - clear Jaundice- Absent Lung- clear Oedema- Absent Temperature - Normal Lymph Node – Not enlarged Thyroid- not enlarged Pulse- 84 beat/min Breast: Normal

10. Abdominal Examination: Inspection: No abnormality seen Inspection: No abnormality seen

11. Palpation: Non tender Non tender No mass detected No mass detected Temperature – not raised Temperature – not raised

12. Percussion: No fluid thrill or shifting dulness No fluid thrill or shifting dulness

13. Per- vaginal examination: Inspection: vulva- healthy Inspection: vulva- healthy Speculum examination: vagina and cervix looks normal Speculum examination: vagina and cervix looks normal Bimanual examination: Bimanual examination: - Uterus bulky - Uterus bulky - Fornices free - Ovaries normal

14. Investigations: CBC CBC Blood grouping and Rh typing Blood grouping and Rh typing RBS RBS Blood urea serum creatinine Blood urea serum creatinine Urine R/M/E Urine R/M/E X-ray chest P/A view X-ray chest P/A view T3, T4 and TSH T3, T4 and TSH USG of Whole abdomen USG of Whole abdomen

15. Salient feature : My patient Mrs. Marjina wife of Mr. Akkas aged 45years Muslim lady from Sakrail Modhukhali admitted in FMCH with the complaints of irregular menstrual cycle with excessive bleeding. She also complains generalized weakness. She has no history of liver, thyroid diseases or bleeding disorder. She didn’t take any drug related to such type of symptoms. My patient Mrs. Marjina wife of Mr. Akkas aged 45years Muslim lady from Sakrail Modhukhali admitted in FMCH with the complaints of irregular menstrual cycle with excessive bleeding. She also complains generalized weakness. She has no history of liver, thyroid diseases or bleeding disorder. She didn’t take any drug related to such type of symptoms. On general examination- she was found moderately anaemic and normotensive. Abdominal examination reveals no abnormality. On general examination- she was found moderately anaemic and normotensive. Abdominal examination reveals no abnormality. On vaginal examination revealed bulky uterus, free Fornices. All the investigation normal except HB%. On vaginal examination revealed bulky uterus, free Fornices. All the investigation normal except HB%.

16. Diagnosis: Clinically it appears to be a case of DUB Clinically it appears to be a case of DUB

17. Differential Diagnosis: Adenomyosis Adenomyosis Fibroid Uterus Fibroid Uterus

18. Treatment : Total Abdominal hysterectomy with conservation of both ovaries if they are look healthy. Total Abdominal hysterectomy with conservation of both ovaries if they are look healthy.