Hysteroscopy can diagnose all, except:
Ans. is c, i.e. AdenomyosisRef: Novak 14th/ed, p787, 15th/ed, p786-2, Shaw 15th/ed, p494; Williams Gynae 1st/ed, p950-1* Hysteroscopy is the endoscopic technique of visualizing the interior of uterus directly.Q* It is both diagnostic and therapeutic.Patient Preparation:* In premenopausal women, hysteroscopy is ideally performed in the early proliferative phase of menstrual cycle, when endometrium is relatively thin. This allows small masses to be easily identified and removed.* Alternatively agents like progestins, combined pills, Danazol and GnRH agonist can be administered prior to anticipated surgery.* Hysteroscope consists of a rigid 4mm diameter telescope so, cervix has to dilated to 4mmQ for insertion of hysteroscope.Distension media:* Because the anterior and posterior uterine walls are in apposition, a distention medium is required to expand the endometrial cavity for viewing.* Distension media includes CO2 and low viscous fluids such as sorbitol, mannitol and glycine solutions.* To expand the cavity, intrauterine pressure of these media must reach 45 to 80mm of Hg. it should not exceed 100mg of Hg because high pressure can result in increased intravasation of medium into the patient's circulation and fluid volume overload.Most common media used for diagnostic purpose - CO2 Most common media used for therapeutic purpose - GlycineContraindications:- Infection (except in case of misplaced IUCD)- Pregnancy- Genital malignancyDiagnostic Indications of hysteroscopy:Let us understand the diagnostic indications of hysteroscopeA hysteroscope can visualize the interior of uterus so, it can diagnose* Any congenital malformation of uterus and can also help in differentiating between a bicornuate uterus from a septate uterus.Q* Any uterine synechiae (as in Asherman syndrome).Q* Misplaced IUCD.Q* Submucous fibroidQA hysteroscope can visualize the cornua so, it can diagnose* Any cornual pathologyHysteroscope can directly visualize the endometrium so, it can diagnose* Endometrial lesions like - endometrial polyp, endometrial hyperplasia, endometrial cancer, endometrial T.B.Q* Pregnancy-related conditions like: Molar tissue or products of conception.QBesides these hysteroscopy is also indicated inQ:* Unexplained abnormal uterine bleedingQ- Pre menopausalQ- Post menopausalQ* Selected infertility cases: In case of- Abnormal HSGQ- Unexplained infertilityQ* Recurrent spontaneous abortion* The therapeutic indications of hysteroscope are (here also don't mug up, just try to understand them).Q* To excise uterine septumQ* To lyse adhesions in Asherman's syndromeQ* To retrieve lost IUCDQ* Hysteroscopic myomectomyQ* PolypectomyQ* Endometrial ablation for menorrhagiaQ* Tubal occlusion for control of fertilityQ* Intratubal ballooning in tubal blockageQAs far as adenomyosis is concerned - it can be suspected on hysteroscopy by appearance of diverticuli but definitive diagnosis requires transvaginal ultrasonography.For management of adenomyosis hysterectomy is the definitive treatment"Endometrial ablution and resection using hysteroscopy has been used to successfully treat dysmenorrhea and menorrhagia caused by adenomyosis. However, complete eradication is problematic. - Williams Gynae 1st/ed, p209Also know:Technique for visualization ofCervixColposcopyFallopian tube* To see its mucosa* To see its lumen SalpingoscopyFalloscopyAbdominal cavityLaparoscopy
Asherman's syndrome
Septate uterus
Adenomyosis
TB endometritis
Gynaecological Diagnosis