music It's a typical day. A patient has noticedsome itching, or maybe an unpleasant vaginal odor. During her exam, the ian willcheck vaginal pH, examine any discharge that's present, and collect a sample. Then, it'son to the microscope. music This is where you'll gather more specificinformationabout what's causing those vaginal symptoms. We'll show you how to prepare andexamine vaginal wet preps and how to do a whiff test. The results, combined with the patient's vaginal pH test, will aidthe diagnosis.
Under the microscope, you'll be looking for trichomonads, yeast, and the clue cells associated with bacterial vaginosis. We'll show you how to recognize them. music First, the microscope itself: This is a compoundlight microscope. It has several objective lenses on a rotating mount. For our purpose,one of these has to be a 10x low power objective, and one has to be a 40x for greater magnifiion.This flat part, under the objectives, is the stage. Under the stage is the condenser. Belowthat, at the base of the microscope, is the light source. There are two knobs that controlfocus; one for coarse adjustment and one for
fine adjustment. And these are the oculars,or eyepieces. We'll come back to the microscopea minute, but first, let's look at how to prepare wet mount slides. The complete vaginal wet mount involves botha saline prep and a potassium hyoxide, or KOH, prep. When the vaginal sample was collected,the swab was placeda test tube with approximately half a milliliter of saline. So, for the salineprep, you only have to take a op of the suspension and place it on a slide. Add acoverslip, being careful to avoid trapping air bubbles. Your saline slide is ready.Place a second op of the vaginal sample on another slide and add one op of 10 percentKOH. Sniff the preparation immediately, using
your hand to waft any odor toward your nose.This is the whiff test. Note if there's a fishy or amine odor. Then add a coverslip,avoiding air bubbles. Keepmind that you must work quickly to prepare and examine thewet mounts. That's because trichomonads may lose their characteristic motility within15 to 20 minutes. Before we move on now, though, let's lookat the cast of characters you may discover. These are normal squamous epithelial cellsfoundthe vagina. They're large, flat cells with a small nucleus and a large area of cytoplasm.Note that there is some granularitythe cytoplasm.
Polymorphonuclear leukocytes are known asPolys, or PMNs. They may also be called white blood cells, or WBCs. These are small roundcells. Several lobes of the nucleus are visible within the surrounding cell cytoplasm. Findingmany PMNs may indie infection. Trichomonads are pearshaped protozoa whichmove by means of flagella. Trichomonads are similarsize to PMNs and are identifiedby their characteristic jerking movement. The actual flagella may be too thin and toorapidlymoving to be seen. A clue cell is a squamous epithelial cellcoated with enough small bacteria that at least 75 percent of the cell's border is obliterated.It may look as if someone has spread glue
over the cell and pressed itsand. Cluecells are associated with bacterial vaginosis, a conditionwhich the normal microbialflora of the vagina is disrupted. Yeast may be foundtwo forms. Pseudohyphaeare the long, tubular, branching forms. Budding yeast are paired yeast cells that resemblea shoe print. The larger part is the sole and the smaller bud is the heel of the shoe. The saline prep will allow you to see epithelialcells, PMNs, trichomonads, and clue cells. You can also see yeastsaline, but sometimesit's hidden by epithelial cells or by PMNs. Red blood cells, sperm, and bacteria can alsobe seen.
Myoma Uterine Fibroids What is Myoma Causes Symptoms and Treatment for Myoma
A fibroid is a benign tumor that mainlyconsists have muscular tissue and usually grows inside the uterus. Fibroids are also called myomas. Its size ranges widely, from a small tumor the size of a pea to a large tumor almost the size of theuterus. Myomas are classified into three types,depending on the loion where they are found. The intramural myoma, a fibroid thatgrows
the muscular wall of the uterus. This subserosal myoma, a fibroidloed just beneath the outside mucosal covering of the uterus.Here the fibroid projects to the outside and occasionally remainsconnected with the uterus only through a small stalk. The submucosal myoma, a tumor that grows beneath the surface ofthe uterus lining. Therefore, this type of fibroids can growinto the uterine cavity. The actual causes have development ofa fibroid are still unclear.
However, it has been documented thatfibroids are associated with high levels of estrogen, the female sex hormone. Fibroids can only developed duringreproductive years of women. Following menopause, the production of estrogen decreases which will usually cause fibroids toshrink or disappear. Myomas are more commonnonpregnant and infertile women. In general, fibroids are asymptomatic
or associated with just a few complaintsif any complaints. If any complaints occur, then the loion, size and type of thefibroid are the major factors. Fibroids can affect nearby structures.They can cause compression of the bladder, which may lead to urinary complaints, or may obstruct the intestine, which may resultconstipation. Othercomplaints can be: backaches, abdominal problems, menstrual flowdisturbances.
Fibroids can impede normal childbirth,which may require caesarean delivery. Fibroids relatively more often lead tomiscarriages. Whenever fibroids cause symptoms, theyneed to be removed or shrinked. Mediions sometimes cause fibroid toshrink by blocking the production and secretion of estrogen. In other cases, surgery may be requiredto remove the fibroid.
The type of surgery depends on theloion of the fibroid. Sometimes it's possible to remove thefibroid with the help of the tube entered through the vagina and theprocedure is called hysteroscopic myomectomy. In other cases, surgery through theabdominal wall may be necessary. In the case of a large fibroid,hysterectomy may be the only solution. This option only applies when there isno desire to have more chilen. You generalpractitioner can give you more