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POSTMENOPOZAL KANAMADA AYIRICI TANI ve TEDAVİ

TANIM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hastayı rahatlatın.. ,[object Object]

Neden araştırılmalı? ,[object Object]

Etyoloji ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Anamnez ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Kanamanın kaynağı ,[object Object],[object Object],[object Object]

Üriner sistem ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gastrointestinal Sistem ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vulvanın inspeksiyonu ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Kanama vajen kaynaklı mı ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Kanama serviks kaynaklı mı ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transvajinal Ultrasonografi ,[object Object],[object Object],[object Object],[object Object],[object Object]

TV-USG Endometriumu değerlendirme tekniği ,[object Object],[object Object],[object Object],[object Object]

Endometrial kalınlık için cut-off kaç milimetre? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Endometrial kalınlık < 4-5 mm ise hastayı eve gönderelim mi? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endometrial kalınlık ≥ 4-5 mm ise.. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Başka kimlere endometrial biopsi yapalım? Neden? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Salin İnfüzyon Sonohisterografi (SIS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Postmenopozal kanamada önce SIS mi endometrial biyopsi mi? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SIS - yanlış pozitif sonuçlar ,[object Object],[object Object],[object Object]

Postmenopozal kanama tanısında histeroskopi (H/S) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Postmenopozal dönemde TVUSG (Adneksal Kitleler) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Postmenopozal Kanama ile İlişkili Adneksal Kitleler ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

USG’de malignite kriterleri ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CA 125 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ACOG-SGO (2002) Jinekolojik Onkoloji Konsultasyonu ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Postmenopozal dönemde basit (uniloküle) over kistleri ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tamoksifen ve Uterus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tamoksifen kullanan hastanın takibi (ACOG önerileri) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tamoksifen kullanan postmenopozal hastada kanama olursa endometrial örnekleme yapılmalıdır..

HRT sırasında vajinal kanama ,[object Object],[object Object]

HRT sırasında vajinal kanama ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HRT sırasında vajinal kanama ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vulvovajinal atrofi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Servikal polip ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endometrial kanser ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endometrial atrofi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endometrial hiperplazi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Atipisiz Endometrial hiperplazi Atipisiz endometrial hiperplazi 3 ay progestin tedavisi (3.- 6. aylarda endometrial biopsi ) (Ek jinekolojik endikasyon varsa) Histerektomi Persistan atipisiz end hiperplazi Endometrial biopsi takipleri ile progestin tedavisine devam (Hasta histerektomiyi kabul etmez ise) Kanama devam ediyorsa Jinekolojik endikasyon Histerektomi Kanser korkusu

Atipili Endometrial hiperplazi Atipili endometrial hiperplazi Cerrahi uygun değilse Histerektomi End ca H/S biopsiler ile ekarte edildikten sonra Megestrol acetate (80-160 mg x 1) (3 ay sonra endometrial biopsi) Regresyon var ise tedaviye endometrial biopsi takipleri ile devam Persistan atipili endometrial hiperplazi

“ Tanısal olmayan materyal” “Materyal yok” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endometrial polip ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Submukoz myom ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Uterin Sarkom ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

Siklik östrojen/progestin tedavisi İlk 3-6 ay kanama düzensizlikleri 3-6 aydan sonra devam eden kanama Konservatif yaklaşım Hastaya güven telkini TVUSG ile endometrial değerlendirme Endometrial biopsi Endometrial proliferasyon Progestin uygulama zamanının uzatılması (?) Tanısal değil SIS / Histeroskopi Endometrial hiperplazi veya kanser Polip, submukoz myom Uygun tedavi Uygun yaklaşım ve tedavi Normal Tedavi şeklinin gözden geçirilmesi

Devamlı kombine östrojen/progestin tedavisi İlk 6 ay kanama ya da lekelenme 6 aydan uzun süren düzensiz kanama Konservatif yaklaşım Hastaya güven telkini TVUSG ile endometrial değerlendirme Endometrial biopsi Endometrial atrofi -Tanısal değil SIS / Histeroskopi Polip Submukoz myom Normal Uygun tedavi Hasta ile tedavinin devamını görüş

Tamoksifen kullanan ve kanaması olan postmenopozal hastada tedavi ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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