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OB Gyn > book of yueng > Flashcards

book of yueng Flashcards

1
Q

what do we want to avoid when putting in lap ports?

A

deep and superficial epigastrics

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2
Q

what is the origin of the superficial epigastric

A

femoral

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3
Q

what is the origin of the deep epigastric?

A

external iliac

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4
Q

how do you avoid the superficial epigastric

A

transillumination

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5
Q

in what layer is the deep epigastric?

A

rectus abdominus fascia

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6
Q

how do you avoid the deep epigastric

A

stay lateral to the rectus abdominus fascia (or lateral to the insertion of the round ligament at the inguinal canal)

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7
Q

what is endometriosis

A

ectopic endometrial glands and stroma

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8
Q

how do you diagnose endometriosis?

A

with a biopsy that shows endometrial glands and stroma

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9
Q

what does endometriosis look like

A

gun powder lesions

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10
Q

how do you find the ureter

A

at the pelvic brim (above the bifurcation of the common iliac into the internal and external iliacs–this is NOT water under the bridge)

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11
Q

where is the water under the bridge

A

where the ureter crosses under the uterine artery

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12
Q

how can you tell that it is a ureter

A

vermiculation

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13
Q

where can you find the uterine artery

A

at the level of the cervical os

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14
Q

what do you call the uterine artery traveling up the uterus?

A

ascending branch of the uterine artery

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15
Q

why is the ascending uterine artery tortous

A

so that it can expand with the uterus

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16
Q

triangle of doom

A

round ligament and medial umbilical fold (houses epigastric)

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17
Q

where does the round ligament attach

A

the round ligament goes into the deep ring of the inguinal canal

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18
Q

what artery is in the round ligament

A

Samson’s artery (branch of uterine artery)

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19
Q

does prevelance of endometriosis go up or down with obesity

A

prevelance of endometriosis goes down with obesity and most pts with endometriosis are normal weight

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20
Q

what type of estrogen comes from fat

A

esterone *made by aromatase*

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21
Q

what is the substrate for aromatase to make to estrone in fat?

A

androstendione

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22
Q

what is the substrate for aromatase to make estrodial

A

testosterone

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23
Q

does estrogen cause endo

A

no

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24
Q

is endo found in the uterus

A

no, it’s ectopic

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25
Q

why remove the uterus in endo cases?

A

to remove the suspected source of the endometriosis

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26
Q

why do we sometimes remove ovaries in endo cases?\ why remove the fallopian tubes

A

endometriosis can be estrogen responsive tubes can be a source of ovarian cancer

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27
Q

what ligament suspends the ovary?

A

IP ligament (infundibulopelvic)

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28
Q

which ligament attaches the ovaries to the uterus

A

uterine -ovarian ligament

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29
Q

what can damage the ureters (4 things)

A

ligation thermal injury kinking ischemia **kinking is most common**

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30
Q

what is most common cause of damage to ureters

A

kinking

31
Q

when does kinking of the ureters usually occur

A

at the closing of the vaginal cuff

32
Q

during cysto, what does a ureteral jet tell us

A

the ureter is patent (but not necessarily undamaged)

33
Q

How do you evaluate for ureter damage intra operatively

A

cysto visual jets at UO

34
Q

what dyes can you give patients to look for ureter damage?

A

methylene blue (can rarely causes methemoglobinemia) indigo carmine (national shortage) fluoresceine

35
Q

what can you do if one of the ureters is not patent?

A

give IVF bolus release vaginal cuff call urology

36
Q

what can you do post operatively to evaluate ureters

A

IV pyelogram(gold standard, not commonly done) CT scan (lets you look at nearby structures)

37
Q

what is first line tx for endo pelvic pain

A

NSAIDs because there’s up regulated prostaglandin release due to the endo lesions

38
Q

what does endometriosis look like on US

A

ground glass

39
Q

what is primary dysmenorrhea?

A

pain from uterus contraction

40
Q

what tx for primary dysmenorrhea

A

NSAIDs bc pain is thought to be due to prostaglandins

41
Q

what is secondary dysmenorrhea

A

pain from a pathology and not just uterine contractions. e.g. fibroids, infection, endometriosis

42
Q

what does a simple cyst look like on US

A

small black circle

43
Q

what is a complex cyst

A

anything that isnt a simple cyst or small black circle on US

44
Q

what are possible characteristics of complex cysts

A

irregular borders hyperechoic (calcifications…think dermoid cyst) multiloculated air fluid levels

45
Q

can you diagnose endometriosis on US

A

no dx requires biopsy/pathology. you can only say that US raises suspicion

46
Q

when you poke a cyst and chocolate comes out, does that mean it is an endometrionoma

A

nope, have to have pathology. could be a hemorrhagic cyst.

47
Q

what is one way to tell the difference between hemorrhagic cyst and endometrionoma?

A

you can do serial US. the hemorrhagic cyst will usually resolve over time

48
Q

what is the most dangerous part of laproscopy

A

insertion of first port because you have to do it blindly

49
Q

what is the omentum

A

policeman of the abdomen bc it can wall off infections

50
Q

ovaries are supplied directly by _____

A

aorta

51
Q

right ovary, right kidney, right adrenal gland drain to ——

A

directly to vena cava

52
Q

left ovary, left kidney, left adrenal gland drain to…

A

renal vein first before vena cava

53
Q

external iliac artery passes through….and becomes….

A

external iliac artery passes through inguinal ligament and becomes femoral artery

54
Q

in primary amenorrhea, you can see the girl has secondary sex characteristic so her endocrine axis is intact and US shows her anatomy is intact. What could be causing primary amenorrhea

A

pregnancy weight loss/athlete triad/stress imperforate hymen

55
Q

in primary amenorrhea, you can see the girl has secondary sex characteristic so her endocrine axis is intact and US shows she doesnt have a uterus. What could be causing primary amenorrhea

A

mullerian agenesis

androgen insensitivity syndrome

you can tell the difference between these two by looking at testosterone level and karyotype

56
Q

in primary amenorrhea, you can see the girl lacks secondary sex characteristic so her endocrine axis is not intact and US shows she does have a uterus. What could be causing primary amenorrhea?

A

Kallmans (hypothalamus -no mass! no GnRH)

craniopharyngeoma (anterior pituitary-mass)

Turners

In Kallmans and craniopharyngeoma, you make zero LH, FSH . get MRI to distinguish

in Turner’s, tons of LH and FSH trying to turn on nonfunctional ovaries. Karyotype and transvaginal US

57
Q

primary amenorrhea and no sense of smell

A

Kallmans

58
Q

primary amenorrhea, intact endocrine system, missing top 1/3 of vagina, uterus, tubes

A

mullerian agenesis

(mullerian ducts –> upper 1/3 of vagina, uterus, tubes)

59
Q

Turner’s syndrome

secondary sex characteristics?

anatomy?

A

Turner: streak ovaries, has vagina, vulva, uterus, tubes

estrogen progesterone low –> can’t develop secondary sex characteristics. Elevated LH, FSH bc no neg feedback

*give estrogen and progesteron, **GET ECHO! (most commonly coarctation of aorta, bicuspid aortic valve)

60
Q

definition of secondary amenorrhea

A

3-6 months or missed 3 periods

61
Q

first steps in secondary amenorrhea workup

A

pregnancy test, TSH, prolactin level

all negative: progesterone challenge, if positive–> not ovulating, probably PCOS

if neg, estrogen/progesterone test. If no bleeding, ashermans or ablation of endometrium. If yes bleeding, then endometrium is fine it’s the axis thats messed up. Get FSH, LH, and FSH:LH ratio. If these high, it’s an ovary prob

62
Q

retrograde theory of endometriosis

A

Retrograde Menstruation. Retrograde menstruation theory is the oldest principle explaining the aetiology of endometriosis. This theory proposes that endometriosis occurs due to the retrograde flow of sloughed endometrial cells/debris via the fallopian tubes into the pelvic cavity during menstruation

doesnt explain why premenstral, postmeno females get endometriosis

63
Q

endo’s evil twin

A

interstitial cystitis

pelvic pain, bladder irritability, frequency, dysparunia

64
Q

medial umbilical ligament

A

remnant of fetal umbilical arteries

65
Q

median umbilical ligament

A

remnant of fetal urachus

66
Q

posterior pedicle of internal iliac

A

becomes three vessles

iliolumbar

lateral sacral

superior gluteal

(I love sex)

67
Q

in hysterectomy, clamp and cauterize round ligament (samson’s arter), then dissect anterior leaf of broad ligament in order to….. and then the posterior leaf of broad ligament in order to…

A

dissect anterior leaf of broad ligament to dissect off bladder and then the posterior leaf to avoid ureters

68
Q

why remove fallopian tubes during hysterectomy

A

bc ovarian cancer can originate in the fallopian tubes especially the fimbriae

69
Q

what is primary infertility

A

nulliparious woman, trying for a year , not on contraception, + “random coitus”

70
Q

what is primary amenorrhea

A

pt has never had menses

71
Q

what is secondary amenorrhea

A

pt used to have menses but has missed 3 cycles/6months

72
Q

what are causes of secondary amenorrhea

A

PCOS

asherman’s

pregnancy

thyroid problems

prolactinemia

menopause, ovarian failure, ovarian insenstivity (Savage)

73
Q

what vessles in IP ligament

A

ovarian vessles

74
Q

treatment for endometriosis

A

nsaids

OCPs

progesterone analogs (medroxyprogesterone, levongesterol)

danazol (steroid) (stops LH, FSH peaks)

gonadotropin releasing hormone modulators (decreases estrogen)

surgery

OB Gyn (2 decks)

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