Chapter 40 - Gynecology Flashcards
What does the round ligament do?
Allows for anteversion of the uterus
What does the broad ligament contain?
Uterine vessels
What does the infundibular ligament contain?
Ovarian artery, nerve, vein
What does the cardinal ligament do?
Holds cervix and fun box
When can you see pregnancy on ultrasound?
Six weeks
With what beta hCG is a fetal pole seen?
6000
At what hCG is a gestational sac seen?
1500
What is a missed abortion?
First trimester bleeding, closed os positive second ultrasound, no heartbeat
What is a threatened abortion?
First trimester bleeding, positive heartbeat
What is a incomplete abortion
Tissue protrudes through os
What is an ectopic pregnancy?
Acute abdominal pain; positive beta hCG, negative ultrasound for sac; missed period, Vaginal bleeding, hypotension
What are risk factors for ectopic pregnancy?
Previous tubal manipulation, PID, previous ectopic pregnancy. Shock and hemorrhage can occur from the ectopic pregnancy
What are the symptoms of endometriosis and how is it diagnosed?
Dysmenorrhea, infertility, despareuinia Laparoscopy shows blue mass
What are the symptoms of pelvic inflammatory disease?
Pain, nausea, vomiting, fever, vaginal discharge. Most commonly occurs in the first half of the menstrual cycle
Risk factors include whoring it up
Cervical motion tenderness, cervical cultures, Gram stain
What is mittelschmerz?
Rupture of graafian follicle. Causes pain that can be confused with appendicitis. Occurs 14 days after first day of menses
What is the number one type of vaginal cancer?
Squamous cell carcinoma. DES can cause clear cell carcinoma
What is botryoides?
Rhabdomyosarcoma of the vagina that occurs in young girls
Xrt
What are risk factors for vulvar cancer?
Old, fat, nulliparous
TX: less than 2 cm wide local excision and ipsilateral inguinal node dissection. Greater than 2 cm vulvectomy with bilateral inguinal dissection, postop XRT
What is the leading cause of gynecologic death?
Ovarian cancer. Decreased risk with OCP’s and bilateral tubal ligation. Increased risk with nulliparity, late menopause, early monarchy
What are the types of ovarian cancer?
Teratoma, granulosa theca, Sertoli leydig storms ovarii, choriocarcinoma, mucinous, serous papillary
What type of ovarian cancer has the worse prognosis?
Clear-cell
What stage ovarian cancer is bilateral ovaries?
One
What is the most common initial site of regional spread of ovarian cancer?
The other ovary
What is the treatment for ovarian carcinoma?
Total abdominal hysterectomy and bilateral oophorectomy for all stages. Pelvic and a para aortic lymph node dissection. Omentectomy, four quadrant washes
What is the chemotherapy for ovarian cancer?
Cisplatin and paclitaxel
What is the stomach cancer that has metastasized to ovary? What is shown on pathology?
Krukenberg tumor. Pathology shows signet rings
What is meige’s syndrome?
Pelvic ovarian fibroma that causes ascites and hydrothorax
What is the most common malignant tumor in female genital tract?
Endometrial cancer
What are the risk factors for endometrial cancer?
Nulliparity, late first pregnancy, obesity, tamoxifen, unopposed estrogen
What is vaginal bleeding in postmenopausal woman until proven otherwise?
Endometrial cancer
What subtypes of endometrial carcinoma have worse prognosis?
Serous and papillary
What nodes does cervical cancer go to first?
Obturator nodes
What types of HPV are associated with cervical cancer?
16 and 18
What is the most common type of cervical cancer?
Squamous cell
How do you cervical carcinoma?
Stage 1 and 2A-total abdominal hysterectomy. Stages 2-4 xrt
Where the stages of cervical cancer?
One cervix
Two upper two thirds of vagina
Three pelvis, sidewall, lower one third of vagina, hydronephrosis
Four bladder and rectum
What do you do with ovarian cysts in a post menopausal patient
If septated, has increased vascular flow on Doppler, has solid components, or has papillary projections-oophorectomy with intraoperative frozen sections; TAH if ovarian CA
What do you do with ovarian cyst in a premenopausal patient?
If septated, has increased vascular flow on Doppler, has solid components, or has papillary projections-oophorectomy with intraoperative frozen sections
What do you do with an incidental ovarian mass at the time of laparotomy for another procedure?
Postmenopausal-oophorectomy, frozen section, TAH and BSL if ovarian CA
Premenopausal patient-complicated
What do you do with abnormal uterine bleeding in a patient under 40?
Usually from anovulation. Treat with Medroxyprogesterone. If leiomyomas-GnRH
What do you do with abnormal uterine bleeding in a patient older than 40?
Usually from cancer or menopause-need biopsy
What are contraindications to estrogen therapy
Endometrial cancer, active thromboembolic disease, Undiagnosed vaginal bleeding, breast cancer
What can a uterine endometrial polyp present as?
Progressively heavier menses
What is caused by uterine fibroids?
Recurrent abortions, infertility, bleeding
Under hormonal influence.
What is the most common vaginal tumor?
Invasion from surrounding or distant structure
Appendicitis with pregnancy causes what?
Increased risk of premature labor and fetal mortality
What is a hydatidiform mole?
Malignancy risk with partial mole; complete mole is of paternal origin. Treat with methotrexate
What do you get with toxic shock syndrome?
Fever, erythema, diffuse desquamation, nausea, vomiting. Associated with highly absorbent tampons (gag).
What do you do with ovarian torsion?
Remove torsion and check for viability
What do you do with adnexal torsion with vascular necrosis?
Adnexectomy
What do you do with ruptured tubo-ovarian abscess?
Drainage
How do you diagnose ovarian vein thrombosis?
CT scan. Treat with heparin
What do you do with postpartum pelvic thrombophlebitis?
Heparin and antibiotics
