GYN Flashcards
What are the causes of pelvic relaxation/pelvic organ prolapse?
- Loss of support
- -Birth trauma (older women who have had multiple children)
- -Chronic elevations of intra-abdominal pressure (obesity, chronic cough, or repetitive heavy lifting)
- -Intrinsic weakness
- -Atrophic changes cause by aging or estrogen loss - Genetic
What are the manifestations of pelvic relaxation/pelvic organ prolapse?
- Urethrocele or urethral detachment
- Cystocele
- Rectocele
What are the clinical presentations of pelvic relaxation/pelvic organ prolapse?
- Pressure and heaviness low in the abdomen or pelvis
- Backache
- Dyspareunia (difficult or painful sexual intercourse)
- Urinary incontinence, frequency, hesitancy, incomplete voiding
- Recurrent UTI
- Constipation (loss of rectal support)
- Painful incomplete defecation
True or False: The degree of incontinence directly correlates with the degree of pelvic relaxation.
False
What is the mechanism of urinary incontinence?
There is unequal transmission of intra-abdominal pressure to the bladder and urethra.
What is the mechanism of stress incontinence?
Bladder pressure exceeds urethral pressure at times of stress or strain.
What are the nonsurgical treatments of pelvic relaxation/pelvic organ prolapse?
- Bladder training and biofeedback
- Medical therapy (drugs)
- Kegel exercises
What drugs can be used in medical therapy for pelvic relaxation/pelvic organ prolapse?
- Anticholinergics
- Beta agonists
- Dopamine agonists
- Antidepressants
Knowledge of what female aspect is critical in GYN surgical population?
Menstrual cycle
Why are many GYN procedures very bloody?
Uterus is very vascular and blood loss can happen very quickly
Cystocele is what?
When bladder is prolapsing into vagina
What is a rectocele?
When rectum is lapsing into vaginal wall
How does urine flow occur?
When pressure inside bladder exceeds pressure in urethra
What are options for surgical treatment of pelvic relaxation and prolapse ?
-- Anterior vaginal wall repair === Support to bladder and urethra -- Retropubic suspension procedure === Repairs defects in endopelvic fascia -- Sling procedure === Replaces support of bladder neck and urethra
What is a presence of endometrial tissue in extrauterine locations?
Endometriosis
At what age is endometriosis most likely to occur?
20’s and 30’s
What is the most widely accepted cause of endometriosis?
Retrograde menstruation
Where is the most common site that endometriosis is found?
Ovaries (60%)
What are some symptoms of endometriosis?
- Dysmenorrhea
- Dyspareunia
- Infertility (may be only sign)
- Abnormal bleeding (only occurs 1/3 of time)
- Pelvic pain
What does endometriosis have to be distinguished from and how is this done?
– Distinguished from pelvic inflammatory disease
– Direct visualization during diagnostic laparoscopy or laparotomy
What is medical treatment for endometriosis?
- Combined estrogen and progestin oral contraceptives
- - Gonadotropin-relasing hormone agonist
What is surgical treatment for endometriosis?
- CONSERVATIVE: Excision, cauterization, or ablation of lesions
- DEFINITIVE : Total abdominal hysterectomy with bilateral salpingo-oophorectomy
What are the benign tumors that are caused by estrogen production and effects around 30% of women?
Leiomyoma (fibroids)
What much fibroids be distinguished from because they resemble a pelvic mass?
Distinguished from pregnancy
What are symptoms of leiomyomas?
- Pain most likely from dysmenorrhea
- Bleeding (most common symptom) from increased amount and duration of flow during menorrhagia
- Pressure symptoms related to size and number of tumors
What is torsion of a pedunculated myoma?
– When the myoma has a stock that is twisted and cuts off blood supply to that area, resulting is very acute, tremendous pain
What is the diagnosis of leiomyomas performed?
– Clinical exam
=== Abdominal palpation
– Direct visualization via hysteroscopy
How is the degree of enlargement stated when dealing with leiomyomas?
In terms used to estimate equivalent gestational size of a baby
T or F: The majority of patients who have fibroids do not require surgery
TRUE
What are 2 surgical options for fibroids?
- Myomectomy for younger patients who are still in childbearing years
- Hysterectomy for women who have completed childbearing
What is the most common indication for a hysterectomy?
Leiomyomas (fibroids)
What is the most common type of GYN cancers?
Cervical cancer
What is the classical presentation of cervical cancer?
There is no classic presentation but symptoms may include abnormal bleeding or postcoital bleeding
What is the identifiable precursor lesion that identifies cervical cancer and how is it obtained?
What – Cervical intraepithelial neoplasia (CIN) is precursor
– PAP smear check CIN
What are the treatments for cervical cancer?
- Cryotherapy: ablation / freezing to prevent progression
- Loop electrosurgical excision procedure (LOOP) : cone biopsy/excision
- Radical hysterectomy w/ removal of lymph nodes
- Radiation therapy for patients with higher stages of disease or poor surgical candidates
What is the type of cancer that is most considered in post-menopausal women with progressive uterine enlargement?
Uterine cancer (leiomyosarcoma)
What are 3 risk factors associated with uterine cancer?
- Obesity
- DIabetes
- HTN
What is the 2nd most common GYN cancer?
Endometrial cancer
What is most common indication of endometrial cancer?
Abnormal bleeding
What is definitive treatment for endometrial cancer?
TAH with bilateral salpingo-oophorectomy
Which GYN cancer has highest mortality rate?
Ovarian cancer
What is unique to ovarian cancer that has to do with what age the woman contracts the disease?
– Ovarian cancers in reproductive age are benign
– Ovarian tumors in postmenopausal women are malignant 1/4 of time
What gynecologic procedure use high-frequency sound reflections to identify body tissues and structures and is safe during pregnancy?
Ultrasonography
What is procedure called that calls for contrast material to put through cervix into uterine cavity and has x-rays taken at intervals to ensure a patent pathway for the egg to travel?
Hysterosalpingography
What is the procedure called that uses a fixed microscope to evaluate the surface of cervix, vagina, and vulva?
Colposcopy
What is a D & C?
Dilation and curettage
- Dilation opens the cervix to allow access to endometrial cavity
- Curettage is scraping of uterine lining
What is a D & E?
Dilation and evacuation
– Abortion
What is the specific marker used to test for pregnancy?
Human chorionic gonadotropin (hCG)
levels are directly correlated with gestational age
Why are urine tests not as reliable for detecting pregnancy?
- Vary in sensitivity
- - May be positive by day 25 after last menstrual period
Who gets pregnancy tested before surgery?
All women of childbearing age
