GYN Flashcards
Hypotonic media fluid deficit for hysteroscopy
1000 mL
Redating GA via US <9w
> 5d
Redating GA via US 9w to <16w
> 7d
Redating GA via US 16w to <22w
> 10d
Redating GA via US 22w to <28w
> 14d
Redating GA via US 28w +
> 21d
Septic abortion treatment
Amp/gent/clinda
Covers gram positives, resistant gram neg aerobes, gram neg anaerobes
Ovarian torsion risk factors
Ovarian mass >5 cm
Reproductive age
Pregnancy, ovulation induction
- progesterone supplementation needed until 10w if corpus luteum removed
Adolescents with normal ovaries (46% of cases)
2-12% risk of recurrence
Ovarian torsion ultrasound findings
Edematous ovary (sn 86%, sp 18%)
Heterogeneous appearing (sn 85%, sp 18%)
Peripheral follicles, abnormal location
Decreased doppler flow (sn 85%, sp 37%)
Whirlpool sign of ovarian vessels
Perioperative medication management
Continue: beta blockers, statins, SSRIs, corticosteroids, thyroid hormone
Discontinue: diuretics, ARBs, ACE-I, oral anticoagulation, NSAIDs, herbal supplements
Adjust dosing: insulin
Individualize: aspirin, clopidogrel
Femoral triangle borders
Inguinal ligament
Adductor longus (medial)
Sartorius (lateral)
Contains femoral n/a/v (lateral to medial)
Endometrial ablation relative contraindications
Increased risk of endometrial CA (anovulation, obesity, tamoxifen, Lynch)
Postmenopausal
Patient desires amenorrhea
Myometrial thinning after uterine surgery
Uterine anomalies
Chronic pelvic pain definition, prevalence
Pain lasting 6+ months
6-25% of reproductive aged women
Features of partial mole
69 XXX/XXY
small for dates
hCG <100k
GTN rate 1-5%
Fetal parts present, focal villous edema
+p57 (trophoblast atypia)
Features of complete mole
46 XX
large for dates
Theca-lutein cysts up to 30%
hCG >100k
GTN rate 15-20%
absent fetal parts, widespread villous edema
negative p57 stain
Adnexal mass findings suspicious for malignancy
Multilocular
Papillary excrescences
Solid components
Ascites
Doppler flow
MTX relative contraindications
Cardiac activity
High initial hCG (>5k)
Ectopic >4 cm
Declines blood products
Pre-op labs for htn, diabetes
HTN: BUN/creatinine, + electrolytes if on ACE/ARB/diuretics
DM: serum glucose
Common peroneal nerve injury finding
Footdrop
Caused by incorrect positioning/stirrups
L4-S2
Lateral calf, dorsum foot
Femoral nerve injury finding
Can’t climb stairs, anteromedial thigh numbness
L2-4, quadriceps muscle
Obturator nerve injury finding
Inability to adduct
L2-4, adductor longus
Superomedial thigh
Genitofemoral nerve injury finding
Loss of sensation at vulva/labia majora, anterior superior thigh (or burning)
L1-2, retractor compression
Cell salvage contraindications
Absolute:
- hypotonic fluids (rbc hemolysis), toxic solutions (antibiotics, iodine, alcohol)
- contamination with hemostatic agents or bone cement
Relative:
- Bacterial infection of wound, active malignancy in surgical field
Ilioinguinal nerve injury
Inferior abdominal wall, labia majora, mons
Iliohypogastric nerve injury
Inferior abdominal wall, superolateral gluteal
Tibial nerve injury
Plantar surface of foot
Dermoid cyst characteristics
- Hyperechoic lines (dermoid mesh)
- Rokitansky protuberance
- Solid components with shadowing in background, ie. hair, aka “tip of the iceberg”
- Points - solid components causing hyperechoic points
Indirect inguinal hernia
Most common
Internal inguinal ring (where round ligament/vas deferens exits abdomen); borders include transversalis fascia and inferior epigastric vessels
Direct inguinal hernia
More common in men
Hesselbach triangle; borders include inferior epigastric vessels (laterally), inguinal ligament, rectus fascia
Perineal body components
Superficial transverse perineal
Bulbospongiosus
External anal sphincter
Bladder injury management
- <2mm: expectant management
- 2mm-1cm: expectant or 1-2 layer closure with absorbable suture, foley in place 5=7d
- > 1 cm: 1-2 layer repair
- > 3 cm: 2 layers of delayed absorbable suture, foley in 5-14d
Lidocaine max doses
Without epi: 4mg/kg
With epi: 7mg/kg
Lidocaine toxicity
Oral: metallic taste, circumoral numbness, tongue paresthesias
CNS: change in alertness/restlessness, seizures, tinnitus
Bowel injury management
Superficial sharp/thermal injury: primary oversewing
Partial thickness seromuscular: single layer closure
Full thickness <1 cm: double layer closure
Full thickness >1 cm: primary repair or resection
Large delayed thermal injury: resection, drain, consider diverting ostomy
Surgicel
Oxidized regenerated cellulose
Plant derived
Activates extrinsic coagulation pathway/platelet aggregation
Arista
aka Microporous polysaccharide hemospheres
Absorbs water, concentrates platelets and blood proteins
Plant derived
Only agent approved for arterial bleeding
Gelfoam/surgifoam
aka Gelatin matrix
Absorbs blood and fluid> mechanical hemostasis and matrix for clot formation
Porcine derived
Floseal/surgiflo
aka Thrombin
Bovine/human/recombinant derived
Converts fibrinogen to fibrin
Postoperative fever days 1-2
Wind
Pneumonia, aspiration, atelectasis if <24h
Postoperative fever days 3-5
Water
UTI
Postoperative fever days 4-6
Walking
DVT or PE
Postoperative days 5-7
Wound
Surgical site infection
Postoperative day 7+
Wonder drugs
Drug fever
Pelvic ureter injury management
Within 6 cm of bladder - ureteroneocystostomy preferred
- with or without psoas hitch, consider boari flap
