Gyn Flashcards
Round ligament
allows anteversion of uterus
Broad ligament
contains uterine vessels
Infundibular ligament (IP)
contains ovarian artery, nerve, and vein
Cardinal ligament
holds cervix and vagina
Pregnancy
can see on US at 6 weeks
fetal pole usually seen with bHCG of 6,000
gestational sac seen with bHCG of 1,500
Missed abortion
1st trimester bleeding, closed os, positive sac on US, no heart beat
Threatened
1st trimester bleeding, positive heart beat
Incomplete
tissue protrudes through os
Ectopic
acute abdominal pain; +bHCG, negative US for sac; missed period, vaginal bleeding and hypotension
RFs: previous tubal manipulation, PID, previous ectopic
- significant shock and hemorrhage can occur -
Endometriosis
symptoms: dysmenorrhea, infertility, dyspareunia; can involve rectum and cause bleeding during menses (scope shows blue mass); ovaries most common site
Tx: OCPs
Pelvic Inflammatory Disease
most commonly occurs in first 1/2 of menstrual cycle
Dx: cervical motion tenderness, cervical cultures, Gram stain
Tx: ceftriaxone, doxycycline
Gonococcus - diplococci
Chlamydia - granuloma lypmphadenopathy
Complications: infertility, ectopic
Syphilis
positive dark-field microscopy, chancre
Mittelschermz
rupture of graafian follicle; causes pain that can be confused with appendiciits; occurs 14 days after 1st day of menses
Vaginal cancer
1 primary - squamous cell CA
DES - can cause clear cell CA of vagina
Botryoides - rhabdosarcoma that occurs in young girls
XRT - used for most cancers of vagina
Vulvar cancer
elderly, nulliparous, obese; usually unilateral
- tx: < 2cm (stage I) - WLE and ipsilateral inguinal node dissection; > 2cm (stage II or greater) - vulvectomy with bilateral inguinal dissection, postop XRT if close margins < 1cm
- Pagets VIN III or higher - premalignant
Ovarian cancer
leading cause of gyn death; symptoms: bloating, distension, pelvic pain, pelvic pressure, change in stool habits, change in urinary habits, abnormal vaginal bleeding
- decrease risk with OCPs and b/l tubal ligation
- increase risk with nulliparity, late menopause, early menarche, perineal talc use
Types of ovarian cancer
teratoma; granulosa-theca (estrogen secreting, precocious puberty); Sertoli-Leydig (androgens, masculinization); struma ovarii (thyroid tissues); choriocarcinoma (beta-HCG); mucinous; serous; papillary; clear cell type (worst prognosis)
Staging of Ovarian cancer
Stage I - one or both ovaries only Stage II - limited to pelvis Stage III - spread throughout abdomen Stage IV - distant mets - most common initial site of regional spread is other ovary
Treatment of ovarian cancer
total abdominal hysterectomy and bilateral oopherectomy for all stages; pelvic and para-aortic LN dissection; omentectomy; 4 quadrant washes; chemo cisplatin and paclitaxel (taxol)
Krukenberg tumor
stomach CA that has metastasized to ovary; path shows signet ring cells
Meige’s syndrome
pelvic ovarian fibroma that causes ascites and hydrothorax (excision of tumor cures syndrome)
Endometrial cancer
most common malignant tumor in female genital tract; risk factors: nulliparity, late 1st pregnancy, obesity, tamoxifen, unopposed estrogen; vaginal bleeding in postmenopausal pt is endometrial ca until proved otherwise; uterine polyps have very low change of malignancy (0.1%); serous and papillary subtypes - worst prognosis
Staging and Treatment Endometrial Cancer
Stage I - Endometrium; TAHBSO or XRT
Stage II - Cervix; TAHBSO or XRT
Stage III - Vagina, peritoneum, ovary; TAHBSO and XRT
Stage IV - bladder and rectum; TAHBSO and XRT
Cervical cancer
goes to obturator nodes 1st; assoc with HPV 16, 18; squamous cell CA most common
Staging of Cervical Cancer
Stage I - cervix; TAH
Stage II - upper 2/3 of vagina; IIa TAH; IIB XRT
Stage III - pelvis, side wall, lower 1/3 of vagina, hydronephrosis; XRT
Stage IV - bladder and rectum; XRT
- microscopic disease without basement membrane invasion - cone biopsy (conization)
Treatment of cervical cancer
- microscopic disease without basement membrane invasion: cone biopsy (conization)
- stage I and IIa: total abdominal hysterectomy (TAH)
- stages IIb to IV: XRT
Ovarian cysts postmenopausal patient
- if septated, has increase vascular flow on Doppler, has solid components, or has papillary projections –> oophorectomy with intraoperative frozen sections; TAH if ovarian cancer
- if none of above are present, follow with ultrasound for 1 year –> if persists or gets larger –> oophorectomy with intraoperative frozen sections; TAH if ovarian cancer
Ovarian cysts premenopausal patient
- if septated, has increase vascular flow on doppler, has solid components, or has papillary projections –> oopherectomy with intraoperative frozen sections (algorithm very complicated after this, weighing how aggressive the cancer is compared with desire for future pregnancy)
- if none of above are present, can follow with US; surgery if suspicious findings appear
Incidental ovarian mass at time of laparotomy for another procedure (postmenopausal patient)
*oopherectomy, frozen section, TAH, BSO if ovarian cancer at time of initial surgery
Incidental ovarian mass at time of laparotomy for another procedure (premenopausal patient)
*much more complicated; likely will need partial oophorectomy and frozen section; if cancer removal of tube and ovary (need to have gyn look at this); then determine whether patient wants children, if not go with TAH (usually at second procedure)
Abnormal uterine bleeding < 40 y old
anovulation; tx medroxyprogesterone; if leiomyomas tx with GnRH
Abnormal uterine bleeding > 40 y old
cancer or menopause; need biopsy
contraindications to estrogen therapy
endometrial cancer, active thromboembolic disease, undiagnosed vaginal bleeding, breast cancer
Uterine endometrial polyp
can present as progressively heavier menses
Uterine fibroids (leiomyomas)
under hormonal influence; recurrent abortions, infertility, and bleeding
most common vaginal tumor
invasion from surrounding or distant structure
appendicitis with pregnancy
increase risk of premature labor and fetal mortality
hydatidiform mole
malignancy risk with partial mole; complete mole is of paternal origin; tx: chemo (methotrexate)
Toxic shock syndrome
fever, erythema, diffuse desquamation, nausea, vomiting; associated with highly absorbent tampons
Ovarian torsion
tx: remove torsion and check for viability
adnexal torsion with vascular necrosis
tx: adnexectomy
ruptured tuboovarian abscess
tx: drainage
ovarian vein thrombosis
dx: CT scan; tx: heparin
Postpartum pelvic thrombophlebitis
tx: heparina and antibiotics
