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Advanced Principles > GYN Surgery > Flashcards

GYN Surgery Flashcards

1
Q

What does a D&C consist of?

A

Removal of uterine contents or uterine lining by scraping with a thin medal rod or suction

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2
Q

What two drugs can be given to help relax the uterus for a D&C?

A

Terbutaline and NTG

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3
Q

What utertonic drug is a naturally produced hormone?

A

Oxytocin

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4
Q

Where is Oxytocin produced and how is it released into circulation?

A

Produced in the hypothalamus or haring bodies of the posterior pituitary gland
Released by the posterior lobe of the pituitary gland

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5
Q

What are the uses for utertonic drugs?

A

Prevent/treat postpartum hemorrhage
Ripen cervix and induce labor
Manage incomplete or elective abortions

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6
Q

What is the dose of Hemebate?

A

250mcg IM

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7
Q

What is the dose of Methergine?

A

0.2mg

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8
Q

Why is it important not to administer Methergine IV?

A

Can cause extreme HTN

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9
Q

What is the only FDA approved abortion pill?

A

RU486 Mifeprex

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10
Q

What is the limit to take Mifeprex?

A

Must be taken within the first 49 days of pregnancy

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11
Q

When is a D&C typically performed?

A

Between 6-12weeks of pregnancy

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12
Q

When is a D&E performed?

A

Between 12-24 weeks of pregnancy

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13
Q

Why is a conization of the cervix typically performed?

A

Diagnosis of squamous or glandular intraepithelial lesions

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14
Q

What methods can be used for a conization of the cervix?

A

Scalpel (cold-knife)
Laser
Electrosurgical excision loop (LEEP)
Large loop excision of the transformation zone (LLETZ)

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15
Q

What method of conization will give the cleanest specimen?

A

Scalpel (cold-knife), but requires GA

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16
Q

Why do some surgeons prefer GA for conization of the cervix when it can be under regional?

A

It minimizes the potential for patient movement and hence thermal injury

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17
Q

What is the purpose of injecting fluids into the uterus for a hysteroscopy?

A

To help expand the uterus and allow for better visualization

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18
Q

Why is it so important to monitor fluid deficits after dilation of the uterus has been done with a hypotonic solution?

A

Water intoxication
Fluid overload
Electrolyte abnormalities

19
Q

How many liters usually have to be absorbed for S/S to appear?

A

Usually greater than 2L

20
Q

What are early signs and symptoms seen with water toxicity?

A

HTN
Dyspnea
EKG changes
Dilutional Hyponatremia

21
Q

How should the provider proceed with treating water toxicity?

A

Restrict IVF, high salt diet and may need diuretic

22
Q

As a general rule, how much does serum Na levels decrease by for every liter of hypotonic fluid absorbed?

A

Decreases by 10mmol/L

23
Q

What are the three types of tubal ligation?

A

Banded
Cauterized
Tied and cut

24
Q

Where is the most common place for an ectopic pregnancy?

A

Fallopian tube

25
Q

What is the second leading cause of maternal mortality?

A

Ruptured Ectopic pregnancy

26
Q

Where can referred pain be felt if a ruptured ectopic pregnancy occurs?

A

Shoulder pain from blood leaking up and irritating the diaphragm

27
Q

What is the second most common surgery performed on women of child bearing age?

A

Hysterectomy

28
Q

What are the three types of laparoscopic hysterectomies?

A

Total laparoscopic hysterectomy
Laparoscopically assisted vaginal hysterectomy
Robot assisted laparoscopic hysterectomy

29
Q

What are advantage to a laparoscopic hysterectomy versus an open?

A

Less pain
Shorter hospital stay/recovery
Smaller incision/less risk of infection

30
Q

What situations is an open hysterectomy best to in?

A

Large tumors and Cancer

31
Q

What does a radical hysterectomy consist of?

A

Removal of the uterus, cervix, ovaries, fallopian tubes, upper vagina, parametrium and pelvic lymph nodes

32
Q

Why might a surgeon request indigo carmen during a hysterectomy?

A

To help identify if an injury has occurred and its location

33
Q

What symptoms does a woman typically have if a myomectomy is required?

A

Heavy bleeding
Pelvic pain
Anemia

34
Q

What surgical history would be of concern to the provider that is taking care of a laboring mother?

A

Previous myomectomy can cause uterine rupture

35
Q

What is the most accurate method of assessing disease status in ovarian cancer?

A

Second look laparotomy

36
Q

What procedure is performed to determine extent of cancer?

A

Staging laparotomy

37
Q

What does a radical vulvectomy consist of?

A

Removal of the groin tissue and entire vulva
deep fascia of the thigh, periosteum of pubis, and inferior fascia of urogenital diaphragm, medial thigh, groins, and lower abdomen; resection of the inguinal and often pelvic lymph nodes

38
Q

What age range is vulvar cancer most common?

A

Women older than 60 years of age

39
Q

What is a pelvic exenteration?

A

Remove all cancer tissue from the pelvis and create a

surgical diversion for urine and stool

40
Q

How is urine eliminated after a pelvic exenteration?

A

Urostomy

41
Q

What causes an increase incidence of renal disease postop pelvic exenteration?

A

UTI and Obstruction

42
Q

What is one of the most common complaints with GYN surgeries?

A

PONV

43
Q

What interventions can be done to reduce baseline risk of PONV?

A 
Consider regional anesthesia
Gastric suctioning prior to extubation
IV hydration
Avoid HoTN
Minimize opioids
44
Q

What adverse effect is the lithotomy position associated with?

A

Compartment syndrome

Advanced Principles (16 decks)

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