GYN Surgery Flashcards
What does a D&C consist of?
Removal of uterine contents or uterine lining by scraping with a thin medal rod or suction
What two drugs can be given to help relax the uterus for a D&C?
Terbutaline and NTG
What utertonic drug is a naturally produced hormone?
Oxytocin
Where is Oxytocin produced and how is it released into circulation?
Produced in the hypothalamus or haring bodies of the posterior pituitary gland
Released by the posterior lobe of the pituitary gland
What are the uses for utertonic drugs?
Prevent/treat postpartum hemorrhage
Ripen cervix and induce labor
Manage incomplete or elective abortions
What is the dose of Hemebate?
250mcg IM
What is the dose of Methergine?
0.2mg
Why is it important not to administer Methergine IV?
Can cause extreme HTN
What is the only FDA approved abortion pill?
RU486 Mifeprex
What is the limit to take Mifeprex?
Must be taken within the first 49 days of pregnancy
When is a D&C typically performed?
Between 6-12weeks of pregnancy
When is a D&E performed?
Between 12-24 weeks of pregnancy
Why is a conization of the cervix typically performed?
Diagnosis of squamous or glandular intraepithelial lesions
What methods can be used for a conization of the cervix?
Scalpel (cold-knife)
Laser
Electrosurgical excision loop (LEEP)
Large loop excision of the transformation zone (LLETZ)
What method of conization will give the cleanest specimen?
Scalpel (cold-knife), but requires GA
Why do some surgeons prefer GA for conization of the cervix when it can be under regional?
It minimizes the potential for patient movement and hence thermal injury
What is the purpose of injecting fluids into the uterus for a hysteroscopy?
To help expand the uterus and allow for better visualization
Why is it so important to monitor fluid deficits after dilation of the uterus has been done with a hypotonic solution?
Water intoxication
Fluid overload
Electrolyte abnormalities
How many liters usually have to be absorbed for S/S to appear?
Usually greater than 2L
What are early signs and symptoms seen with water toxicity?
HTN
Dyspnea
EKG changes
Dilutional Hyponatremia
How should the provider proceed with treating water toxicity?
Restrict IVF, high salt diet and may need diuretic
As a general rule, how much does serum Na levels decrease by for every liter of hypotonic fluid absorbed?
Decreases by 10mmol/L
What are the three types of tubal ligation?
Banded
Cauterized
Tied and cut
Where is the most common place for an ectopic pregnancy?
Fallopian tube
What is the second leading cause of maternal mortality?
Ruptured Ectopic pregnancy
Where can referred pain be felt if a ruptured ectopic pregnancy occurs?
Shoulder pain from blood leaking up and irritating the diaphragm
What is the second most common surgery performed on women of child bearing age?
Hysterectomy
What are the three types of laparoscopic hysterectomies?
Total laparoscopic hysterectomy
Laparoscopically assisted vaginal hysterectomy
Robot assisted laparoscopic hysterectomy
What are advantage to a laparoscopic hysterectomy versus an open?
Less pain
Shorter hospital stay/recovery
Smaller incision/less risk of infection
What situations is an open hysterectomy best to in?
Large tumors and Cancer
What does a radical hysterectomy consist of?
Removal of the uterus, cervix, ovaries, fallopian tubes, upper vagina, parametrium and pelvic lymph nodes
Why might a surgeon request indigo carmen during a hysterectomy?
To help identify if an injury has occurred and its location
What symptoms does a woman typically have if a myomectomy is required?
Heavy bleeding
Pelvic pain
Anemia
What surgical history would be of concern to the provider that is taking care of a laboring mother?
Previous myomectomy can cause uterine rupture
What is the most accurate method of assessing disease status in ovarian cancer?
Second look laparotomy
What procedure is performed to determine extent of cancer?
Staging laparotomy
What does a radical vulvectomy consist of?
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
What age range is vulvar cancer most common?
Women older than 60 years of age
What is a pelvic exenteration?
Remove all cancer tissue from the pelvis and create a
surgical diversion for urine and stool
How is urine eliminated after a pelvic exenteration?
Urostomy
What causes an increase incidence of renal disease postop pelvic exenteration?
UTI and Obstruction
What is one of the most common complaints with GYN surgeries?
PONV
What interventions can be done to reduce baseline risk of PONV?
Consider regional anesthesia Gastric suctioning prior to extubation IV hydration Avoid HoTN Minimize opioids
What adverse effect is the lithotomy position associated with?
Compartment syndrome
