Gynecological and Obstetrical Surgery (Chapter 24 and 34)-Part 1 Flashcards
Focuses on the treatment and prevention of disease affecting the female reproduction system
Gynecological and Reproductive Surgery
Fertility medicine combines _____ and _____ to achieve and maintain pregnancy
gynecology and endocrinology
_____ relates to the process of pregnancy and birth (parturition)
Obstetrics
What houses and protects the fetus during pregnancy?
uterus
The superior (upper) portion of the uterus is called the _____ and lies above the insertion of the _____.
fundus
fallopian tubes
The middle portion of the uterus is called the _____.
body
The lower portion of the uterus is the _____.
cervix
The uterus lies between the _____ and the _____.
the bladder anteriorly and the sigmoid colon posteriously
What is capable of expansion to accommodate a growing fetus?
uterus
In the uterus much of the of the corpus consists of _____ called the _____ and composed of _____ layers.
involuntary muscle
myometrium
three
The inner layer of the uterine corpus prevents _____ into the tubes of peritoneal cavity, which could result in endometriosis.
reflux of menstrual flow
The inner layer of the uterine corpus also contributes to the competency of the _____ to prevent premature expulsion of the fetus.
internal os sphincter
Middle layer of the uterine corpus encloses _____.
large blood vessels
The muscle fibers of the middle layer of the uterine corpus act as living ligatures for _____ after delivery.
hemostasis
The outer layer of the uterine corpus has _____ action, ejecting _____, _____, or the _____.
expulsion
menstrual flow and clots
an aborted embryo
fetus at term
Which uterine ligaments suspend the uterus from the pelvic wall?
broad ligaments
The broad ligaments are composed of a broad _____ extending from each lateral surface of the uterus to the pelvic wall.
double sheet of peritoneum
Which uterine ligaments help suspend the uterus anteriorly and are located above the broad ligaments, near the fallopian tubes.
round ligaments
The round ligaments are _____ that extend from the anterior surface of the lateral borders of the fundus to the labia majora.
fibrous muscular bands
Which uterine ligaments provide the primary support for the uterus and are located below the broad ligaments.
cardinal ligaments
The _____ are attached to the lateral vaginal fornices and supravaginal portion of the cervix.
cardinal ligaments
The cardinal ligaments act as a _____.
supportive pivot
Which uterine ligaments attach the uterus to the sacrum and curve along the bottom of the uterus?
uterosacral ligaments
The uterosacral ligaments are peritoneal folds containing _____ and _____.
connective tissue and involuntary muscle
_____ secrete the female hormones.
ovaries
The ovaries lie on each side of the _____.
uterus in the upper portion of the pelvic cavity
The ovaries are suspended by the _____, or peritoneal tissue attached to the uterus by ovarian ligaments.
mesovarium
Development and release of the ova are influenced by the pituitary gland, which stimulates the gonadotropic hormones _____ and _____.
luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
The clitoris is a highly _____ that contains sensitive _____.
vascular organ
erectile tissue
What is the female erectile organ composed of bilateral cavernosa and a glans?
clitoris
The clitoris the female homolog to the _____.
penis
The perineum is located between the _____ and the _____.
posterior vaginal wall and the anus
Incision into the perineum exposes the strong _____ and _____ of the _____.
connective tissue and muscles
pelvic floor
What may be incised during the second stage of labor to prevent tearing?
perineum
Characterized by hormonal and physical changes that occur regularly from the onset of menarche (menstrual periods) until menopause (cessation of natural childbearing).
Ovarian (menstrual) cycle
The ovarian (menstrual) cycle is approximately _____ long.
28 days
The ovarian (menstrual) cycle has _____ distinct phases.
3
The _____ of the ovarian (menstrual) cycle lasts from day 1 to day 14.
follicle phase
The _____ of the ovarian (menstrual) cycle begins approximately 14 days from the start of the cycle and lasts from 16 to 32 hours.
ovulatory phase
During the ovulatory phase, the _____, and _____ is secreted by the follicle (the corpus lutem [CL]) and causes the release of the ovum.
estrogen level falls, and progesterone
The ovum is picked up by the _____ to enable fertilization
fimbriae of the fallopian tubes
The _____ of the ovarian (menstrual) cycle begins approximately on day 16 and lasts approximately 12 days.
luteal phase
After ovulation, the corpus luteum secretes _____ and _____.
estrogen and progesterone
What are Bartholin gland abscess?
infection of a Bartholin gland may occur if the gland is obstructed
What is the most common and easily treated cancer of the reproductive tract with early diagnosis?
Cervical cancer
What may be associated with HPV types 16, 18, 31, and 33?
Cervical cancer
Early detection of cervical cancer is done with a _____, _____, and _____.
Pap smear, cervicography, and culposcopy.
Associated with obesity and high levels of circulating estrogen.
Endometrial cancer
Endometrial tissue develops anywhere outside the uterus, most often on the abdominal viscera.
Endometriosis
Endometriosis is most often on the _____.
abdominal viscera
During _____ tissue remains responsive to hormonal changes and causes pain, bleeding, and scarring
endometriosis
Fibroid tumor, benign neoplasm arising from the uterine smooth muscle tissue, attached to the uterine body and develops in any of the tissue layers.
Leiomyoma
Persistent or bleeding ovarian follicle that fails to regress after ovulation can become cystic.
Ovarian cyst
Condition caused by herniation of the rectum into the vaginal wall.
rectocele
Condition caused by herniation of the bladder into the vaginal wall.
cystocele
An _____ occurs when a weakness of the uterosacral ligaments allow the intestine to bulge into the vaginal vault.
Enterocele
Weakness and stretching of the cardinal ligaments, the uterus bulges into the vagina.
Uterine prolapse
Implantation of the embryo outside the uterine cavity is an emergency that requires immediate surgical intervention to prevent rupture and hemorrhage.
Ectopic (extrauterine pregnancy)
Includes routine blood tests and serum CA-125 test (tumor marker blood test).
preoperative malignancy screening
During a preoperative malignancy screening _____ can provide a further means of assessment
laparoscopy
Commonly used to assess the reproductive system and the stages of pregnancy.
pelvic or transvaginal ultrasound
New technique that provides greater clarity of ultrasonic images.
Sonohysterography
During a sonohysterography _____, _____, or _____ is injected into the uterine cavity through a small transcervical catheter before ultrasound testing.
normal saline, lactated Ringer solution, or 1.5% glycine
Imaging technique that safer, painless, and does not require exposure to radiation.
Sonohysterography
During a _____ a. Radiological contrast medium is injected into the uterus and fallopian tubes.
Hysterosalpingography (HSG)
Used to screen for cervical cancer.
Papanicolaou (Pap) test
During a Papanicolaou (Pap) test superficial _____ are collected from the _____ with a delicate plastic “brush,” the brush is then swirled in _____, which is used to prepare a series of miscroscope slides
endocervical (epithelial) cells
internal cervical os
prep solution
Microscopic examination and biopsy of the cervix.
Colposcopy
During a colposcopy, the _____ is painted with _____, which causes preinvasive cells to appear _____, these areas are biopsied with forceps.
cervix
acetic acid
white
Used to treat epithelial carcinoma of the cervix or severe dysplasia (abnormal cells).
cone biopsy of the cervix
A _____ involves the removal of a circumferential core of tissue around the cervical canal.
cone biopsy of the cervix
The _____ performed using a local anesthetic and an electrosurgical loop filament; the technique is referred to as a _____.
cone biopsy of the cervix
loop electrosurgical excision procedure (LEEP)
LEEP can be done during _____ in the outpatient setting.
culposcopy
During a _____, a semirigid or rigid hysteroscope is used to examine the interior of the uterus and to perform selective operative procedures.
hysteroscopy
During a hysteroscopy, the uterus is filled with a _____ to increase visibility.
clear fluid
Most gynecological procedures are performed with the patient in the _____ or _____ position.
supine or lithotomy
In the lithotomy position, protect the patient’s _____ and _____ at all times, even when patient is anesthetized
modesty and dignity
In the lithotomy position, all patients must wear _____ or a _____.
antiembolism stockings or a sequential pressure device
When the patient is placed in the lithotomy position, raise both legs simultaneously and slowly into the stirrups—this requires _____, no exceptions.
two people
In the lithotomy position, make sure hips are slightly _____; at no time should the knees or hips be allowed to drop laterally, because this can dislocate the knees or avulse the hip joint.
externally rotated
In the lithotomy position, raise or lower the patient’s legs only after the _____ has advised it is safe; placing patient in lithotomy position may cause changes in _____.
anesthesia care provider
blood pressure
In the lithotomy position, when operating the _____, make sure patient’s hands are not near the break.
lower table break
In the lithotomy position, when lowering the legs from the stirrups, follow the same procedure as for raising them; _____ are required, and must be performed slowly to prevent injury.
two people
During _____, the scrub is in an awkward position.
vaginal procedures
Skin prep and draping usually includes both _____ and _____ prep with insertion of a _____.
abdominal and vaginal
Foley catheter
A _____ is inserted after the vaginal prep for selected laparoscopic procedures.
uterine manipulator (internal cervical retractor)
When prepping, the _____ is performed first; this is to prevent possible _____ from splashed droplets during perineal prep.
perineal prep
contamination of the abdomen
During prep, always prepare the two sites _____, not _____
sequentially
simultaneously
During prep, a separate _____ and _____ are required for each site
prep kit and gloves
Procedures of the _____ require atraumatic graspers and delicate dissecting instruments; a bipolar electrosurgical unit (ESU) is used rather than a monopolar type.
fallopian tubes
_____ are used to anastomose the fallopian tubes.
microinstruments
Open _____ of the _____ require a general surgery setup with uterine clamps, plus additional atraumatic clamps (Babcock forceps and vascular forceps) for handling the fallopian tubes, ovaries, and bowel; long instruments are needed for patients who are deep bodied and for deep pelvic procedures; harmonic shears and a high-frequency (HF) vessel-sealing system often are used during uterine surgery.
gynecological procedures
pelvic cavity
_____ require vaginal speculums and long instruments, including uterine clamps and heavy dissecting scissors.
Transvaginal pelvic procedures
_____ require graduated cervical dilators, uterine sounds, forceps, sharp and smooth curettes, and an ample supply of sponges; suction and monopolar ESU of HF bipolar electrosurgical unit are needed for all procedures.
Transcervical procedures
Many reproductive drugs are available to control _____, _____, and _____.
fertility, hormonal dysfunction, and diseases of the reproductive system
_____ are used to identify and trace anatomical structures during assessment.
Colored dyes
Used during a hysterosalpingogram to verify the patency of the fallopian tubes.
Methylene blue dye
Used during culposcopy to reveal areas of abnormal cervical tissue
Acetic acid (Monsel solution)
Used during culposcopy for staining the cervix during the Schiller test.
Lugol solution
Causes constriction of blood vessels when injected.
Vasopressin (Pistressin)
Used in emergency cardiac response.
Vasopressin (Pistressin)
May be injected into the uterus during hysterectomy or into a benign uterine tumor to prevent bleeding during removal.
Vasopressin (Pistressin)
Drugs that enhance _____ are given during labor and after cesarean section and abortion.
uterine contractility
Administered after delivery of the fetus and placenta to prevent postpartum hemorrhage.
Oxytocin (Pitocin)
An ergot alkaline that is administered after abortion to enhance uterine contractions and control uterine bleeding.
Methylergonovine (Methergine)
Sutures for uterine ligaments and vessels.
absorbable synthetic 0 to 2-0 taper needle
Sutures for bladder reflection.
absorbable synthetic 2-0 to 3-0 small taper needle
Sutures for ovary.
absorbable synthetic 3-0 to 4-0 small taper needle
Sutures for fallopian tube repair/anastomosis.
inert monofilament or braided 5-0 to 7-0
Sutures for vaginal vault.
absorbable synthetic 2-0 to 3-0 medium curved needle
Sutures for plastic procedures of the vulva.
Nylon, Prolene, or other monofilament, 3-0, 4-0; 3/8 cutting needle
