Gynecology Pathophysiology and Anesthesia Flashcards
What are important preoperative considerations for gynecology procedures? (6)
- Malignancy
- Fertility
- Sexual function
- Mentrual cycle
- Surgical bleeding
- Positioning
What can cause pelvic relaxation/pelvic organ prolapse? (8)
- birth trauma
- increased intra-abdominal pressure
- obesity
- chronic cough
- heavy lifting
- weakness
- atrophy by aging or estrogen loss
- genetics
How does pelvic organ prolapse present in the patient? (3)
Manifestations
- Urethrocele or urethral detachment
- Cystocele
- Rectocele
What does this depict?
cystocele
Note: Rectocele is depicted on this side of the card for reference.
KNOW
How does cystocele/rectocele (pelvic prolapse) present? (7)
- “Pressure” and “heaviness” low in the abdomen or pelvis
- Painful defecation
- Backache
- Dyspareunia–painful sexual intercourse
- Urinary incontinence, frequency, incomplete voiding
- Recurrent UTI
- Constipation
What are nonsurgical treatments for pelvic relaxation and prolapse? (3)
Bladder training and biofeedback
Drugs
- Anticholinergics
- Beta agonists
- Dopamine agonists
- Antidepressants
Exercises (Kegels)
What are surgical treatments for pelvic relaxation and prolapse?
Anterior vaginal wall repair–provides support to the bladder and urethra by reinforcing the endopelvic fascia and vaginal epithelium
Retropubic suspension
Sling procedure–supplement/replace support of the bladder neck and urethra using suture or slings
What is endometriosis?
Presence of endometrial tissue in extrauterine locations
Note: Red = common sites of endometriosis
Endometriosis is commonly described in women who are in their ___’s and ___’s.
20’s and 30’s
Where is endometriosis commonly found? (5)
Pouch of Douglas
Round ligament
Ovaries (60%)
Fallopian tubes
Sigmoid colon
Where is endometriosis LESS commonly found? (3)
Surgical scars
Umbilicus
Organs outside the pelvic cavity
What are the clinical features of endometriosis? (5)
Dysmenorrhea–NOT directly related to amount of disease
Dyspareunia
Infertility–may due to scarring
Abnormal bleeding–only occurs 1/3 of the time
Pelvic pain–chronic pain due to scarring
Endometriosis can be diagnosed by what surgical procedures? (2)
diagnostic laparoscopy
laparotomy
What is the medical treatment for endometriosis? (4)
Combined estrogen/progestin oral contraceptive agents
Progestin alone
Danazol–a testosterone derivative
Gonadotropin-releasing hormone agonist
What is the surgical treatment for endometriosis? (2)
Conservative would include excision, cauterization, or ablation of lesions
Radical would include total abdominal hysterectomy with bilateral salpingo-oophorectomy and removal of adhesions
Salpingo = tubes
Oophoro = ovaries
What are leiomyomas?
fibroids
What determines the growth of leiomyomas?
hormones
Growth potential is related to estrogen production.
Menopause generally stops growth.
What is the pathological mechanism of leiomyomas?
Exact mechanism is unknown, but we need to rule out malignancy.
What are the symptoms of leiomyomas? (3)
Pain
Bleeding–most common symptom
Pressure symptoms
How are leiomyomas diagnosed? (3)
Clinical exam
Imaging–ultrasound most common because CT and MRI is not cost effective
Hysteroscopy
Leimyomas are generally malignant. True or false?
False, most are benign and 30% of women are affected.
Do most leiomyomas require treatment?
No, most are medically managed and examined routinely.
What are surgical treatments for leiomyomas? (2)
Myomectomy in younger pts whose fertility is compromised
Hysterectomy for non-childbearing women
Which surgical treatment, myomectomy or hysterectomy for removal of leiomyomas has higher complications?
myomectomy
What is a newer treatment for leiomyomas?
Pharmacological removal of estrogen by suppression of the hypothalamic-pituitary-ovarian axis through use of gonadotropic-releasing hormone agonist (GnRH analogs)
What are signs of cervical cancer? (2)
No classical presentation, but include:
- postcoital bleeding
- abnormal uterine bleeding
Identifiable precursor lesion–CIN (cervical intraepithelial neoplasia)
What is a cheap and noninvasive screening test for cervical cancer?
Pap smear
What type of anesthesia is used to determine the staging of cervical cancer?
General
Further assessment by CT scanning or MRI.
What is the treatment for cervical cancer? (4)
Cryotherapy
LEEP (loop electrosurgical excision procedure)–sometimes done locally
Radical hysterectomy with removal of lymph nodes
Radiation
What is the most common GYN cancer type?
In what population is it common?
What is the treatment?
Uterine (Leiomyosarcoma)
Post-menopausal women
Hysterectomy
What type of cancer has an overall good rate of survival?
What is most common symptom?
What is the treatment?
Endometrial cancer
Abnormal bleeding
Total hysterectomy with bilateral salpingo-oophorectomy
What GYN cancer has the highest morality rate?
Ovarian
Early detection is difficult and symptomatic only after extensive metastasis.
Most ovarian enlargements in women of reproductive age are benign. True or false?
True
Note: Ovarian tumors in postmenopausal women are malignant 25% of the time.
What is ultrasonography?
High-frequency sound reflection used to identify different tissues and structures
Very short bursts of low-energy sound waves to the body
Transmission of waves differs with different types of tissues
Safe during pregnancy because of low-energy sound waves
What is hysterosalpingography?
Contrast material is put through the cervix into the uterus
X-rays are taken to assess progression of dye through the uterus, fallopian tubes, and into the abdominopelvic cavity.
Hyster = uterus
What test is used for infertility evaluation?
Hysterosalpingography
What procedure is performed to evaluate the surface of the cervix, vagina, and vulva and is used to make direct biopsies?
Colposcopy
Colp-o = vagina
What is D&C and what type of anesthesia is performed?
Dilation and Curettage
General anesthesia because it is painful.
Note: Dilation involves opening the cervix and curettage is scraping of the uterine lining.
What is a hysteroscopy?
What is the type of anesthesia performed?
Small endoscopes are used to view the endocervix and endometrial cavity.
Outpatient procedure is done under local or general.
What are the indications for a hysterectomy? (3)
Benign or malignant changes of the uterine wall
Abnormalities of the cervix
Menstrual disturbances that are not improved with conservative treatments.
What is a total hysterectomy?
Removal of all of the uterus
What is a radical hysterectomy?
Removal of the uterus with very wide margins of surrounding tissue, often includes lymph node biopsy.
What are the 2 approaches for a hysterectomy?
Vaginal–less invasive
Abdominal
What are possible positions for GYN procedures?
Lithotomy
Supine
What are the possible anesthetic complications of GYN procedures? (4)
Steep trendelenberg
Blood loss
Allergic reaction
Coagulopathy
What are the types of pregancy tests? (3)
hCG (human chorionic gonadotropin)–directly related to gestational age
urine test–takes 25 days after last menstrual cycle for a positive result
serum test–detects within 1 week
In early pregnancy, hCG concentrations _____ every 2 days.
What does inadequate rise of hCG indicate?
double
nonviable gestation or ectopic pregancy
What are diagnostic purposes for a laparoscopy? (4)
Pelvic pain
Infertility
Congenital abnormalities
Small masses
What are therapeutic purposes for laparoscopy? (3)
Lysis of adhesions
Endometriosis treatment
Sterilization
