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AP: Summer Exam 3 > Gynecology Pathophysiology and Anesthesia > Flashcards

Gynecology Pathophysiology and Anesthesia Flashcards

1
Q

What are important preoperative considerations for gynecology procedures? (6)

A
  • Malignancy
  • Fertility
  • Sexual function
  • Mentrual cycle
  • Surgical bleeding
  • Positioning
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2
Q

What can cause pelvic relaxation/pelvic organ prolapse? (8)

A
  • birth trauma
  • increased intra-abdominal pressure
  • obesity
  • chronic cough
  • heavy lifting
  • weakness
  • atrophy by aging or estrogen loss
  • genetics
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3
Q

How does pelvic organ prolapse present in the patient? (3)

A

Manifestations

  • Urethrocele or urethral detachment
  • Cystocele
  • Rectocele
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4
Q

What does this depict?

A

cystocele

Note: Rectocele is depicted on this side of the card for reference.

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5
Q

KNOW

How does cystocele/rectocele (pelvic prolapse) present? (7)

A
  • “Pressure” and “heaviness” low in the abdomen or pelvis
  • Painful defecation
  • Backache
  • Dyspareunia–painful sexual intercourse
  • Urinary incontinence, frequency, incomplete voiding
  • Recurrent UTI
  • Constipation
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6
Q

What are nonsurgical treatments for pelvic relaxation and prolapse? (3)

A

Bladder training and biofeedback

Drugs

  • Anticholinergics
  • Beta agonists
  • Dopamine agonists
  • Antidepressants

Exercises (Kegels)

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7
Q

What are surgical treatments for pelvic relaxation and prolapse?

A

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

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8
Q

What is endometriosis?

A

Presence of endometrial tissue in extrauterine locations

Note: Red = common sites of endometriosis

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9
Q

Endometriosis is commonly described in women who are in their ___’s and ___’s.

A

20’s and 30’s

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10
Q

Where is endometriosis commonly found? (5)

A

Pouch of Douglas
Round ligament
Ovaries (60%)
Fallopian tubes
Sigmoid colon

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11
Q

Where is endometriosis LESS commonly found? (3)

A

Surgical scars

Umbilicus

Organs outside the pelvic cavity

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12
Q

What are the clinical features of endometriosis? (5)

A

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

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13
Q

Endometriosis can be diagnosed by what surgical procedures? (2)

A

diagnostic laparoscopy

laparotomy

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14
Q

What is the medical treatment for endometriosis? (4)

A

Combined estrogen/progestin oral contraceptive agents

Progestin alone

Danazol–a testosterone derivative

Gonadotropin-releasing hormone agonist

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15
Q

What is the surgical treatment for endometriosis? (2)

A

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

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16
Q

What are leiomyomas?

A

fibroids

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17
Q

What determines the growth of leiomyomas?

A

hormones

Growth potential is related to estrogen production.

Menopause generally stops growth.

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18
Q

What is the pathological mechanism of leiomyomas?

A

Exact mechanism is unknown, but we need to rule out malignancy.

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19
Q

What are the symptoms of leiomyomas? (3)

A

Pain

Bleeding–most common symptom

Pressure symptoms

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20
Q

How are leiomyomas diagnosed? (3)

A

Clinical exam

Imaging–ultrasound most common because CT and MRI is not cost effective

Hysteroscopy

21
Q

Leimyomas are generally malignant. True or false?

A

False, most are benign and 30% of women are affected.

22
Q

Do most leiomyomas require treatment?

A

No, most are medically managed and examined routinely.

23
Q

What are surgical treatments for leiomyomas? (2)

A

Myomectomy in younger pts whose fertility is compromised

Hysterectomy for non-childbearing women

24
Q

Which surgical treatment, myomectomy or hysterectomy for removal of leiomyomas has higher complications?

A

myomectomy

25
Q

What is a newer treatment for leiomyomas?

A

Pharmacological removal of estrogen by suppression of the hypothalamic-pituitary-ovarian axis through use of gonadotropic-releasing hormone agonist (GnRH analogs)

26
Q

What are signs of cervical cancer? (2)

A

No classical presentation, but include:

  • postcoital bleeding
  • abnormal uterine bleeding

Identifiable precursor lesion–CIN (cervical intraepithelial neoplasia)

27
Q

What is a cheap and noninvasive screening test for cervical cancer?

A

Pap smear

28
Q

What type of anesthesia is used to determine the staging of cervical cancer?

A

General

Further assessment by CT scanning or MRI.

29
Q

What is the treatment for cervical cancer? (4)

A

Cryotherapy

LEEP (loop electrosurgical excision procedure)–sometimes done locally

Radical hysterectomy with removal of lymph nodes

Radiation

30
Q

What is the most common GYN cancer type?

In what population is it common?

What is the treatment?

A

Uterine (Leiomyosarcoma)

Post-menopausal women

Hysterectomy

31
Q

What type of cancer has an overall good rate of survival?

What is most common symptom?

What is the treatment?

A

Endometrial cancer

Abnormal bleeding

Total hysterectomy with bilateral salpingo-oophorectomy

32
Q

What GYN cancer has the highest morality rate?

A

Ovarian

Early detection is difficult and symptomatic only after extensive metastasis.

33
Q

Most ovarian enlargements in women of reproductive age are benign. True or false?

A

True

Note: Ovarian tumors in postmenopausal women are malignant 25% of the time.

34
Q

What is ultrasonography?

A

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

35
Q

What is hysterosalpingography?

A

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

36
Q

What test is used for infertility evaluation?

A

Hysterosalpingography

37
Q

What procedure is performed to evaluate the surface of the cervix, vagina, and vulva and is used to make direct biopsies?

A

Colposcopy

Colp-o = vagina

38
Q

What is D&C and what type of anesthesia is performed?

A

Dilation and Curettage

General anesthesia because it is painful.

Note: Dilation involves opening the cervix and curettage is scraping of the uterine lining.

39
Q

What is a hysteroscopy?

What is the type of anesthesia performed?

A

Small endoscopes are used to view the endocervix and endometrial cavity.

Outpatient procedure is done under local or general.

40
Q

What are the indications for a hysterectomy? (3)

A

Benign or malignant changes of the uterine wall

Abnormalities of the cervix

Menstrual disturbances that are not improved with conservative treatments.

41
Q

What is a total hysterectomy?

A

Removal of all of the uterus

42
Q

What is a radical hysterectomy?

A

Removal of the uterus with very wide margins of surrounding tissue, often includes lymph node biopsy.

43
Q

What are the 2 approaches for a hysterectomy?

A

Vaginal–less invasive

Abdominal

44
Q

What are possible positions for GYN procedures?

A

Lithotomy

Supine

45
Q

What are the possible anesthetic complications of GYN procedures? (4)

A

Steep trendelenberg

Blood loss

Allergic reaction

Coagulopathy

46
Q

What are the types of pregancy tests? (3)

A

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

47
Q

In early pregnancy, hCG concentrations _____ every 2 days.

What does inadequate rise of hCG indicate?

A

double

nonviable gestation or ectopic pregancy

48
Q

What are diagnostic purposes for a laparoscopy? (4)

A

Pelvic pain
Infertility
Congenital abnormalities
Small masses

49
Q

What are therapeutic purposes for laparoscopy? (3)

A

Lysis of adhesions

Endometriosis treatment

Sterilization

AP: Summer Exam 3 (7 decks)

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