OB GYN Flashcards
Differential diagnosis for female with possible appendicitis
In women, it is important to include
Mittleschmirz, salpingitis, tuboovarian abscess, ovarian torsion, ruptured ovarian cyst
and shared diff: Infectious causes, such as mesenteric adenitis, urinary tract infection, pyelonephritis, should also be considered.
most common gynecologic causes for lower-abdominal pain
complications of pregnancy (ectopic pregnancy or spontaneous abortion), hemorrhagic or ruptured ovarian cysts, pelvic inflammatory disease (PID), ovarian torsion, dysmenorrhea, degenerating uterine leiomyomas, endometriosis, pelvic adhesive disease.
Nongynecologic causes that should be considered include appendicitis, diverticulitis, acute cystitis, and urinary calculi
work up right lower abdominal pain in 35-year-old female
Menstral history
Sexual history
Pregnancy history
Quantitative Beta hCG
CA 125 (ovarian CA) AFP (ovarian CA) LDH (ovarian CA) Inhibin level (ovarian CA)
LFT
Urinalysis
CVC
BMP
In addition to pelvic ultrasound (Doppler to eval ovarian flow)
CT scan
When no intrauterine gestational sac is noted with an hCG level over 1,500 to 2,000 mIU/ mL,
then an ectopic pregnancy should be strongly considered.
If the hCG level rests below this discriminatory zone,
then serial hCG levels can be helpful to differentiate between a normal and abnormal early gestation
levels usually rise at least 66% over 48 hours.
While an adnexal mass can be found with an ectopic pregnancy, it can be differentiated by:
usually smaller than those associated with torsion
often is paraovarian in location.
treatment of ectopic
Historically, surgical removal was the standard approach to treatment.
With accurate hCG assays and improving ultrasound technology, earlier diagnosis has made medical management with methotrexate more prevalent.
Management of ruptured ovarian cyst
Usually conservative with ultrasound have no knowledge often resolving within six weeks
If in the genetic instability may require urgent surgical intervention
Cherney incision
When a pfannestiel incision is converted by detaching the rectus muscle from the tendon insertions on the pubic symphasis
Time cut off for irreversible ovarian necrosis with torsion
24 hours
Management with a over that remains dark or dusky after detorsion
Leave it in place do surveillance of viability
Assessment of questionable perfusion to ovary after detorsion
fluorescein injecton
ovarian bivalves
ovarian cystectomy
Used to concert over in reproduction aged
Benign pathology or indeterminate
Elliptical incision over the top of the anti-mesenteric portion of the ovary mass
Separate it from the surrounding strumma with mets
Do not rupture or still trimmer
Hemostasis with suture ligation and cautery
Sorrows left open or reapproximated with fine suture
Salpingo-oophorectomy
Develop pararectal space
infundibulopelvic ligament at the pelvic sidewalk - incision parallel to the round ligament toward the white line of Toldt
External iliac artery in vain identified
Blunt dissection meal two these vessels to open up the pararectal space
Identify ureter over the iliac vessels by lifting the infundibulopelvic ligament
Window is made between the ureter and ovarian vessels
Ligate divide her ovarian vessels
Fallopian tube and utero ovarian ligament transected at the uterus
Management of incidental simple ovarian cyst in reproductive aged
Female less than 5 cm
This is usually functional and will resolve on its own leave it there
