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PCV > Vol.5-Ch.1 "Gynecology" > Flashcards

Vol.5-Ch.1 "Gynecology" Flashcards

1
Q

Which female reproductive organs are internal or external?

Which of the two categories are the most important for reproduction and which only has accessory function?

A

Internal:

  • Ovaries
  • Fallopian Tubes
  • Uterus
  • Vagina

External: AKA the VULVA or PUDENDUM (collectively)

  • Perineum
  • Mons Pubis
  • Labia(s)
  • Clitoris
  • Urethra

The internal repro organs are the most important and the external are accessory

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2
Q

What is an Episiotomy?

A

An incision of the perineum during child birth to prevent spontaneous tearing

(sexual assault can also lead to damage of the perineum)

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3
Q

What is the Mons Pubis?

A

A fatty layer of tissue over the Pubic Symphysis.

During puberty estrogen causes the fat to begin depositing here and functions as a cushion to protect the pubic symphysis during sex.

Estrogen also causes the mons pubis to become covered in hair and activates sebaceous glands and sweat glands

The two labia(s) are fatty folds the extend from the mons pubis.

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4
Q

What happens to the labia minora during sex?

A

It becomes engorged with blood (its highly vascular and innervated) and the sebaceous glands that are activated during puberty begin secreting lubricants

ALSO the Prepuce is the fold of the LMinora that covers the clitorus

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5
Q

What is the Vestibule?

A

The vestibule contains the urethral opening and external opening to the vagina (introitus) and it is protected by the labia minora

The Skene and Bartholin glands are what secrete lubricant for these structures

The vestibule also houses the Hymen in virgins; a thin fold of mucus membrane that forms the external border of the vagina, partly closing it.

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6
Q

Why do women get more bladder infections and UTI than men?

A

Because their urethra is shorter! So it is easier for bacteria to travel up the urethra and the UTIs are because the male penis carries bacteria into the vagina.

(hints more sex = higher chances of frequent UTIs)

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7
Q 
Vagina Facts (4)
Main 3 functions?
A
  • The vagina is mostly smooth muscle
  • Connects External Genitalia to the uterus
  • Primary blood supply is the Vaginal Artery
  • Lower 3rd is innervated by the Pudendal Nerve
  • 3 MAIN FUNCTION
    a) female organ of copulation aka receives penis
    b) aka the birth canal, forms final passage of birth
    c) provides outlet for menstrual blood and tissue
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8
Q 
Uterus Facts (
Main Function?
A

MAIN FUNCTION = provide a site for fetal development

  • 3 LAYERS OF TISSUE

A) ENDOMETRIUM - Innermost layer, this is the layer the builds up due to estrogen and progesterone during the menstrual cycle to possibly receive implantation of a fertilized ovum. If it does not then is soughs off and is excreted out of the vagina.

B) MYOMETRIUM - Thick middle layer and has it’s own 3 LAYERS; the OUTER layer is primarily over the fundus has longitudinal fibers and allow for expulsion of the fetus after cervical dilation, the MIDDLE and thicker layer has figure 8 shaped fibers that interlace and surround large blood vessels which after birth contract to help control any bleeding and also to help the sloughing during menstruation, the INNER layer has circular smooth muscle that form sphincters at the point of fallopian tube attachment and the opening of the cervix.

C) PERIMETRIUM - It is a serous membrane which partially covers the corpus (body) of the uterus. The most important aspect of the partial coverage is that it allows access to the uterus for a C-section without the risk of tearing the visceral peritoneum lining the abdomen.

  • Extensive blood supply primarily from the Uterine Arteries which are branches from the Iliac Artery.
  • It is innervated by the autonomic NS
  • Has TWO PARTS, the body (corpus) and the cervix (neck); the upper two thirds is smooth muscle and the lower is the cervix.
  • The cervix is the lower part of the uterus and connects to the vagina, this is what dilates to 10cm during pregnancy to allow for the baby to begin traveling out.
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9
Q

What is one way the uterus is used to to determine gestational age of pregnancy?
At what weeks is this most accurate?

A

You can measure the distance from the fundus of the uterus and the pubic symphysis aka the fundal height.

1cm = 1 week

This is most accurate from the 22nd to 34th week.

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10
Q

What are the two functions of the Ovaries?

they are super important!

A
  • The secretion of Estrogen and Progesterone in response to the release of the Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) from the Anterior Pituitary.
  • The development and release of eggs (Ova)
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11
Q

The fallopian tubes move the eggs via _____?

Fertilization usually occurs at what point in the fallopian tube?

A

Peristalsis

The distal 3rd
remember its Fertilization not Implantation which is in the uterus

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12
Q

How often do women have a menstrual cycle?
How long does it last?
When does it start? (Age)

A

Women generally have a cycle every 28 days

The onset of cycles is called MENARCHE, and is at roughly 10-14yo

A cycle can take between 21-32 days so ALWAYS ASK WHAT IS NORMAL FOR THE PT. However, the variance in cycle length occurs during the pre-ovulatory phase ; the time from ovulation to menstruation is ALWAYS 14 DAYS.

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13
Q

What is controlled by the release of Estrogen and Progesterone from the ovaries?

What controls the release of Estrogen and Progesterone?

A

Estrogen and Progesterone control the ovarian-menstrual cycle, pregnancy, and lactation

They are controlled by FSH and LH from the Ant Pituitary

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14
Q

Proliferate Phase of the Menstrual Cycle (x6ish)

A
  • It is the FIRST 2 WEEKS and is dominated by Estrogen which causes the engorgement of the endometrium.
  • Women have around 200,000 immature ovarian follicles called GRAAFIAN FOLLICLES
  • In response to increased FSH and Estrogen, a follicle matures and ruptures, releasing its egg through the ovary’s outer covering.
  • In response to a surge of LH, around day 14, ovulation (release of an egg) occurs.
    (***The key between this and the last “-“ is that LH is low during the maturation of a follicle but both LH and FSH spike during ovulation, but LH spikes more)
  • The cilia of the fallopian tube “sweep” the egg in and move it towards the uterus
  • The ruptured follicle will develop into the Corpus Luteum b/c of the influence of LH; it is a small yellowing body of cells, which produce progesterone during the second half of the menstrual cycle. (***Estrogen is produces throughout this whole cycle but progesterone only comes around during the corpus luteum development phase until it is atrophied)
  • If it is not fertilized, the corpus luteum will atrophy 3 days prior to the menstrual cycle ; if the woman had sex within 24 hours of ovulation then fertilization is possible and will cause the corpus luteum to produce progesterone instead of atrophy until the placenta takes over that function
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15
Q

Secretory Phase of the Menstrual Cycle

A
  • The stage immediately surrounding ovulation (release of an egg)
  • During this period estrogen levels drop sharply if the egg is not fertilized and which means progesterone is dominant
  • Uterine vascularity also increases here to prepare for implantation of a fertilized egg
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16
Q

Ischemic Phase of the Menstrual Cycle

A

If fertilization does not occur, then estrogen and progesterone levels fall and the endometrium becomes pale and small blood vessels rupture

17
Q

Menstrual Phase of the Menstrual cycle

A

The is the phase marked by vaginal bleeding. It starts from the first day that blood, mucus, and cellular debris begin excreting from the vagina. This can typically last 3-5 days and on average 50mL of blood is lost; but all this can vary.

18
Q

What is Pre-Menstrual Syndrome (PMS)?
What is Premenstrual Dysphoric Disorder (PMDD)?
What is Menopause?

A

PMS is marked physical S&Ss immediately prior to the onset of their menstrual period. It can include breast tenderness/engorgement, bloating/fluid retention, abdominal pain, transient weight loss/gain, cravings, or emotional distress.

PMDD This is a severe version of PMS usually with severe depression, irritability, or tension but can also be physical

Menopause is the cessation of menses (menstrual cycle), it is the end of ovarian function and estrogen secretion. Typically occurs from 45-55. S&Ss are usually hot flashes, night sweats, and mood swings.

19
Q

What are the 2 most common complaints of women in child bearing years and most common complaints in Medical Gynecologic Emergencies?

A
  • Abdominal Pain

- Vaginal Bleeding

20
Q

What is Dysmenorrhea?

Dyspareunia?

A

Dysmenorrhea - Severe discomfort during menstrual cycles

Dyspareunia - painful intercourse

21
Q

What is Gravida, Para or Parity, and Abortion used to describe?

A

Gravida = G - Is the number of times a woman has been pregnany

Para = P - how many deliveries

Abortions = Ab - how many of the pregnancies ended before the 20th week no matter the cause

G3 P2 Ab1
Would mean 3 pregnancies, 2 deliveries, and 1 abrotion.

***twins or more only count as ONE DELIVERY

22
Q

What is an easy way for women to determine the regularity of the amount of bleeding in a cycle?

A

How many tampons or pads were needed.

23
Q

For women with abd pain or vaginal bleeding it is very important to ask ____?

A

Last Menstrual Period (LMP) or Last Normal Menstrual Period (LNMP)

24
Q

Oral Contraceptives have been associated with what negative S&Ss?
IUDs?

A

Oral have been linked with hypertension, stroke, heart attack, PE

IUDs have been linked with perforation in the uterus, uterine infections, or irregular uterine bleeding
(Especially when left in longer than recommended which is normally 2 years)

25
Q

What are two ways to assess if there is a bleeding emergency aka too much blood is being lost in a vaginal bleeding pt?

A

A TILT TEST will asses for orthostatic hypotension secondary to blood loss, you will see a sudden drop in BP and raise in HR when moving form a supine to a standing or seated position.

If more than 2 sanitary pads are used per hour

26
Q

What are the 2 categories gynecologic emergencies can typically be divided into?

A

Medical or Traumatic

27
Q

What is Pelvic Inflammatory Disease (PID)?

A

It is an infection of the female reproductive system either by bacterium, virus, or fungi. MOST COMMON LY CAUSED by Gonorrhea or Chlamydia. This most often affects the Uterus, Fallopian Tubes, and Ovaries. It may be acute or chronic and may CAUSE:

  • Abdominal Pain (Guaranteed and most common) that is diffuse and in the lower abdomen, exhibiting rebound tenderness MAKING IT HARD TO DISTINGUISH FROM APPENDICITIS.
  • Secondary tubule infection can cause infertility
  • Untreated and sever cases can lead to fever, chills, nausea, vomiting, and SEPSIS
  • Foul smelling discharge, often yellow
  • Can sometimes cause adhesions in which the pelvic organs stick together and commonly causes pelvic pain and increased chance of infertility and ectopic pregnancies

The primary TREATMENT is antibiotics

28
Q

What does raising one’s knees to their chest do for abdominal pain discomfort?

A

It reduces it because it takes pressure off of the peritoneum

29
Q

What is a Rupture Ovarian Cyst?

A

Cysts are fluid filled pockets. They can occur on an ovary, especially when an egg is released and a cyst known as a Corpus Luteum Cyst takes it’s place. When the cysts rupture they leak a small amount of blood into the abdomen which can get on the peritoneum which is easily irritated by blood and will cause rebound tenderness and abdominal pain. They tend to rupture suddenly during intercourse or physical activity cause sharp acute symptoms. Often a big sign will be Unilateral Abdominal Pain.

(Although again I bet this would be hard to distinguish against if it was on the right ovary near where the appendix is)

30
Q

What is Cystitis?

A

It is a Urinary Bladder Infection, or UTI, which is caused by bacteria entering the urinary tract via the urethra and ascending to the bladder and ureters. If untreated that can continue to the kidneys. Typically a UTI will cause abdominal pain, a change in urinary frequency, dysuria (painful pee), a low grade fever, and/or hesitancy (trouble starting or stopping pee stream). Sometimes the urine may have small traces of blood.

31
Q

What is Mittelschmerz?

A

It is the abdominal pain associated with midcycle ovulation. It is thought that the pain is caused by irritation of the peritoneum due to follicle rupture or bleeding at the time of ovulation.

32
Q

What is Endometritis?

A

An infection of the uterine lining, and is occasionally a secondary complication of miscarriages, childbirth, or gynecologic procedures. Often causes, abdominal pain, bloody, foul smelling discharge, and fever.

33
Q

What is Endometriosis?

A

Is a condition in which endometrial tissue is found outside the uterus. Usually it occurs in the abdomen of pelvis but CAN occur anywhere, even the lungs and CNS. This tissue responds to hormonal changes and will bleed as is seen in endometrial tissue in the uterus. Which means it will bleed in a cyclical pattern and that blood will cause, pain, irritation, scarring, or even adhesions. The most common sign is a dull, cramping pelvic pain that is usually related to menstrual cycles. Definitive treatments involves, surgery, hormonal therapy, anti-inflammatory drugs, and analgesics

34
Q

What is an Ectopic Pregnancy?

A

An implantation of a fetus outside the uterus. Most commonly in the fallopian tubes, which is a surgical emergency! This will cause severe pain on the affected side and if the tube ruptures it will cause massive hemorrhaging.

35
Q

What is the most common cause of nontraumatic vaginal bleeding?
What is menorrhagia?
What are Uterine Fibroids?

A

Most common non traumatic cause of vaginal bleeding is a spontaneous abortion (miscarriage). If your pts last menstrual period (LMP) has been over 60 days and then this happens, a miscarriage should be assumed.

Menorrhagia is an excessive menstrual flow. Remember that all bleeding can be life threatening so even if this is the cause of bleeding still watch for shock.

Uterine Fibroids (Leiomyomas) are non-cancerous tumors that develop in the uterus. They are the most common pelvic tumor found in 1 of 5 women of childbearing years.

36
Q

Management of Nontraumatic Vaginal Bleeding?

A
  • Absorb blood flow ; DO NOT PACK THE VAGINA
  • Transport in position of comfort
  • Initiate O2 and IV access as needed
37
Q

Causes and management of traumatic gynecologic trauma?

A
  • Most common cause is laceration secondary to sexual assault.
  • Straddle injury is the most common blunt trauma (like from riding a bike or horse)
  • Manage lacerations by direct pressure but DO NOT PACK INSIDE THE VAGINA EVER. If the injury is internal all you can do is absorb the blood and transport as treatment will often require surgery.
38
Q

What are the general rules when it comes to questioning/treating a post-sexual assault victim?

A
  • Do not acquire about the specifics of the event
  • Do not ask about if there was penetration
  • Do not ask about the pts sexual history
  • Ask ONLY about pts physical injuries
  • Typically have a female medic work the pt if possible

TREAT THE PT LIKE A CRIME SCENE, disturb and handle as little as possible

39
Q

4 things to remember when documenting a sexual assault call

A
  • State the pts remarks accurately
  • Objectively state you findings
  • Document any evidence turned over to the hospital staff and the name of the person you gave it to
  • DO NO include your opinions as to whether rape occurred or not

PCV (8 decks)

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