Week 5 - Gynaecology

Question 1

Conditions of surgery

Answer 1

Benign conditions;
Cancer;
Infertility;
Incontinence
Ovarian cyst
Endometriosis
Fibroids
Prolapse
Hysteroscopy / hysterectomy
Urinary incontinence
fistula

Question 2

Hysteroscopy

Answer 2

Like a teloscope - visual examination for diagnosis that goes through the cervix to the uterine cavity.

Diagnostic tool:
Infertility;
Irregular menstruation;
Bleeding post menopause;
Miscarriage;

Question 3

Ovarian cyst

Answer 3

Fluid filled sacs that form in the ovaries
- common in early child bearing years

Types of cysts

• Functional Cyst - Forms during ovulation. When the egg is not released, or the sac doesn’t dissolve once the egg has been released

Polycystic ovaries - follicle where the eggs mature prior to releasing fail to open. A cyst forms in the follicle.

Endometriomas - small sections of uterine tissue that grow around the ovaries - grow in a cyst formation
Cystadenomas - outside of the ovary itself - cyst with fluid

Dermoid cysts -

Question 4

Dermoid cyst

Answer 4

Teratoma: known as dermoid as they contain ‘dermal’ appendages

Question 5

Endometriosis

Answer 5

Endometrium (tissue that lines the uterus) is found in abnormal sites around the body.
Family trend (not hereditary)
Typically throughout the pelvis;
Pain, pain and pain
Pain during sex, bowel motions, back pain,
lethargy
Infertility

Question 6

Endometriosis treatment

Answer 6

DRUGS! - paracetamol, ibuprofen, naprogesic, contraceptive pill

Analgesics;
NSAIDS;
Hormone therapy;

Treatment
Surgery - laparoscopy - diathermy endometrial growths

Alternative therapies - Chinese herbal (literature supporting positive experience with symptoms - no scientific in reducing symptoms or fertility)

Question 7

Prolapse

Answer 7

Can be bladder, uterus or bowel
Can have similar limitations between the 3

Pelvic floor muscles weaken
Ligaments stretch
Inadequate support for uterus
Descends into vaginal canal

Minor slip - can be a simple repair with sutures
Major - removal

Question 8

Hysterectomy (LAVH)

Answer 8

General anaesthetic;
Laparoscopic approach (4 small key holes)
C02 insufflation - to distend abdomen
Uterus resection; removed vaginally 
Ovary sparing +/-;
Absorbable sutures

Question 9

Types of Hystectomy

Answer 9

Partial - 2/3 of uterus removal
Total - complete uterus and cervix
Radical - uterus, fallopian tubes, ovaries, cervix, back half of vagina

Question 10

Percutaneous Nephrolithotomy

Answer 10

General anaesthetic;
Avoid anticoags and NSAIDS for at least 1 week prior;
X-ray guided;
Nephrostomy tube remaining for drainage.

Question 11

Benign Prostate H

Answer 11

Hyperplasia
Hypertrophy

Incidence

Treatment

Question 12

Trans Urethral Resection of Prostate (TURP)

Answer 12

Spinal anaesthetic +/_ sedation;
Electrocautery (or diathermy) vs laser;
Post spinal complications;

RISK: exposure of open venous blood vessels and excessive irrigation fluid - entering into the circulatory system = turps syndrome

Question 13

TURPS syndrome

Answer 13

Uptake of irrigating fluid through the venous bed of the prostate;
Average rate of absorption 20ml/min
Circulatory overload
Hyponatreamia

Question 14

Alternative prostate options

Answer 14

Photoselective laser prostate resection
GreenLight laser
High energy laser that vaporises tissue;

Transurethral Needle Ablation
TUNA
Low-level radio waves through twin needles to heat & kill the obstructing prostate cells.

Question 15

Endometrial ablation

Answer 15

Diathermy the inside wall of the uterus. Cortorising the endometrium

Question 16

Fibroids

Answer 16

Smooth muscle tumour in the uterus sometimes outside

Benign
slowish growing
can grow significantly
can be as large as rockmelon/watermelon size

Symptoms:
Pain
increased abdominal pressure
Abnormal uterine bleeding 
recurrent miscarriage
infertility

Question 17

Types of prolapse

Answer 17

Cystocoele (bladder), Uterine prolapse (uterus), rectocoele (rectum)

Question 18

Vesico-vaginal fistula

Answer 18

Fistula - connection between two sections that wouldn’t not normally be present. This fistula is from tissue ischaemia from necrosis from extended labour.

Question 19

Percutaneous nephrolitholotomy

Answer 19

Primary procedure to manage kidney stones
X-ray
Sequential dilatation to enable telescope or forceps remove stones
General Anaesthetic
Avoid anticoags and NSAIDS - 1 wk prior
Nephrostomy tube remaining for drainage
Pain - pre op and post op

Question 20

Extra Corporeal Shockwave Lithotripsy

Answer 20

Non invasive method to remove renal calculi
x-ray controlled
post op pain
haematuria
flank (between ribs and hip) petechiae - skin

Question 21

Prostate disease

Answer 21

Size of a walnut
2nd most common surgery - Male over 65 yrs

Benign prostate hyperplasia - increased number of cells in the prostate
Hypertrophy -

Question 22

Alternative prostate options

Answer 22

Photoselective laser prostate resection

Transurethral Needle Ablation

Question 23

Screening

Answer 23

Rectal examination
Prostate Specific Antigen (blood test) elevated can diagnose as prostate cancer
Fine Needle Biopsy (tissue sample by fine needle)

Question 24

Treatment

Answer 24

Radical Prostatectomy - risk of impotence and incontinence

Brachytherapy - targeted radiotherapy
perineum - guidewires with a cell of radioactive