Week 5 - Gynaecology Flashcards
Conditions of surgery
Benign conditions; Cancer; Infertility; Incontinence Ovarian cyst Endometriosis Fibroids Prolapse Hysteroscopy / hysterectomy Urinary incontinence fistula
Hysteroscopy
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;
Ovarian cyst
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 -
Dermoid cyst
Teratoma: known as dermoid as they contain ‘dermal’ appendages
Endometriosis
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
Endometriosis treatment
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)
Prolapse
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
Hysterectomy (LAVH)
General anaesthetic; Laparoscopic approach (4 small key holes) C02 insufflation - to distend abdomen Uterus resection; removed vaginally Ovary sparing +/-; Absorbable sutures
Types of Hystectomy
Partial - 2/3 of uterus removal
Total - complete uterus and cervix
Radical - uterus, fallopian tubes, ovaries, cervix, back half of vagina
Percutaneous Nephrolithotomy
General anaesthetic;
Avoid anticoags and NSAIDS for at least 1 week prior;
X-ray guided;
Nephrostomy tube remaining for drainage.
Benign Prostate H
Hyperplasia
Hypertrophy
Incidence
Treatment
Trans Urethral Resection of Prostate (TURP)
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
TURPS syndrome
Uptake of irrigating fluid through the venous bed of the prostate;
Average rate of absorption 20ml/min
Circulatory overload
Hyponatreamia
Alternative prostate options
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.
Endometrial ablation
Diathermy the inside wall of the uterus. Cortorising the endometrium
Fibroids
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
Types of prolapse
Cystocoele (bladder), Uterine prolapse (uterus), rectocoele (rectum)
Vesico-vaginal fistula
Fistula - connection between two sections that wouldn’t not normally be present. This fistula is from tissue ischaemia from necrosis from extended labour.
Percutaneous nephrolitholotomy
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
Extra Corporeal Shockwave Lithotripsy
Non invasive method to remove renal calculi
x-ray controlled
post op pain
haematuria
flank (between ribs and hip) petechiae - skin
Prostate disease
Size of a walnut
2nd most common surgery - Male over 65 yrs
Benign prostate hyperplasia - increased number of cells in the prostate
Hypertrophy -
Alternative prostate options
Photoselective laser prostate resection
Transurethral Needle Ablation
Screening
Rectal examination
Prostate Specific Antigen (blood test) elevated can diagnose as prostate cancer
Fine Needle Biopsy (tissue sample by fine needle)
Treatment
Radical Prostatectomy - risk of impotence and incontinence
Brachytherapy - targeted radiotherapy
perineum - guidewires with a cell of radioactive
