between which two organs does the uterus lie
bladder
rectum
4 paired ligaments supporting uterus
broad
round
cardinal
uterosacal
area of uterus above openings of tubes
fundus
body of uterus communicates with cervix at…
internal os
cervix communicating with vagina is…
external os
3 layers of uterus
outer: serous
middle: myometrium
innter: endometrial
salpinx
tube/trumpet
purpose of tubes
ova from ovaries to uterus
how do tubes move ova
peristalsis/ciliary movement
right adnexa close to which 2 GI structures
cecum
appendix
ligament suspends ovaries
ovarian ligament
2 layers of ovaries
outer cortex
inner medulla
layer of ovary containing nerves, blood, and lymph vessels
medulla
layer of ovary containing follicles in different levels of maturity
cortex
2 functions of ovaries
make ova
endocrine glands-hormones
hormones produced by ovaries
estrogen: secondary sex characteristics, growth of uterine lining during period
progesterone: implantation of fertilized ovum, development of embryo
what ligament is fallopian tube in
broad
3 functions of vagina
sexual intercourse
menstrual bleeding
end of birth canal
anterior vaginal wall is near…
bladder
urethra
lower posterior vaginal wall close to…
rectum
projection of cervix into vagina divides into regions
fornices: anterior, posterior, right and left lateral
posterior fornix contacts
periotneum of cul-de-sac of Douglas pouch
external organs of the vulva
labia minora, laabia majora, clitoris, vestiblue, bartholin’s glands, vaginal opening, urethral opening
what bony structure is the mons pubis situated over
anterior symphysis pubis
what lies within labia majora
labia minora
homolog of penis
clitoris
vestibule openings for what structures
vaginal
urethral
2 paraurethral ducts on either side of urethral meatus
Skene’s
glands & ducts on lower end of vagina
Bartholin’s
self-retaining vaginal speculum
Grave’s speculum/bivalved
weighted vaginal speculum
Auvard
3 types of uterine dilators
Hank
Hegar
Goodell
2 self-retaining abdominal retractors in GYN
O’Sullivan O’Connor
balfour and blade
why is a simple vulvectomy done and what is removed
carcinoma in situ (multicentric)
labia majora, minora, possibly clitoris
position and incision for simple vulvectomy
lithotomy
wide elliptical
lasers most commonly in GYN
CO2
ND:YAG
Argonp
2 procedures to remove vulvar structures, inguinal nodes, portion of round ligament & saphenous vein and skin from abd. and groin
radical vulvectomy
groin lymphadenectomy
position for radical vulvectomy/groin lymphadenectomy
supine
trendelenburg
low lithotomy
prep area for radical vulvectomy/groin lymphadenectomy
abdomen
thighs
vulva
urethral marker to prevent urethral postop damage in radical vulvectomy/groin lymphadenectomy
catheter
drains in radical vulvectomy/groin lymphadenectomy
closed-wound
catheter
cystocele procedure
anterior colporrhaphy
herniated bladder into anterior vaginal wall
rectocele procedure
posterior colporrhaphy
herniation of rectum into vagina
enterocele
hernia sac w/ intestine between anterior and posterior vaginal walls
instrument on vaginal tissue for A&P repair
allis / wide allis
vesicovaginal fistula is..
between bladder and vagina
2 apporaches for vesicovaginal fistula
vaginal
abdominal (transperitoneal)
rectovaginal fistula
rectum and vagina
vaginal approach
why is a vesicourethral suspension
urinary stress incontinence
difference between Marshall Marchetti and Burch procedures
Marshall: tack to symphysis pubis
Burch: cooper’s ligament
procedure to repair deep laceratinos of cervix from childbirth
trachelorrhaphy
purpose of uterine sound in D&C
depth and direction of uterine cavity
procedure to aspirate uterine contents
suction curettage
why is a Shirodkar done
incompetenet cervix
suture in Shirodkar procedure
mersilene polyester tape around os of cervix
after colposcopy and punch biopsy how can conization be done
cryo, cautery, cold knife, loop electrosurgical, laser excisional
what is inserted vaginally when cesium is done for cancer
intracavitary implant and cesium needles
loaded in radiation dept
where is needle placed in culdocentesis…why
posterior vaginal fornix
intraperioneal bleeding, ectopic pregnancy, tuboovarian abscess
how is a Bartholin’s cyst treated
marsupiliazation
what is marsupialization
drain cyst in vagina create new ductal opening
endoscopic visualization of uterine cavity and tubal orifices
hysteroscopy
3 indications for hysteroscopy
abnormal bleeding, lost IUD, adhesions, fibroids, polyp
3 contraindications for hysteroscopy
pelvic infection
cervical malignancy
heavy bleeding
3 media used to distend uterus for hysteroscopy
hyskon
CO2
D5W
Sorbitol
Mannitol
Saline
2 complications of hysteroscopy media
hyponatremia
hypertension
instruments after hyskon
rinse in hot water
what does endometrial ablation treat and what is the goal
abnormal uterine bleeding
amenorrhea or reduced bleeding
2 sources of energy for endometrial ablation through hysteroscope
ESU, laser, microwave
3 contraindications for vaginal hysterectomy
large uterine tumor
pelvic malignancy
overlooked metastatic disease
in vag hyst what is done to facilitate dissection and decrease bleeding
infiltrate vaginal walls with normal saline or local anesthetic
endoscopic visualization of peritoneal cavity w/pneumo
position?
laparoscopy
lithotomy
if chromotubation is done what is placed in cervix
intrauterine cannula
liquids in normal saline to check tube patency
methylene blue
indigo carmine
how is tubal patency checked in laparoscopy
inject dye/contrast chromotubation
veress needle vs. hassan
needle: blind stab
hassan: valve of trocar sleeve make opening
what is LAVH, why does the surgeon use a laparoscope
lap assisted vag hyst: remove uterus from ligaments and vessel
visualize pelvis to see disease
what is removed in panhysterectomy
uterus, tubes, ovaries cervix, corpus
in TAH what is done with down below instruments
separate setup contamination
what are fibroids
benign tumors from myometrium
what is abdominal myomectomy? is uterus preserved?
remove single/multiple fibroids
yes
name for Wertheim procedure, what is done?
radical hysterectomy: uterus, tubes, ovaries, ligaments, upper vagina, lymph nodes
for malignancy
pelvic exenteration
rectum, sigmoid colon, bladder, distal ureters, internal iliacs, lateral brancehs, pelvic reproductive organs, lymph nodes, pelvic floor, peritoneum, levator muscle, perineum
what is created for urinary and bowel diversinos in pelvic exenteration
bladder: ileostomy
bowel: colostomy
what is oopherectomy and salpingo-oopherectomy
remove ovary and tube
tuboplasty and approaches
reconstruct tubes
open, laparoscopic
tubal ligation and 3 ways
interrupt tube continuity sterilization
coagulate, clip, silastic band
self-retaining retractor for tubal ligation w/minilaparotomy
large Graves bivalved speculum
2 hazards of performing abdominal surgery on pregnant patient
fetal injury: anesthesia
premature labor
C-section
deliver feteus from abdominal and uterine incisions
4 indications for C-section
failure to progress, malposition, abruptio placentae, uterine dysfunction
abruptio placenta/previa
placenta: premature detachment of placenta
previa: attachment low
position for C-section and why is right side elevated
supine w/ wedge
displace uterus from interior vena cava
incision for c-section
low transverse pfannensteil
why is speed important in c-section with anesthesia
fetal hypoxia-low blood pH (metabolic acidosis)
respiratory depression
what is used to extend incision in c-section
lister bandage scissors
fingers
when & why is bulb syringe used
after head comes through
suction mouth nose of amniotic fluid
why is oxytocin given, when, and how
uterine contraction before birth if natural
after birth in c-section (decrease size of uterus)
10-20 units IV or intrauterine
instruments used on uterine edge after infant is delivered
ring/pean forceps, pennington clamp
bartholin gland purpose
vaginal lube
why is a bimanual exam under anesthesia helpful
more relaxed, less painful
complication of GYN surgery that leads to loss of renal functino
severed ureters
schiller’s test
stain vagina and cervical squamous epithelium with lugol’s
lugol’s turns normal tissue…
brown
when should lugol’s not be used
iodine allergy
what layers are scraped in fraction d&C
endocervical
endometrial
2 positions for culdoscopy
lithoromy
knee-chest
indications for vaginal hysterectomy
uterine prolapse
pelvic relaxation/stress incontinence
myoma
irregular bleeding
premalignant lesion
