Gynecology Pathophysiology and Anesthesia Flashcards
(49 cards)
What are important preoperative considerations for gynecology procedures? (6)
- Malignancy
- Fertility
- Sexual function
- Mentrual cycle
- Surgical bleeding
- Positioning
What can cause pelvic relaxation/pelvic organ prolapse? (8)
- birth trauma
- increased intra-abdominal pressure
- obesity
- chronic cough
- heavy lifting
- weakness
- atrophy by aging or estrogen loss
- genetics
How does pelvic organ prolapse present in the patient? (3)
Manifestations
- Urethrocele or urethral detachment
- Cystocele
- Rectocele
What does this depict?
cystocele
Note: Rectocele is depicted on this side of the card for reference.
KNOW
How does cystocele/rectocele (pelvic prolapse) present? (7)
- “Pressure” and “heaviness” low in the abdomen or pelvis
- Painful defecation
- Backache
- Dyspareunia–painful sexual intercourse
- Urinary incontinence, frequency, incomplete voiding
- Recurrent UTI
- Constipation
What are nonsurgical treatments for pelvic relaxation and prolapse? (3)
Bladder training and biofeedback
Drugs
- Anticholinergics
- Beta agonists
- Dopamine agonists
- Antidepressants
Exercises (Kegels)
What are surgical treatments for pelvic relaxation and prolapse?
Anterior vaginal wall repair–provides support to the bladder and urethra by reinforcing the endopelvic fascia and vaginal epithelium
Retropubic suspension
Sling procedure–supplement/replace support of the bladder neck and urethra using suture or slings
What is endometriosis?
Presence of endometrial tissue in extrauterine locations
Note: Red = common sites of endometriosis
Endometriosis is commonly described in women who are in their ___’s and ___’s.
20’s and 30’s
Where is endometriosis commonly found? (5)
Pouch of Douglas
Round ligament
Ovaries (60%)
Fallopian tubes
Sigmoid colon
Where is endometriosis LESS commonly found? (3)
Surgical scars
Umbilicus
Organs outside the pelvic cavity
What are the clinical features of endometriosis? (5)
Dysmenorrhea–NOT directly related to amount of disease
Dyspareunia
Infertility–may due to scarring
Abnormal bleeding–only occurs 1/3 of the time
Pelvic pain–chronic pain due to scarring
Endometriosis can be diagnosed by what surgical procedures? (2)
diagnostic laparoscopy
laparotomy
What is the medical treatment for endometriosis? (4)
Combined estrogen/progestin oral contraceptive agents
Progestin alone
Danazol–a testosterone derivative
Gonadotropin-releasing hormone agonist
What is the surgical treatment for endometriosis? (2)
Conservative would include excision, cauterization, or ablation of lesions
Radical would include total abdominal hysterectomy with bilateral salpingo-oophorectomy and removal of adhesions
Salpingo = tubes
Oophoro = ovaries
What are leiomyomas?
fibroids
What determines the growth of leiomyomas?
hormones
Growth potential is related to estrogen production.
Menopause generally stops growth.
What is the pathological mechanism of leiomyomas?
Exact mechanism is unknown, but we need to rule out malignancy.
What are the symptoms of leiomyomas? (3)
Pain
Bleeding–most common symptom
Pressure symptoms
How are leiomyomas diagnosed? (3)
Clinical exam
Imaging–ultrasound most common because CT and MRI is not cost effective
Hysteroscopy
Leimyomas are generally malignant. True or false?
False, most are benign and 30% of women are affected.
Do most leiomyomas require treatment?
No, most are medically managed and examined routinely.
What are surgical treatments for leiomyomas? (2)
Myomectomy in younger pts whose fertility is compromised
Hysterectomy for non-childbearing women
Which surgical treatment, myomectomy or hysterectomy for removal of leiomyomas has higher complications?
myomectomy
