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32 Cards in this Set
- Front
- Back
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No longer is there a routine panel of pre-op testing. WHY?
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Poor sensitivity and specificity in predicting adverse outcomes
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EKG for women > _____, known cardiac disease, increased risk for cardiac disease, risk of electrolyte abnormalities, major surgical procedures (within 1 month)
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55
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CXR for women over ___, suspected cardiac or pulmonary disease (within the past 6 months)
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60
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IUP: Intravenous Pyelogram - not an
effective pre-op screening because why? |
it does not decrease risk of ureteral injury
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What 3 imaging modalities?
Can all help evaluate a suspicious pelvic mass and detect areas suggestive of metastic disease. |
CT Scan - MRI - US
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Elderly Women:
- increased risk for: MI, PE, CVA, DVT, pneumonia, infection, sepsis - decisions on operability based on ______what? |
health status not chronologic age
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For any recently unstable condition, get an internist to declare the pt "______"
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“medically stable”
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How long should pt stop smoking before surgery?
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8+ weeks prior
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HTN pts should take meds on the morning before surgery, exept which kind?
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diuretics (stop 2 days prior)
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Major complication of bowel prep?
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dehydration
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What age is high risk?
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> age 40
surgery for malignancy/lower extremity orthopedic > 30 minute procedure inhibitor deficiency state |
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What womanly condition is high risk?
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Pregnancy is a hypercoagulable state so any surgery carries a higher risk of thromboembolism.
All women undergoing gyn surgery benefit from antithromosis prophylaxis. WHY??? - patient placed in stirrups - manipulation of pelvic vasculature Women on HRT / OC’s: stop 6 weeks prior |
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Pulmonary Risk Factors:
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- upper abdominal surgery
- > 3 hours - poor general health status - COPD - smoking within 8 weeks Probable risks: GET Emergency surgery PaCO2 > 45mmHg Possible risks: current upper respiratory infection, abnormal CXR, age > 70 years old |
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Cervical conization = cone biopsy
What is it? |
Refers to the excision of a cone-shaped portion of the cervix surrouding the endocervical canal and including the entire transformation zone
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The good and the bad of Ablative Procedures: Cryo - Laser
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Good: this is an alternative to conization
Bad: - no pathologic specimens - Cervical tissue is destroyed - purely therapeutic, not of diagnostic value |
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Goal of Cervical Conization Procedures
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to remove the entire transformation zone
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Diff b/w cold and hot cervical conization
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Cold: knife
Hot: cauterizer |
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What cervical conization procedure?
- thin wire - different sized loops - 30 - 40 watts - blend of coagulation / cutting |
LEEP
instrument that looks like a pen with heated wire on the end of it. |
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What does Lugol's solution do?
(on a cervix) |
It doesn't stick to bad tissue
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Cervical Conization Procedures are done on a pregnant pt if what?
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only if there is a strong suspicion of invasive cancer
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Frequently get positive margins / residual disease with pregnant pt's cervical conization procedures. WHY??
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too shallow trying to avoid your complications
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Which cervical conization procedure is this?
To reduce pregnancy loss Helps with hemostasis |
Cone - Cerclage Procedure
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******
Who do you consult with before surgery? |
*******
Anesthesia Cardiology Pulmanology |
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What route does the uterus come out most popularly with hysterectomy?
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Abdominal route is the MC
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indications for hysterectomy
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Leiomyomata
Pelvic Pain Pelvic Relaxation Abnormal uterine bleeding Malignant or pre-malignant disease |
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**REMEMBER** (Hysterectomy)
Confirm absence of cervical dysplasia In women with AUB, exclude ______ cancer |
endometrial
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“Total” vs. “Subtotal” Hysterectomy
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Total = cervix plus uterus
Subtotal = supracervical = uterus only |
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When the ovary cannot be salvaged or insufficient tissue remains, _______-ectomy is performed
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oophor-
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Indications for Oophorectomy
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Benign ovarian neoplasms
Prophylactic oophorectomy Adnexal torsion with necrosis Ovarian malignancy TOA unresponsive to abx Definitive surgery for endometriosis |
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Aspiration of ovarian cysts:
Not recommended. Why? |
No tissue for pathology
Cytology of fluid not reliable for exclusion of malignancy High rate of recurrence No better results with aspiration than observation alone (except pain relief with decrease in size) |
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Refers to a procedure that surgically secures the ovary in a fixed anatomical location so it can’t freely return to its normal position
May shorten it’s lifespan if transposed due to changes in blood supply |
Oophoropexy
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Indications for Oophoropexy
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Shielding pre-menopausal ovary from radiation damage
Torsion, to prevent recurrence and preserve function Prevent adherence to vaginal apex which causes dyspareunia To facilitate access for oocyte retrieval |
