Repro: Monzo- Lecture 2&3 "gyn Surgeries"; Kek

Front 1

what do you legally have to get before any procedure that explains risks, benefits, and alternatives.

Back 1

informed consent

Front 2

If someone refuses treatment, what must you do?

Back 2

write down and sign that they refused treatment or preventative measures

Front 3

What are the current recommendations for pre-op evaluation?

Back 3

H&P, pregnancy test (<60yo), hematocrit, creatinine, and DEPENDING ON SITUATION: CBC (pulmonary fxn tests for evaluation of dyspnea/COPD); ECG (women>55 or risk), CXR,

Front 4

What pre-op imaging studies help with evaluation?

Back 4

IUP (intravenous pyelogram) - however, doesn't decrease risk of ureteral injury; CT; MRI; US (help evaluation suspicious pelvic mass and detect areas suggestive of metastatic disease)

Front 5

what is a coincidental appendectomy?

Back 5

going ahead and taking out an appendix so no else would have to do it later (while your in there...)

Front 6

What pre-op measures should you do to prevent post-operative problems?

Back 6

give antibiotics prophylactically and in elderly patients do an in-patient bowel prep to prevent dehydration

Front 7

Name some important risk and factors concerning surgery on elderly women.

Back 7

They have an increased risk for MI, PE, CVA, DVT, pneumonia, infection, and sepsis. Operability is based on health status not age; ALL ABOUT IMPROVING QUALITY OF LIFE.

Front 8

what measures should you take to ensure hemo stability?

Back 8

stop herbals, aspirin, anticoagulants; get blood type and screen;

Front 9

Who medically clears the patient?

Back 9

all her doctors (doesn't mean surgery is going to go perfectly); STOP SMOKING (8wks prior and post)!(extra: plastic surgeon will not operate on people that smoke - vasoconstriction; delay healing)

Front 10

Can hypertensives take their medication before surgery?

Back 10

YES!, stop diurectics 48hrs prior

Front 11

Why are bowel preps done prior to surgery?

Back 11

preventative: less injury to bowel if empty and not in the way, limits fecal spillage and lessens risk of infection (complication of bowel prep: dehydration)

Front 12

Who is at high risk for thromboembolism?

Back 12

women >40; cancer patients; procedures lasting>30min; pregnant women; legs in stirrups (static blood); women on HRT and OC (stop 6wks prior to surgery)

Front 13

What is involved in the pre-op cardiac assessment?

Back 13

check for any caridac risks; SBE (subacute bacterial endocarditis) prophylaxis with pts with cardiac abnormalities (do echo if murmur present)

Front 14

List the pulmonary risk factors that put a pt at risk for pulmonary complications.

Back 14

upper abdominal surgery; last >3hrs; poor general health; COPD; smoker; general anesthesia; emergency surgery; PaCO2>45mmHg; current URI, abnormal CXR; age >70

Front 15

What is the difference in cone-knife biopsy and conization procedures?

Back 15

cold cone knife biopsy - you actually remove a cone shaped piece of the transformation zone and endocervical canal to diagnose cervical cancer; conization is taking a piece - its a more generally procedure (not in the shape of a cone)

Front 16

Name excisional treatments.

Back 16

use: 1)scalpel, 2)Laser, 3)Electrosurgery/Diathermy (LEEP- Loop Electrosurgical Excision Procedure and LLETZ -Large Loop excision of the Transformation Zone = both are same thing) - advantage of LLETZ/LEEP= tissue can be sent for examination unlike laser where they are destroyed

Front 17

What are ablative procedures and name the disadvatages.

Back 17

cryo-laser; good alternative to conization, but there is no specimen left to look at - it is ablated; purely therapeutic, not for diagnosis

Front 18

what is the goal of a cervical conization procedure?

Back 18

to remove the entire transformation zone

Front 19

Why don't you remove low grade HPV?

Back 19

high incidence of stenosis with conization procedures and low incidence of advancing

Front 20

If you have to do a LEEP during pregnancy, what do you do to prevent miscarriage?

Back 20

do a cervical cerlage procedure - place a stich in the cervix to reduce pregnancy loss

Front 21

Why are D&C (dilation and curettage) done?

Back 21

diagnostic (sampling endometrium, endometrial hyperplasia, insufficient tissue on biopsy, cervical stenosis preventing biopsy, concomitantly wih hysteroscopy/laparoscopy)

Front 22

List the therapeutic indications of D&C.

Back 22

treatment of incomplete, inevitable, missed, septic, and induced abortion; tx of molar pregnancy; manage DUB

Front 23

What are the contraindications to D&C?

Back 23

viable, desired intrauterine pregn.; bleeding diathesis; acute vaginal, cervical, or pelvic infection; cervical cancer obstructing the cervical canal

Front 24

List the complications of D&C.

Back 24

anesthesia related, hemorrhage, uterine perforation, infection, Asherman's Syndrome, Trophoblast embolization

Front 25

What is the most common immediate complication of a D&C?

Back 25

uterine perforation

Front 26

Explain the minimally invasive hysteroscopy.

Back 26

under general anesthesia: insert a tiny telescope into the uterus and inspect the uterus and tubal ostia for any abnormalities; can use a solution to distend the cavity for better visual

Front 27

What are the benefits of hysteroscopy?

Back 27

quick recovery, minimal post-op pain; no wound to get infected

Front 28

Name some contra-indications for a hysteroscopy.

Back 28

systemic health problems, esp. cardio-pulm; pelvic infection; excessive bleeding; cervical cancer; pregnancy (exception: IUD removal)

Front 29

Name some reasons a hysteroscopy would fail?

Back 29

if done in the office: too much pain or stenosis of cervix - can't dilate well; OR: too much bleeding, can't see; may perforate

Front 30

Name the technique used in women with DUB that prevents the lining from growing back.

Back 30

endometrial ablation called resectoscope - used with hysteroscopy

Front 31

Who is a good candidate for ablation?

Back 31

women with abnormal uterine bleeding who have completed child bearing - 1st do an endometrial biopsy to R/O hyperplasia/cancer and any other intrauterine pathologies

Front 32

When is hysteroscopy with resectoscope (ablation) not recommended?

Back 32

large cavity (>12cm), hyperplasia/cancer; submucosal fibroid/polyp, severe dysmenorrhea

Front 33

Name the instrument. Telescope through umbilical port to visualize pelvic organs on a video monitor.

Back 33

Laparoscopy

Front 34

Describe how laparoscopy is done.

Back 34

use general anesthesia, inflate the abdomen with CO2, trocar is placed through an incision that allows the use of different instruments needed; there are 3 incisions made that allow for different instruments: midline and laterally in the lower abdomen with trocar through umbilicus

Front 35

Who should not have a laparoscopic surgery?

Back 35

people with health problems (cardio, pulm); people with hx of multiple abdominal surgeries (too many adhesions causing limited access)

Front 36

Name the most common performed gynecologic procedure.

Back 36

hysterectomy - 90% are for a benign cause and abdominal route is the most common

Front 37

Name some medical and surgical alternatives to hysterectomy.

Back 37

Hormonal Tx: progestins for hyperplasia; GnRH analogs (for painful endometriosis); Pain Control; Conization; Endometrial Ablation; D&C, Hysteroscopy; Abdominal Myomectomy

Front 38

What are the main indications for doing a hysterectomy?

Back 38

Leiomyomata, Pelvic Pain, Pelvic Relaxation, Abnormal Uterine Bleeding, malignant or pre-malignant disease

Front 39

What are the concerns of the patient when having a hysterectomy?

Back 39

problems with: 1) sexual fxn (research shows no change); 2)Pelvic Organ prolapse; 3) incontinence/constipation; 4)Cyclic Vaginal Bleeding; 5) must have PAPs afterwards

Front 40

What are the concerns for the doctor when doing hysterectomies?

Back 40

length of surgery/hospital stay is longer; amount of blood loss/transfusion rate; few complications/ureteral injury; routine screening post-op

Front 41

Name the 4 routes of hysterectomies.

Back 41

abdominal, vaginal, LAVH (laparoscopic assisted vaginal hysterectomy), and Total Laparoscopic hysterectomy.

Front 42

what is the difference in a total vs subtotal hysterectomy?

Back 42

total = cervix plus uterus; subtotal= supracervical (uterus only)

Front 43

According to the ACOG, what is the safest route of doing a hysterectomy?

Back 43

vaginal

Front 44

Compare a vaginal vs. abdominal hysterectomy?

Back 44

Vaginal= shorter hospital stay, speedier recovery, fewer infections or fevers

Front 45

Compare laparoscopic hysterectomy vs. abdominal hyst.

Back 45

Lap= less blood loss, shorter hospital stay, speedier recovery, fewer wound infections, longer operating time, more UTIs

Front 46

compare lap vs. vaginal hysterectomy.

Back 46

similar outcomes, Lap= takes longer in OR

Front 47

If surgery is for a benign case, always try and ____ salvage the ovaries.

Back 47

salvage

Front 48

Name the indications for oophorectomy.

Back 48

benign ovarian neoplasms; prophylactic oophorectomy; adnexal torsion with necrosis; ovarian malignancy; TOA unresponsive to antibiotics; definitive treatment for endometriosis

Front 49

What is the difference in laparotomy vs. laparoscopy?

Back 49

opening up the abdomen vs. three small incisions and using a scope; laparoscopy - newer and better

Front 50

If you find a malignancy, what must you do immediately.

Back 50

get a frozen section done right then; if malignant do an open surgical procedure for staging; have a gyn-onco on standby

Front 51

When doing laparoscopic surgery, what tools can you use to remove tissue.

Back 51

loop, bipolar electrocautery, stapling device, and harmonic scalpel

Front 52

Name the possible complications with ovarian surgery.

Back 52

bleeding, injury to bowel/bladder, ureteral injury, ovarian remnant syndrome, spillage of malignant cells

Front 53

Why should you not aspirate ovarian cysts?

Back 53

no tissue for pathology, not reliable for exclusion of malignancy, high rate of recurrence

Front 54

name the term that describes moving the ovary from its normal position to preserve its fxn and get it out of harms way.

Back 54

oophoropexy

Front 55

What are some disadvantages of oophorectomy, esp. in a younger woman.

Back 55

early menopause (hot flashes, vaginal atrophy); osteoporosis, increase in LDL, decrease in libido

Front 56

What measures do you take to prevent surgical sites infections?

Back 56

maintain sterile techniques, attention to hemostasis, sharp dessection, minimal tissue destruction, prophylactic ABX,

Front 57

What measures do you take post-operatively to reduce risks of complications.

Back 57

DVT prophylaxis/Heparin, compression stockings, pulmonary spirometry, early ambulation