SUR 104 unit 3

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jb124
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173872
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SUR 104 unit 3
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2012-09-28 00:16:08
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OB GYN surgeries
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OB/GYN surgeries
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  1. parturition
    birth
  2. fertility medicine combines what to achieve and maintain pregnancy?
    gynecology and endocrinology
  3. size and shape of uterus
    3 inches long and 2 inches deep
  4. what does uterus do?
    houses and protects the fetus during pregnancy
  5. what is uterus composed of?
    • thick muscular tissue
    • suspended by ligaments that completely enclose the organ
  6. superior portion of the uterus
    fundus
  7. middle portion of uterus
    body
  8. lower portion of uterus
    cervix
  9. lines the uterus and changes under hormonal influence and with pregnancy
    endometrium
  10. thick muscular layer that is continuous with the muscles of the vagina and fallopian tubes
    myometrium
  11. outer serous layer of the uterus
    perimetrium
  12. which uterine layer contracts during childbirth and menses?
    myometrium
  13. pouch formed by reflection of abdominal peritoneum over bladder
    cul-de-sac
  14. fold of peritoneum over bladder
    bladder flap
  15. ligaments that suspend uterus from pelvic wall
    broad ligaments
  16. ligaments that lie above the broad ligaments near the fallopian tubes that help suspend uterus anteriorly
    round ligaments
  17. ligaments that lie below broad ligaments and provide primary support for uterus
    cardinal ligaments
  18. ligaments that curve along bottom of the uterus and attach it to the sacrum
    uterosacral ligaments
  19. how many sections do fallopian tubes have?
    4
  20. section of fallopian tubes that connects to the uterus
    interstitial section
  21. midportion section of fallopian tubes
    isthmus
  22. widened portion of fallopian tube
    ampulla
  23. terminal end of fallopian tube
    infundibulum
  24. small projections that extend from the end of fallopian tube that direct ovum toward infundibulum during ovulation
    fimbriae
  25. ligament that suspends fallopian tube from upper margin of pelvis
    infundibulopelvic ligament
  26. secrete female hormones
    ovaries
  27. peritoneal tissue that suspends ovaries - attached to uterus by ovarian ligaments
    mesovarium
  28. how many eggs do ovaries contain?
    approximately 1 million
  29. fibrous outer layer of ovary - contains follicles that hold ova
    cortex
  30. inner core of ovary composed of connective and vascular tissue
    medulla
  31. development and release of ova are influenced by what?
    pituitary gland
  32. what hormones does pituitary gland stimulate?
    LH and FSH
  33. recessed areas around cervix
    fornices
  34. incision of the perineum during the second stage of labor to prevent tearing
    episiotomy
  35. hormonal and physical changes that occur regularly from the onset of menarche until menopause
    ovarian cycle
  36. what is ovarian cycle controlled by?
    complex feedback system involving hormones of pituitary, hypothalamus, and ovaries
  37. phases of ovarian cycle
    • follicular phase
    • ovulatory phase
    • luteal phase
  38. follicular phase
    • this phase lasts from day 1 to day 14
    • levels of FSH and LH rise
  39. ovulatory phase
    • begins approximately 14 days from start of cycle and lasts from 16 to 32 hours
    • estrogen level falls
    • progesterone is secreted by follicle and causes by release of ovum
  40. luteal phase
    • begins approximately on day 16 and lasts approximately 12 days
    • corpus luteum secretes estrogen and progesterone, which changes endometrium
    • FSH and LH levels fall, CL regresses and endometrial lining shed
  41. medical assessment for procedures is derived from?
    • menstrual history
    • obstetrical history
    • use of contraceptives
    • history of previous infection
    • signs and symptoms
    • current medications and allergies
    • family history
    • social history
  42. excessive bleeding during menstruation
    menorrhagia
  43. painful intercourse
    dyspareunia
  44. most common type of vulvar cancer
    squamous cell carcinoma
  45. most common and easily treated cancer of reproductive tract with early diagnosis
    • cervical cancer
    • detection done with Pap smear and culposcopy
  46. cancer associated with obesity and high levels of circulating estrogen
    endometrial cancer
  47. condition in which endometrial tissue develops anywhere outside uterus
    endometriosis
  48. benign neoplasm arising from the uterine smooth muscle tissue and attached to the uterine body
    • leiomyoma
    • also called fibroid tumor
  49. herniation of rectum
    rectocele
  50. herniation of bladder
    cystocele
  51. uterus bulging into vagina resulting from weakness and stretching of the cardinal ligaments
    uterine prolapse
  52. what is injected into the uterine cavity during a sonohysterography?
    normal saline, lactated Ringer solution, or 1.5% glycine
  53. what is injected into the fallopian tubes and uterus for hysterosalpingography?
    radiological contrast medium
  54. what type of cells are tested for cervical cancer?
    epithelial cells
  55. Pap smear procedure
    epithelial cells are collected from the internal cervical os with a delicate plastic "brush," which is then swirled in prep solution
  56. microscopic examination and biopsy of the cervix
    colposcopy
  57. what happens during a colposcopy?
    the cervix is painted with acetic acid, which causes preinvasive cells to appear white, which are biopsied with forceps
  58. what is treated with cone biopsy?
    • epithelial carcinoma of cervix
    • severe dysplasia
  59. what does a cone biopsy involve?
    removal of a circumferential core of tissue around the cervical canal
  60. procedure in which conization is performed using a local anesthetic and electrosurgical loop filament
    LEEP (loop electrosurgical excision procedure)
  61. what happens during hysteroscopy?
    • semirigid or rigid hysteroscope is used to examine the interior of the uterus and to perform selected operative procedures
    • uterus is filled with a clear fluid to increase visibility
  62. most GYN procedures are performed with the patient in what positions?
    supine or lithotomy
  63. critical safety considerations for lithotomy position
    • protect the patient's modesty and dignity at all times
    • all patients wear antiembolism stockings or sequestial pressure device
    • raise both legs simultaneously and slowly by 2 people
    • make sure hips are slightly externally rotated
    • raise or lower legs only after ACP advised it is safe
    • make sure hands are not near table break
    • lower legs simultaneously and slowly
  64. during open abdominal procedures, where does a right-handed surgeon stand?
    at the patient's left side
  65. during laparoscopic procedures, how is patient positioned?
    low lithotomy position with one assistant positioned at the foot of the table
  66. how is pregnant patient positioned during a laparoscopic procedure?
    modified left lateral position to prevent hypotension from pressure on the vena cava by the fetus
  67. combined abdominal/vaginal procedure prepping
    • perineal prep is performed first
    • always prepare 2 sites sequentially, not simultaneously
    • separate prep kit and gloves required for each site
  68. instruments used for procedures of fallopian tubes
    • atraumatic graspers and delicate dissecting instruments
    • bipolar electrosurgical unit (rather than monopolar)
    • microinstruments used to anastomose the tubes
  69. instruments used for fibrous ligaments
    require tight, strong clamps that do not slip
  70. instruments used for uterus
    heavy dissecting scissors and toothed or grooved clamps for resection
  71. laparoscopic instruments
    • specialized for reproductive structures
    • Babcock or other atraumatic forceps
    • Harmonic shears
    • monopolar hook dissector
    • graspers
    • vessel-sealing system
  72. open GYN procedure instruments
    genearl surgery setup with uterine clamps, plus additional atraumatic clamps, long instruments, Harmonic shears and high-frequency vessel-sealing system
  73. transvaginal pelvic procedure instruments
    vaginal speculums and long instruments including uterine clamps and heavy dissecting scissors
  74. transcervical procedure instruments
    graduated cervical dilators, uterine sounds, forceps, sharp and smooth curettes, ample supply of sponges
  75. what is used during colposcopy for staining the cervix during the Schiller test?
    Lugol solution
  76. drug that causes constriction of blood vessels when injected
    vasopressin (Pitressin)
  77. what drug is used in emergency cardiac response and may be injected into the uterus during hysterectomy or into a benign uterine tumor to prevent bleeding?
    vasopressin (Pitressin)
  78. what drug is administered after delivery of the fetus and placenta to prevent postpartum hemorrhage?
    oxytocin (Pitocin)
  79. what drug is an ergot alkaline administered after abortion to enhance uterine contractions and control uterine bleeding?
    methylergonovine (Methergine)
  80. type of sutures used for uterine ligaments and vessels
    absorbable synthetic 0 to 2-0 Vicryl taper needle
  81. type of sutures used for bladder reflection
    absorbable synthetic 2-0 to 3-0 small taper needle
  82. type of sutures for ovary
    absorbable synthetic 3-0 to 4-0 small taper needle
  83. type of sutures for fallopian tube repair/anastomosis
    inert monofilament or braided 5-0 to 7-0
  84. type of sutures for vaginal vault
    absorbable synthetic 2-0 to 3-0 medium curved needle
  85. type of sutures for plastic procedures of vulva
    Nylon, Prolene or other monofilament, 3-0, 4-0; 3/8 cutting needle
  86. during laparoscopic pelvic surgery, when is the uterine manipulator passed through the cervical os?
    after complete abdominal and vaginal prep, and immediately before surgery
  87. what is maryland dissector used for?
    blunt dissection
  88. what body parts are prepped for laparoscopy?
    abdomen, perineum and vagina
  89. what is often performed in conjunction with a laparoscopy?
    D&C
  90. laparoscopic procedure
    • surgeon elevates abdominal wall by inserting 2 sharp towel clips on either side of umbilicus lifting wall away from retroperitoneal vessels
    • nick is made in periumbilical region with scalpel
    • Veress needle inserted into periumbilical incision
    • saline injected into needle port
    • negative pressure pulls saline into abdomen
  91. what are patients observed for postoperatively after laparoscopy?
    • signs of embolism, infarct, and hemorrhage
    • patients experience shoulder pain for several days postop (referred pain from diaphragm)
  92. first procedure to be performed with laparoscope
    tubal ligation
  93. 3 methods of tubal ligation
    • transection and coagulation
    • fallope ring
    • filshie clip
  94. transection and coagulation method
    • fallopian tube grasped with Babcock forceps
    • HF bipolar unit severs tube and coagulates free ends
  95. fallope ring method
    • surgeon inserts ring applicator through trocar and withdraws loop of fallopian tube into applicator
    • Silastic ring is ejected over the loop which is then released back into pelvis
  96. how does fallope ring work?
    causes local ischemia and eventual necrosis of loop of tissue
  97. filshie clip method
    • filshie applicator is inserted through single port
    • clip applied over fallopian tube and clamped
  98. pomeroy technique
    • through minilaparotomy incision or after cesarean section
    • fallopian tube severed and ligated
    • stump buried in uterine serosa with absorbable sutures
  99. why is exploratory laparoscopy performed?
    to confirm pathology of ovarian mass
  100. removal of ovary
    oophorectomy
  101. removal of ovarian cyst
    ovarian cystectomy
  102. ovarian tumor that arises from one of the germ layers of developing embryo
    teratoma (dermoid cyst)
  103. pelvic washing
    • 50 mL to 100 mL of normal saline introduced into abdomen
    • fluid is then aspirated and retained as a specimen
  104. how does surgeon remove a cyst?
    • incises cortex without rupturing with fine scissors or ESU pencil
    • cortex is removed using blunt dissection
    • atraumatic grasper may be used to facilitate removal
    • suction-irrigator may be used to separate cyst from cortex
    • bipolar ESU controls bleeders
    • specimen placed in specimen retrieval bag and delivered through 10-mm trocar port
  105. how is cyst removed if it is too large for retraction?
    can be reduced with a morcellator and the pieces can be brought out through bag opening
  106. how is a teratoma removed?
    intact by sharp dissection
  107. what frequently occurs as a result of an infection that spreads from lower genital tract to uterus, fallopian tubes and ovaries?
    obstruction of the fallopian tube
  108. causal organism of PID?
    usually Chlamydia trachomatis or Neisseria gonorrhoeae
  109. what is instilled transcervically to establish patency of the fallopian tube during tubal anastomosis?
    indigo carmine or methylene blue dye
  110. what types of sutures are used for tubal anastomosis?
    Nylon or polypropylene 8-0 or 9-0 suture with a tapered needle
  111. removal of uterus by a combined laparoscopic and vaginal approach
    • laparoscopic-assisted vaginal hysterectomy
    • most common approach to hysterectomy
  112. why is LAVH approach performed?
    • benign tumors
    • endometriosis
    • early stage uterine malignancy
  113. procedure in which uterus and cervix is surgically removed through pelvic incision
    total abdominal hysterectomy
  114. patient position for TAH
    supine position
  115. dissection and wide removal of uterus, tubes, ovaries, supporting ligaments, upper vagina, and pelvic lymph node chains
    radical hysterectomy
  116. why is radical hysterectomy performed?
    to treat pelvic malignancy
  117. most common type of cancer in female reproductive tract
    endometrial cancer
  118. excess proliferation of tissue
    hyperplasia
  119. primary symptom of endometrial cancer
    painless bleeding
  120. how is a diagnosis of endometrial cancer made?
    by D&C
  121. radical hysterectomy instruments
    long dissecting instruments (right-angle clamps, long Metzenbaum scissors, toothed forceps, and long, curved hemostats)
  122. sutures for radical hysterectomy
    size 0 and 2-0 synthetic absorbable material
  123. what is patient closely monitored for after radical abdominal or pelvic surgery?
    • urinary output
    • hemorrhage
    • infection
  124. complete removal of rectum, distal sigmoid colon, urinary bladder and distal ureters, and internal iliac vessels and their lateral branches
    pelvic exenteration
  125. why is pelvic exenteration performed?
    to treat metastatic cancer
  126. why is operative hysteroscopy indicated?
    intrauterine pathology, such as polyps, leiomyoma, adhesions, and septal defects of the uterus
  127. what is done to obtain a clear view of the uterine wall for hysteroscopy?
    uterine cavity is distended with fluid
  128. what type of fluid is used to distend bladder for hysteroscopy?
    isotonic solution such as normal saline
  129. what happens if electrolytic solutions are used with the monopolar circuit?
    electricity would be dispersed throughout the fluid and might cause patient burns
  130. low serum sodium level
    hyponatremia
  131. hysteroscope
    rigid or semirigid
  132. what does a rigid scope incorporate?
    12- to 30-degree angled lens at the distal tip
  133. how is the hysteroscope used?
    it is inserted into the uterus with the sheath in place
  134. what kind of light source is included on hysteroscope equipment?
    fiberoptic light cable and xenon light source
  135. what is a uterine resectoscope used for?
    to remove polyps, subcutaneous leiomyomas, and uterine adhesions
  136. destruction and scarification of the endometrium to render it nonfunctional
    endometrial ablation
  137. 3 common ablation methods
    • rollerball ablation
    • global
    • intrauterine device
  138. variety of global ablation methods
    • NovaSure - radiofrequency energy - automatically stops when dangerous
    • ThermaChoice UBT - silicone balloon catheter that distends adn begins a warming cycle up to 188.6 F (87 C) (takes 8 min)

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