1 / 62

SUR 122

SUR 122. OBSTETRICAL & GYNECOLOGICAL SURGERY. OB-GYN Surgery. Female From beginning of menses. OB-GYN Specialists. Obstetricians: pregnancy Gynecologists: Breast Surgery (non-reconstructive) Bladder Tac related Surgeries: pubovaginal Sling, TVT (tension

salena
Télécharger la présentation

SUR 122

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SUR 122 OBSTETRICAL & GYNECOLOGICAL SURGERY

  2. OB-GYN Surgery • Female • From beginning of menses

  3. OB-GYN Specialists • Obstetricians: pregnancy • Gynecologists: Breast Surgery (non-reconstructive) Bladder Tac related Surgeries: pubovaginal Sling, TVT (tension vaginal tape, A & P Repair, etc.) • Can be both or one or the other • Fertility Specialists • Oncology Gynecologist

  4. Obstetrical & Gynecological Surgery • Reasons For: • Diagnose abnormalities • Treat abnormalities • Pain relief • Prevention of pregnancy • Aide in conception for infertile couples • Prevention of spontaneous abortion • Cesarian delivery (abdominal) when vaginal delivery not possible

  5. The Female Reproductive System • Anatomy & Physiology • Pathology • Diagnostic & Pre-operative Testing • Anesthesia & Medications • Basic Supplies, Instrumentation, & Equipment • Positioning, Prep, & Draping • Dressings, Drains, & Post-operative Care

  6. Pelvis • Pelvic girdle • Ilea • Ischia • Pubic bones • Vertebral column • Sacrum

  7. Anatomy & Physiology • External Female Genitalia (Vulva) • Mons pubis • Labia majora • Labia minora • Urethral orifice • Vaginal orifice • Clitoris • Hymen • Perineum • Anus

  8. External genitalia • Labia minora form the clitoris and contain sebaceous glands • Vestibule is the cavity between the labia minora • Contains urethral meatus and Bartholin’s (vestibular) glands • Perineum is the area between vaginal opening and anus • Can stretch with delivery however is frequently cut with an incision called episiotomy to prevent spontaneous tears during vaginal delivery

  9. Vagina External Cervical Os Cervix Uterus Layers of: peritoneum myometrium endometrium Parts of: Body Fundus Adnexa Fallopian Tubes Ovaries Supporting Structures Internal Structures

  10. Vagina • Receptacle to penis • Passageway for menstrual flow • Lower portion is the birth canal

  11. Uterus • Function: • Site of menstruation • Or • Site of implantationif implantation occurs then is the site of fetal development

  12. Uterus • Parts of: • Dome shaped portion=fundus • Central portion=body • Where narrows=cervix • Internal cervical os=where uterus and cervix meet • External os=where cervix meets vagina

  13. Lining of: Perimetrium=outside of uterus covered in a this serous membrane lining Myometrium= -smooth muscle lining -middle layer -fetal support -during labor expels fetus with assistance of hormone oxytocin 3. Endometrium=inner lining2 parts: stratum basalis permanent layerthin Stratum functionalis -produced by s. basalis -temporary layer -shed w/menstruation -produces maternal portion of placenta Uterus

  14. Uterus • Blood supply: • Uterine artery and uterine vein

  15. Ovaries • Function: • Production and expulsion of oocytes (ova or eggs) • Release of hormones: estrogen and progesterone • Are both endocrine and exocrine glands • Exocrine produce eggs (ducts=fallopian tubes) • Endocrine portion produces estrogen and progesterone

  16. Ovaries • Attachments: • Broad ligament -largest formed by a fold of peritoneum -contains fallopian tube, round and ovarian ligaments, blood vessels, lymphatics, and nerves • Suspensory ligament • Ovarian ligament

  17. Ovaries • Suspensory ligament -small peritoneum fold -holds ovaries at upper end -contains blood vessels and nerves • Ovarian ligament -attaches ovaries at their lower end -is actually a thickening in the broad ligament

  18. Fallopian tubes • Egg is caught by finger-like projections called the fimbrae after it is released from the ovary • Funnel shaped end prior to fimbrae=infundibulum

  19. Fallopian tubes • 2 layers: 1.Mucous membrane innermost • Is lined with ciliated columnar epithelial tissue • Allows for movement of the egg • Scarring from STDs can damage or scar this lining rendering a female sterile

  20. Fallopian tubes 2. Muscularis • Smooth muscle • Peristalsis or movement of the egg • So… • Egg movement through the fallopian tubes occurs by cilia and peristalsis • Fertilization must occur in the distal 1/3 of the fallopian tubes for successful implantation into the uterus

  21. Physiology • Ovarian cycle caused by anterior pituitary gland which secretes: • LH “ovulation hormone” • FSH levels must be low to allow ovulation • Causes secretion of estrogen • Menses is caused by a sudden decrease in estrogen and progesterone triggered by no fertilization

  22. Hormones 1. FSH • Produced in anterior lobe pituitary • Causes graafian follicular development • Causes estrogen secretion

  23. Hormones • LH • Produced in anterior lobe pituitary • Continues follicular development • Stimulates estrogen and progesterone production • Causes ovulation

  24. Hormones • Estrogen • Maintenance and development of reproductive organs and female sex characteristics

  25. Hormones • Progesterone • Primary cause of endometrial changes • With Prolactin (hormone) influences mammary glands to develop and secrete milk • Milk secretion and labor is stimulated by oxytocin (hormone)

  26. Physiology • In the ovary > the big 4 hormones are increasing which develops a follicle • Follicle becomes a graafian follicle • Graafian follicle rupture>egg released into fallopian tubes • Outer rind of graafian follicle becomes corpus luteum

  27. Physiology • 2 possibilities: • No fertilization=corpus luteum degenerates and becomes corpus albicans and cycle starts over • Fertilization=corpus luteum maintained four months to suppress egg production and menstruation with estrogen and progesterone • Progesterone levels must be high enough to maintain endometrial lining to sustain pregnancy • Corpus luteum acts as a temporary endocrine gland • After four months placenta is developed and takes over

  28. Obstetrics

  29. Pregnancy (Obstetrics) Procedures • Cerlage (MacDonald or Shirodkar) • Deliveries: • Vaginal • Cesarian sections (C-sections) • Tubal ligations (sterilization procedures) • Emergent hysterectomy

  30. Pregnancy Terminology • Labor • Four stages of: • True labor onset • Cervical dilation complete>birth • Birth>placental delivery • Placental delivery > stabilization of mother • Primapara • 6-18 hours • ½ - 3 hours (dilation 1 cm/hr) • 0-30 min • 6 hours • Multipara • 2-10 hours • 5-30 min (dilation 1.2cm/hr) • 0-30 min • 6 hours

  31. Pregnancy Terminology • Braxton Hicks - “false labor” • Bloody show – onset of labor • Cervical dilation - cervical measurement (0 to 8cm) • Cervical Effacement – thinning of cervix • Crowning - neonate head circumference at its largest point as it passes thru vulvar ring

  32. Pregnancy Terminology • Descent – movement of fetus thru pelvis with contractions • Expulsion – delivery of infant • Gravida - how many times a woman has been pregnant • Parity – number of time a woman has given birth • Position – relationship between presenting infant part & pelvis of mother (OA) most common • Presentation – fetal part overlying pelvic inlet • Station – measurement of the descent of the infant’s presenting part thru the ischial spines

  33. Presentation • Breech - buttocks first • Transverse – crosswise • Footling – feet • Vertex – upper back of head

  34. Obstetrical Complications • Placenta previa – placental implantation over cervix • Abruptio Placenta – premature placental separation

  35. Obstetrical Complications • Abortions • Missed • Incomplete • Imminent • Spontaneous • Voluntary

  36. Benign Cysts Polyps (pedunculated lesion) Fistulas Dysplasia Leiomyoma/Myoma/Fibroid Fibroma Malignant Vulvar Vaginal Cervical Uterine Ovarian Other Endometriosis Cystocele Rectocele (posterior colporrhaphy) Enterocele Ectopic Pregnancy Incompetent Cervix (cerclage) Pathology

  37. Colposcopy Hysteroscopy D & C D & E Laparoscopy Hysterectomy Oophorectomy Salpingectomy Abdominal Hysterectomy subtotal total radical (Wertheim) Vaginal LAVH A & P Repair Le Fort Bartholin’s Cyst (I & D) Gynecological Procedures

  38. Patient symptoms: • Abnormal bleeding • Abdominal pain • Absence of menses (amenorrhea) • Excessive menses (menorrhagia) • Painful menses (dysmenorrhea) • Painful intercourse (dysparunia) • Painful defication (dyschezia)

  39. Pre-Operative & Testing Diagnostic • Physical exam • UA, CBC, Blood Chemistry • Pelvic exam • Bi-manual exam • Colposcopy • PAP (papanicolaou smear) • Schiller Test • Biopsy • Ultrasound • MRI • X-ray • Laparoscopy • D & C

  40. Anesthesia • General • Spinal • MAC with IV Sedation

  41. Medications • Oxytocics: • Stimulate uterine contraction to induce labor • Post-delivery of baby and placental contents to induce uterine contraction allowing for expulsion of excess tissue and clots • Post-delivery to prevent bleeding/hemorrhage

  42. Medications • Lugol’s solution • Iodine based • Identification of abnormal vaginal and or cervical tissue • Tissue that is abnormal will not stain • Tissue that is normal will stain brown • Schiller’s Test

  43. Medications • 3% Acetic Acid • Facilitates cervical visualization by removing cervical mucous • Used during a colposcopy • Methylene blue • Dye • Diluted with NS • Direct > Checks for tubal patency (chromotubation) • IV > excreted by the kidneys into the urine rules out ureteral injury as abdominal procedure concludes

  44. Medications • Antimicrobials • Prophylactic • IV • ung (ointment) utilized with vaginal packing materials

  45. Medications • Hysteroscopy solutions (for uterine distention) • Dextrose 5% (D5W) • Dextran 70% in dextrose • Glycine • Sorbitol • Above may all be used with laser or cautery • Hyskon (rarely used anymore due to ↑ laser use) • No cautery or lasers may be used as would cause systemic absorption>systemic side effects

More Related