Radical hysterectomy
Syn : class 4 radical hysterectomy
Wertheim operation
By this procedure only selective grp of Lymph nodes & only medial 1/2 of cardinal, utero sacral ligaments are removed OR
Removal of uterus tubes ovaries of both sides ,up 1/3 rd vagina adjacent parametrium, draining lymph nodes of cervix
Mucinous cyst adenoma
It is Largest begin ovarian tumor
Origin : arise from totipotent surface epithelium of ovary
Bilateral in 10% cases
Cells resemble those of endocervix
Chance of malignancy 5-10%
Contents : thick mucin- glycoprotein with high polysaccharides
Symptoms of PID
1) B/L lower abd ,pelvic pain (dull)
2) fever headache lassitude
3) irregular excess vaginal bleed
4) abnormal vaginal discharge
5) dysperunia
6) pain discomfort in rt hypochondri due to Perihepatitis (fitz high curtis syndrome)
Culdocentesis
Transvaginal aspiration of peritoneal fluid from cul de sac
• suspected disturbed ectopic pregnancy or haemoperitoneium
• suspected cases of pelvic abscess
Aspiration of peritoneal fluid & its white cell count , if >30k per ml is significant in acute PID
Recto vaginal fistula
Abnormal communication b/w rectum vagina with involuntary escape of flatus or faeces into vagina may be acquired, congenital
C/F: involuntary escape of flatus
If fistula 🤏 incontinence of flatus, loose stool only but not hard stool
Cryptomenorrhea or hematocolpos
There is periodic shedding of endometrium & bleeding but menstrual blood fails to come out from genital tract due to obstruction in passage
Causes : Congenital -imperforate hymen, transverse vaginal septum
Acquired - stenosis of cervix following amputation, cauterisation
Cystocele or prolapse of ant vaginal wall
Formed by laxity & descent of upper 2/3rd of ant vaginal walls
As bladder base closely related to this area there is herniation of bladder through lax ant.wall
Causes : multi parity ,smoking obesity ,pelvic floor weakness, trauma, occupation, asthenia
Krukenberg tumour
Metastatic adenocarcinoma of the ovary, almost all metastasize frm stomach
Spread by lymphatics , peritoneal seeding transcoelomic spread
Histology : signet ring
Delayed puberty
Puberty said to be delayed when breast tissue or pubic hair have not appeared by 13-14 yr or menarche appear as late as 16 yrs
Causes : gonadal dysgenesis
Ovarian failure
Congenital delay
1° hypothyroidism
Cervical polyp
Arise from endocervix rarely ecto stimulus of epithelial overgrowth : hyperoestrinism, chronic irritation by infection, vascular congestion
Small size single red in colour pedicle long enough reach introitus
Symptoms - irregular uterine bleed
Contact bleeding if outside polyp
Vaginal discharge offensive
Red degeneration of fibroid
Carneous degeneration
It occurs in large fibroid during 2nd 1/2 of pregnancy & puerperium
Partial recovery posible Necrobiosis
Causes- not known, vascular origin infection - not play any part
Cut section : raw beef appearance often containing cystic spaces🍖
Odour : fishy due to fatty acids
Colour: haemolysed red cells, Hb
Complications of tubectomy
Abdominal approach :@Immediate - wound infection, peritonitis
@late - incisional hernia
Failure rate - rare
Vaginal approach : hemorrhage, broad ligament hematoma, injury to rectum, @late -dysperunia
Failure rate - more
Cervical biopsy
Confirmatory diagnosis test
Types : surface
👊punch
Wedge
💍Ring
Cone
Acute pelvic pain causes
Due to irritation of peritoneum by either blood or infection
Short duration,sym proportionate to extent of damage
1)Peritoneal irritation:
Disturbed tuabal pregnancy
Ruptured chocolate cyst
2) infection -Acute PID,
3) Chem irritation -abortion
4) non gynec - pancreatitis, UTI
Appendicitis, intestinal obstruction,
Menorrhagia definition, causes
Def : cyclical bleeding at N.Interval bleeding is either excessive in amount or duration or both
Causes : organic, functional
#Organic - fibroid uterus , IUCD , tubercular endometriosis retroverted uterus,granulosa cell T
#Functional - distrubed HPO axis
#C/m causes –DUB, chronic tubo ovarian mass, adenomyosis
Bartholinitis C/F
Local pain discomfort even causes difficulty in walking or sitting
On Ex : tenderness, induration of posterior half of labia palpated b/w thumb out☝finger inside vagina
Causes : gonococcus, e coli, staphylo strepto chlamydia
Perineal body
Obstetrical perineum
Pyramidal shaped tissue where
• pelvic floor
• perineal muscles
• fascia meet b/w vagina & anus
Measured - 4 × 4
Importance - supports levator ani
Vulnerable-injury during childbirth
✂️ these during delivery - episiotomy
Radiotherapy, chemotherapy complications
Hair loss, skin changes
sterility, frequency of urination
nausea & vomiting, immunity low
anemia , thrombocytopenia
Delayed healing, dermatitis
SOB , anxiety grief depression
Cervical biopsy indications
Unsatisfactory colposcopic findings entire margin of lesion not visible
Positive endocervical curettage
When biopsy can’t rule out invasive cancer from CIS or microinvasion
Colposcopy
It is designed to magnify surface epithelium of vaginal part of cervix including entire transformati zone
Magnification -15 to 40 times
Pt with abnormal smear
H/o contact bleeding © -ve smear
When lesion not detected clearly
