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KEY POINTS

Key Points

  • image Gynecologic causes of acute abdomen include PID and tubo-ovarian abscess, ovarian torsion, ruptured ectopic pregnancy, septic abortion. Pregnancy must be ruled out early in assessment of reproductive age patients presenting with abdominal or pelvic pain.

  • image The general gynecology exam must incorporate the whole physical examination in order to adequately diagnosis and treat gynecologic disorders.

  • image Benign gynecologic pathologies that are encountered at the time of surgery include endometriosis, endometriomas, fibroids, and ovarian cysts.

  • image It is critical that abnormal lesions of vulva, vagina, and cervix are biopsied for diagnosis before any treatment is planned; postmenopausal bleeding should always be investigated to rule out malignancy.

  • image Pelvic floor dysfunction (pelvic organ prolapse, urinary and fecal incontinence) is common; 11% of women will undergo a reconstructive surgical procedure at some point in their lives.

  • image Pregnancy confers important changes to both the cardiovascular system and the coagulation cascade. Trauma in pregnancy must be managed with these changes in mind.

  • image Early-stage cervical cancer is managed surgically, whereas chemoradiation is preferred for stages Ib2 and above.

  • image Risk-reducing salpingo-oopherectomy is recommended in women with BRCA1 or BRCA2 mutations.

  • image Optimal debulking for epithelial ovarian cancer is a critical element in patient response and survival. The preferred postoperative therapy for optimally debulked advanced-stage ovarian epithelial ovarian cancer is intraperitoneal chemotherapy.

  • image Long-term sequelae of intestinal and urologic injury can be avoided by intraoperative identification.

PATHOPHYSIOLOGY AND MECHANISMS OF DISEASE

The female reproductive system includes the external (vulva including the labia, clitoris, and vaginal opening) sex organs as well as the internal organs (uterus and cervix, fallopian tubes, and ovaries) that function in human reproduction. The female reproductive tract has a multitude of tightly regulated functions. The ovaries produce the ova (egg cells) and hormones necessary for maintenance of reproductive function. The fallopian tubes accommodate transit of an ovum to the uterus and provide a location for fertilization. The uterus accommodates an embryo that develops into the fetus. The cervix provides a barrier between the external and internal genital tract. Ongoing activities, such as angiogenesis and physiologic invasion, are necessary in order for the reproductive organs to fulfill their purpose and are usurped in disease. Immune surveillance is regulated in a fashion that allows implantation, placentation, and development of the fetus.

Because the pelvis contains a multitude of spatially and temporally varied functions, pathologies range from mechanical events, such as ovarian torsion or ruptured ectopic pregnancy, to infection, such as pelvic inflammatory disease, to mass effects, including leiomyomata and malignancy, that can present with similar and even overlapping symptoms and signs. An acute abdomen presentation in a woman of child bearing image potential can range from pregnancy-related catastrophes, to appendicitis, to a hemorrhagic ovarian cyst.

The ongoing rupture, healing, and regrowth of the ovarian capsule and endometrium during the menstrual cycle use the same series of biologic and biochemic events that are also active in pathologic events such as endometriosis ...

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