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Gynecologic causes of acute abdomen include pelvic inflammatory disease, tubo-ovarian abcess, ovarian torsion, ruptured ectopic pregnancy, and septic abortion. Pregnancy must be ruled out early in assessment of reproductive-age patients presenting with abdominal or pelvic pain.
The general gynecology exam must incorporate the whole physical examination in order to adequately diagnosis and treat gynecologic disorders.
Benign gynecologic pathologies that are encountered at the time of surgery include endometriosis, endometriomas, fibroids, and ovarian cysts.
It is critical that abnormal lesions of the vulva, vagina, and cervix are biopsied for diagnosis before any treatment is planned; postmenopausal bleeding should always be investigated to rule out malignancy.
Early-stage cervical cancer is managed surgically, whereas chemoradiation is preferred for stage IB2 and above.
Pregnancy confers important changes to both the cardiovascular system and the coagulation cascade. Trauma in pregnancy must be managed with these changes in mind.
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.
Radical hysterectomy has unique risks of ureteral fistula and bowel dysfunction.
Risk-reducing salpingo-oophorectomy (RRSO) should be considered in women with BRCA1 or BRCA2 mutations; RRSO and complete hysterectomy should be considered in women with Lynch syndrome.
Optimal debulking for epithelial ovarian cancer is a critical element in patient response and survival. The preferred primary therapy for optimally debulked advanced-stage ovarian epithelial ovarian cancer is intraperitoneal chemotherapy.
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PATHOPHYSIOLOGY AND MECHANISMS OF DISEASE
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The female reproductive tract is a unique component of the body with a multitude of tightly regulated functions. Many of the activities normally ongoing, 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 modified by multiple mechanisms under investigation and regulated in a different fashion, in order to allow implantation, placentation, and development of the fetus. How this potential disruption of normal immune barriers is involved in pathologic events is incompletely understood.
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The pelvis is a very complex area, with a multitude of spatially and temporally varied functions. It is a site where pathologies ranging 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, can present with similar and even overlapping symptoms and signs. An acute abdomen presentation in a woman of child-bearing potential can range from pregnancy-related catastrophes to appendicitis.
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The ongoing rupture, healing, angiogenesis, and regrowth of the ovarian capsule and endometrium during the menstrual cycle uses the same series of biological and biochemical events that are also active in pathologic events such as endometriosis and endometriomas, mature teratomas, dysgerminomas, and progression to malignancy. Genetic abnormalities, both germline and somatic, that may cause competence and/or promote disease are now being uncovered, especially in the progression to malignancy, in pharmacogenomics, and in surgical ...