TY - CHAP M1 - Book, Section TI - Gynecology A1 - Temkin, Sarah M. A1 - Gregory, Thomas A1 - Kohn, Elise C. A1 - Duska, Linda A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Kao, Lillian S. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. PY - 2019 T2 - Schwartz's Principles of Surgery, 11e AB - Key Points 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. 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 vulva, vagina, and cervix are biopsied for diagnosis before any treatment is planned; postmenopausal bleeding should always be investigated to rule out malignancy. 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. Pregnancy confers important changes to both the cardiovascular system and the coagulation cascade. Trauma in pregnancy must be managed with these changes in mind. Early-stage cervical cancer is managed surgically, whereas chemoradiation is preferred for stages Ib2 and above. Risk-reducing salpingo-oopherectomy is recommended in women with BRCA1 or BRCA2 mutations. 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. Long-term sequelae of intestinal and urologic injury can be avoided by intraoperative identification. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/15 UR - accesssurgery.mhmedical.com/content.aspx?aid=1164315225 ER -