TERNOPIL STATE MEDICAL UNIVERSITY

TERNOPIL STATE MEDICAL UNIVERSITY

 METHOLOGICAL INSTRUCTIONS

TO PRACTICAL LESSON FOR 6-Th YEAR STUDENTS

OF FACULTY OF FOREING STUDENTS

Content’s module 9.

 

LESSON ¹ 14 (6 hours)

 

Themes: 

 

THEME 1. “Acute” abdomen in gynecology

THEME 2. Gynecological operations.

THEME 3. Preoperative and postoperative follow-up of gynaecological patients.

 

 Aim:

to be able to recognize the main disease caused the symptoms of “acute abdomen”, to make the correct diagnosis, to learn the methods of treatment and surgical correction of this pathology; to study the methods of preoperative preparation of gynecological patients and the principles of postoperative treatment, be able to reveal the main indications to major surgical procedures performed on women of reproductive age and be acquainted with technique of different operations.

 

 Professional orientation of students:

There are some diseases which have clinic called the “acute abdomen”: ectopic pregnancy, ovarian apoplexy, torsion of the tumor’ pedicle. Extraordinary important is the correct diagnostics and differential diagnostics with surgical pathology. In this cases operation is the only way for the patient’s convalescence, and sometimes for saving of her life. Learning of the pre- and postoperative management of the gynecological patients is important for general practice doctor.

 

1. Methodology of Practical Class– from 9.00-12.00

 

Visual Aids and Material Tools: Tables, slides, compact-disk

 

Theme ¹ 1.

Work 1. To take patients’ history, perform general objective examination of the gynecological patient. Pay attention to the signs of peritoneal irritation.  

Work 2. To prescribe the management for the patients with urgent gynecological problem. To evaluate the results of additional methods of diagnosis which are taken from the female history (speculum, pelvic examination, ultrasound, colposcopy, laboratory findings) and to perform the differential diagnosis with similar diseases.

Work 3. To confirm and formulate the preliminary diagnosis and to prescribe adequate treatment for the patients with gynecological disease.

Theme ¹ 2.

1. Analyzing the female histories to confirm the importance of surgical intervention.

2. To collect the necessary instruments for uterine sounding, culdocentesis, uterine curettage, cervical biopsy.

Theme ¹ 3.  Preoperative care, postoperative treatment of the patients. Management of the patients after intestinal and urinary bladder injury. 

1. To make the plan of preoperative examination to surgical intervention in gynaecological disease.

2. To make the plan of preoperative examination in surgical intervention in uterine myoma.

3. To make the plan of examination before surgical intervention on the adnexa.

4. To perform objective examination of the gynecological patient in the postoperative period, to assess its duration.

5. To prescribe the adequate management of postoperative period of gynecological patient.

 

2. Individual Students Program.

Theme 1. Urgent states in gynecology.

1.     Ectopic pregnancy. Classification, etiology, clinical symptoms.

2.     Outcome of ectopic pregnancy: tubal rupture and tubal abortion, unruptured ectopic pregnancy.

3.     Clinic of ruptured ectopic pregnancy (tubal rupture, tubal abortion).

4.     Clinic of unruptured ectopic pregnancy

5.     Making diagnosis of ectopic pregnancy. Algorithm of diagnostics (ultrasonography, pregnancy test, culdocentesis, laparoscopy).

6.     Surgical and conservative treatment of ectopic pregnancy.

7.     Ovarian, cervical, abdominal pregnancy. Pregnancy in rudimentary horn.

8.     Ovarian apoplexy. Etiology, clinical symptoms, diferential diagnosis, treatment.

9.     Torsion of the tumor’ pedicle. Clinical symptoms, algorithm of diagnostics, surgical treatment.

10. Rupture of ovarian cyst. Clinical symptoms, algorithm of diagnostics, surgical treatment.

9. Rupture of tuboovariam mass. Clinical signs, algorithm of diagnostics, surgical treatment.

10. Trauma of the female sexual organs. Clinical signs, algorithm of diagnostics, surgical treatment.

 

THEME 2.  Typical gynecological operations. Endoscopic operations

1. Uterine sounding. Technique, instruments, indications, contraindications.

2.  Cervical biopsy. Operations on the uterine cervix Emett’, Shturmdorf.  Technique, instruments, indications, contraindications.

3. Polipectomy. Technique, instruments, indications, contraindications.

4.  Culdocentesis. Technique, instruments, indications.

5.  Uterine curettage. Technique, instruments, indications, contraindications.

6. Operations on the fallopian tubes. Technique, instruments, indications, contraindications. Technique, indications, contraindications.

7. Adnexectomy. Technique, indications, contraindications.

8. Ovarian resection. Technique, indications, contraindications.

9. Supracervical (subtotal) hysterectomy. Indications, conditions, technique.

10.  Total hysterectomy. Indications, conditions, technique.

11. Vaginal hysterectomy. Indications, conditions, technique

12.  Endoscopic operations.  Indications, conditions, technique

 

THEME 3. Preoperative care, postoperative treatment of the patients. Management of the patients after intestinal and urinary bladder injury.

1. Aspects of the preoperative management of gynecological patients.

2. Preoperative care of the gynaecological patients.

3. Management of the postoperative period after surgical abdominal  interventions. Prevention of thrombembolic complications.

4. Management of the postoperative period after surgical vaginal  operations.

5. Methods of anesthesia of gynecological operations.

6. Management of the patients after intestinal and urinary bladder injury.

 

3. Seminar discussion of theoretical issues12.30-14.00 (1,5  hours)

 

4. Test evaluation and situational tasks.

1. The basic methods of surgical instruments sterilization are:

A. boiling

B. dry heat sterilization

C. steam sterilization under pressure

D. nothing above

E. all methods are equal

2. During salpingoectomy clips are not putting:

A. on the uterine end of the tube

B. methosalpings

C. on the lig.ovarian proprii

D on all of these anatomical structures

E. nothing above

3. Abnormal spotting in caseof tubal miscarriage may occur:

A. after a delay of menstruation

B. prior to the beginning of next menstrual

C. the beginning of the next menstrual cycle

D. all above

E. nothing above

4. In case of ectopic pregnancy do not use operations:

A. segmental resection of the tube

B. salpingoovariolizis

C. salpingostomy

D. salpingektomy

E. nothing above

5. When supracervical hysterectomy of uterus with both adnexa crossed and ligation of following ligaments:

A. Round, broad, cardinal

B. Round, broad, proper ligament of ovary and tube

C. Round, broad, infundibulopelvicum ligament

D. Round, broad, proper ligament of the ovary, the cardinal, as well as tubes

E. Round, broad, cardinal, infundibulopelvicum ligament.

 

5. Student's individual work from 14.15 till 15.00.

Students, who have not passed control in «MOODLE» system, should stay for individual work and write test control. Students work with thematic training tables, train in computer class, work with license examination test "KROK" and the department database tests, in-depth study of topics according to an individual study program, etc.

 

6. Students should  know:

Theme 1. Urgent states in gynecology.

1. Ectopic pregnancy. Classification, etiology, clinical symptoms.

2. Outcome of ectopic pregnancy: tubal rupture and tubal abortion, unruptured ectopic pregnancy.

3. Clinic of ruptured ectopic pregnancy (tubal rupture, tubal abortion) and unruptured ectopic pregnancy

4. Making diagnosis of ectopic pregnancy. Algorithm of diagnostics (ultrasonography, pregnancy test, culdocentesis, laparoscopy).

5. Surgical and conservative treatment of ectopic pregnancy.

6. Ovarian, cervical, abdominal pregnancy. Pregnancy in rudimentary horn.

7. Ovarian apoplexy. Etiology, clinical symptoms, diferential diagnosis, treatment.

8. Torsion of the tumor’ pedicle. Clinical symptoms, algorithm of diagnostics, surgical treatment.

9 .Rupture of ovarian cyst. Clinical symptoms, algorithm of diagnostics, surgical treatment.

10. Rupture of tuboovariam mass. Clinical signs, algorithm of diagnostics, surgical treatment.

11. Trauma of the female sexual organs. Clinical signs, algorithm of diagnostics, surgical treatment.

 

THEME 2.  Typical gynecological operations. Endoscopic operations

1. Uterine sounding. Technique, instruments, indications, contraindications.

2. Cervical biopsy. Operations on the uterine cervix – Emett’, Shturmdorf.

3. Technique, instruments, indications, contraindications.

4. Polipectomy. Technique, instruments, indications, contraindications.

5. Culdocentesis. Technique, instruments, indications.

6. Uterine curettage. Technique, instruments, indications, contraindications.

7. Operations on the fallopian tubes. Technique, instruments, indications, contraindications. Technique, indications, contraindications.

8. Adnexectomy. Technique, indications, contraindications.

9. Ovarian resection. Technique, indications, contraindications.

10. Supracervical (subtotal) hysterectomy. Indications, conditions, technique.

11. Total hysterectomy. Indications, conditions, technique.

12. Vaginal hysterectomy. Indications, conditions, technique

13. Endoscopic operations.  Indications, conditions, technique

 

THEME 3. Preoperative care, postoperative treatment of the patients. Management of the patients after intestinal and urinary bladder injury.

1. Aspects of the preoperative management of gynecological patients.

2. Preoperative care of the gynaecological patients.

3. Management of the postoperative period after surgical abdominal  interventions. Prevention of thrombembolic complications.

4. Management of the postoperative period after surgical vaginal  operations.

5. Methods of anesthesia of gynecological operations.

6. Management of the patients after intestinal and urinary bladder injury.

 

 

 

7. Student should be able to:

 1. To take patient’s history.

2. To perform a gynecological examination of the patient (speculum examination, pelvic examination) – on phantom.

3. To prescribe the management for the patients with urgent gynecological problem.

4. To perform the differential diagnosis of urgent gynecological diseases with similar problems.

5. To confirm and formulate the preliminary diagnosis and to prescribe adequate treatment for the patients with urgent gynecological disease.

6. To prepare necessary instruments for small gynecological operations.

7. To confirm the indications for small gynecological operations.

8. To learn the main indications, contraindications, technique of the main gynaecological operations.

9. To make the plan of pre- and postoperative examination, and management of gynaecological patients.

 

 

 

 8. Correct answers of test evaluations and situational tasks:

E. 2. C. 3. A. 4. B. 5. C.

 

 

9. References:

À – Basic:  

 1. Gynecology. - Stephan Khmil, Zina Kuchma, Lesya Romanchuk. – Ukrmedknyha. – Ternopil.- 2006. – 380p.

2.  Gynecology  – Edited by Ventskivska. – Kyiv “Medicine” – 2008. – 340p.

3.  “Acute” abdomen in gynecology

 

 

 

 – Additional:

 

1. Obstetrics and gynecology. – Pamela S.Miles, William F.Rayburn, J.Christopher Carey. – Springer-Verlag New York, 1994.

2.Ovarian Cancer, 2nd Ed: By Stephen C Rubin MD,  ByGregory P Sutton MD, By Lippincott Williams & Wilkins Publishers (May 2001)

 

 

 

 

Prepared by doc. Stelmakh O.Y.

 

 

 

Methodical Instruction was discussed and adopted

at the Department sitting 24.05.2012. Minute ¹ 13

 

Methodical instruction was discussed and adopted at the Department sitting

23.05.2013. Minute ¹ 10

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute ¹ __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute ¹ __

Methodical instruction was adopted and reviewed at the Department sitting

__________20__. Minute ¹ __

Methodical instruction was adopted and reviewed at the Department sitting

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