Laproscopy

CO₂

CO, is the gas used to create pneumoperitoneum during laparoscopy.

Other option is – N₂0 : But it is expensive, less soluble in blood and supports combustion.

Also know :

• Instrument used for creating pneumoperitoneum is veress needle.

Flow Rate of CO, for creating pneumoperitoneum 200 – 2000 ml/min & pressure between 15 – 25 mm of Hg.

COPD

CO₂

Laproscopy

10 – 15 mm of Hg

Laparoscopy

Hysteroscopy + Laparoscopy

Laparoscopy

Ans. is d i.e. Fallopian tube

• Laparoscopic visualization of the pelvis is the most accurate method of confirming diagnosis of an acute P1D.
• However, it is not practical to advise diagnostic laparoscopy to all patients of PID,
• Indications of Laparoscopy in Acute PID :

–   Patients not responding to therapy, in order to confirm the diagnosis.

–   To obtain cultures from cul-de-sac or fallopian tube.

–   To drain pus. if necessary.

Thus, cultures can be obtained from both cul-de-sac and fallopian tube.

Telinde’s Operative Gynae. 9/e, p 679 further says

“Laparoscopy is an excellent means of obtaining cultures directly from the tubes.” My answer to this question is Fallopian tube. You can have your opinion.

Ans. is a i.e. CO₂

CO₂ is the gas used to create pneumoperitoneum during laparoscopy.

Other option is N₂0. But it is expensive, less soluble in blood and supports combustion.

Also know :

• Instrument used for creating pneumoperitoneum is veress needle.
• Flow Rate of CO₂ for creating pneumoperitoneum 200 — 2000 ml/min and pressure between 15 — 25 mm of Hg.

11-15 mm Hg REF: Maingot’s 10^th ed p. 243

The intrabdominal pressure during laparoscopy is monitored by insufflator and it is set between 12-15 mm Hg.

Diagnostic Laproscopy REF: Novak’s Gynecology 13^th edition Chapter 15

Traditionally, the diagnosis of PID has been based on a triad of symptoms and signs, including pelvic pain, cervical motion and adnexal tenderness, and the presence of fever.

More elaborate tests may be used in women with severe symptoms because an incorrect diagnosis may cause unnecessary morbidity. These tests include endometrial biopsy to confirm the presence of endometritis, ultrasound or radiologic tests to characterize a tuboovarian abscess (TOA), and laparoscopy to confirm salpingitis visually.

Laparoscopy currently provides the most accurate way to diagnose salpingitis. It should be used when the diagnosis is unclear, particularly in patients with severe peritonitis, to exclude a ruptured abscess or appendicitis.

CO2 retention [Ref: http://humupd.oxfordjournals.org/cgi/reprint/3/5/505 J

Shoulder pain is although a minor complication is exceedingly common and is due to the presence of a significant amount of residual carbon dioxide in the peritoneal cavity, trapped under the diaphragm and causing irritation of the diaphragm and thus referred pain to the shoulder through the phrenic nerve.

Laparoscopy

Cholecystectomy is the definite line of treatment for patients with acute cholecystitis.

Early cholecystectomy performed within 2-3 days of presentation is preferred over interval or delayed cholecystectomy.

Laparoscopic surgery can be performed under local anesthesia, but general anesthesia is preferable. Under local anesthesia, N2O is used as the insufflating agent, and insufflation is stopped after 2 L of gas is insufflated or when a pressure of 10 mmHg is reached.

Laparoscopy is the primary method used for diagnosing endometriosis.

Laparoscopic findings are variable and may include discrete endometriotic lesions, endometrioma, and adhesion formation.

The pelvic organs and pelvic peritoneum are typical locations for endometriosis. Lesions are variable colors, which may include red, white, and black.

Laparoscopic visualization of ovarian endometriomas has a sensitivity and specificity of 97 percent and 95 percent, respectively.

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 10. Endometriosis. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

Ans. is `d’ i.e., Carbon dioxide 

Ans. is ‘c’ i.e., Minimally absorbed 

Ans is ‘d’ i.e. Gaseous embolism through splenic vessels 

The sudden drop in p02 during insufflation of gas for creating pneumoperitoneum suggests gas embolism from entry of the gas into the circulation through exposed vessels in the splenic tear. Gas embolism may also occur due to inadvertent insertion of the trocar into a vessel or an abdominal organ.

Ans. is (b) i.e. 10-15mm of Hg 

The infra-abdominal pressure during laproscopic surgery is monitored by insufflator. The pressure is set between 12­15 mm of Hg. because at higher pressures there is risk of hypercarbia, acidosis and adverse hemodynamic and pulmonary effects.

Ans is b ie CO2 retention 

Shoulder pain is although a minor complication is exceedingly common and is due to the presence of a significant amount of residual carbon dioxide in the peritoneal cavity, trapped under the diaphragm and causing irritation of the diaphragm and thus referred pain to the shoulder through the phrenic nerve.

Ans. B: Laparoscopy

• Physical examination
• Pregnancy test (to rule out anectopic pregnancy)
• White blood cell test (to rule out appendicitis)
• Genital culture (to look for gonorrhea and chlamydia).
• An endometrial biopsy (tissue sample removed from the endometrium)
• Sonogram (if abscesses are suspected)
• Culdocentesis (fluid sample taken from uterine sac)
• Laparoscopy are done.

Laparoscopy is considered the “gold standard” for diagnosis of PID, because it allows visualization of the pelvic organs. The procedure involves inserting a tiny, flexible lighted tube through a small incision just below the navel.

This procedure is recommended when results of the preliminary tests (physical exam, blood tests and cultures) are unclear.

Ans. A i.e. CO₂

Ans. D: Endometriosis

Indications for gynaecological laparoscopy include the following:

• Ovarian cysts and tumours.
• Removal of fibroids (Myomectomy).or destroying them (Myolysis)
• Infertility, lysis of adhesions.
• Infertility, checking the condition and patency of the fallopian tubes.
• Reproductive or tubal surgery
• Endometriosis
• Intraperitonal Haemorrhage
• Polycystic Ovaries
• Pelvic infection (Pelvic Inflammatory disease)
• Egg collection for assisted reproduction
• Sterilization (laparoscopic Sterilization)
• Severe period pain
• Diagnosis and treatment of some uterine anomalies
• Pelvic floor and vaginal prolapse
• Urinary incontinence

Ans. D: Laparoscopy and hysteroscopy

Laparoscopy is combined with hysteroscopy as a comprehensive one-stop infertility work-up, to detect cause of infertility and treat the cause in one go

Ans. Laparoscopy

Ans. b. Diagnostic laparoscopy

• Clinical features of infertility, dysparenuia and cyclic pain are highly suggestive of endometriosis. Laparoscopy is gold standard for diagnosis of endometriosis