Summary

Volledige samenvatting gynaecologie boek 1

119 views 12 purchases

Course
Verloskunde-gynaecologie

Institution
Katholieke Universiteit Leuven (KU Leuven)

Volledige samenvatting van boek 1 van gynaecologie voor het vak verloskunde-gynaecologie. Gemaakt op basis van handboek en eigen lesnotities. Bevat alle te kennen leerstof voor het examen.

[Show more]

Preview 10 out of 97 pages

View example

Uploaded on September 5, 2023
Number of pages 97
Written in 2023/2024
Type Summary

verloskunde
gynaecologie
verloskunde gynaecologie
geneeskunde
master geneeskunde
ku leuven

Institution
Katholieke Universiteit Leuven (KU Leuven)
Education
Geneeskunde
Course
Verloskunde-gynaecologie

Gnkkuleuven

Member since 2 year 239 documents sold

$11.22

Added

Add to cart

Add to wishlist

100% satisfaction guarantee
Immediately available after payment
Both online and in PDF
No strings attached

GYNAECOLOGIE
Inleiding ....................................................................................................................................................... 7
1. Vulvaire pathologie ................................................................................................................................. 9
1.1. Gynatresie/stenose hymen/hematocolpos ..................................................................................... 9
1.1.1. Indeling gynatresie .................................................................................................................... 9
1.1.2. Stenose van het hymen ............................................................................................................ 9
1.2. Hematoom van de vulva .................................................................................................................. 9
1.3. Niet-neoplastische vulvaire afwijkingen ........................................................................................ 10
1.3.1. Lichen sclerosus ...................................................................................................................... 10
1.3.2. Squameuze hyperplasie (leukoplakie) .................................................................................... 10
1.3.3. Andere dermatose .................................................................................................................. 10
1.4. Condylomata acuminata ................................................................................................................ 10
1.5. Vulvaire intra-epitheliale neoplasie (V.I.N.) ................................................................................... 11
1.6. Squameus vulvacarcinoom ............................................................................................................ 12
1.7. Andere maligne vulvaire tumoren ................................................................................................. 13
1.7.1. Melanoma vulvae.................................................................................................................... 13
1.7.2. Vulvaire Paget ......................................................................................................................... 13
1.7.3. Basocellulair carcinoom .......................................................................................................... 13
1.7.4. Carcinoom van de Bartholinklier ............................................................................................ 13
2. Vagina .................................................................................................................................................... 14
2.1 Goedaardige vaginaletsels .............................................................................................................. 14
2.2 Vaginacarcinoom............................................................................................................................. 14
3. Cervix uteri ............................................................................................................................................ 15
3.1. Goedaardige letsels van de baarmoederhals ................................................................................ 15
3.1.1. Cervicitis .................................................................................................................................. 15
3.1.2. Cervicale ectopie ..................................................................................................................... 15
3.1.3. Cervicale erosie ....................................................................................................................... 15
3.1.4. Cervicale transformatiezone................................................................................................... 15
3.1.5. Cervicale wratten .................................................................................................................... 15
3.1.6. Cervicale poliepen ................................................................................................................... 16
3.1.7. Cyste van Naboth .................................................................................................................... 16
3.2. Premaligne en maligne letsels van de baarmoederhals................................................................ 16
3.2.1. Premaligne letsels van de cervix: cervicale intra-epitheliale neoplasieën (CIN) of squameuse
intra-epitheliale letsels (S.I.L.)........................................................................................................... 16

1

, Definities ....................................................................................................................................... 16
Evolutie .......................................................................................................................................... 18
Leeftijd........................................................................................................................................... 18
Etiologie......................................................................................................................................... 18
Diagnose en screening .................................................................................................................. 19
Behandeling................................................................................................................................... 23
Follow-up na therapie van een CIN .............................................................................................. 23
3.2.2. Invasief cervixcarcinoom ........................................................................................................ 23
Voorkomen en etiologie ............................................................................................................... 23
Evolutie en metastasering ............................................................................................................ 23
Stadia ............................................................................................................................................. 24
Prognose ....................................................................................................................................... 24
Histologisch type ........................................................................................................................... 24
Symptomen ................................................................................................................................... 24
Bilan ............................................................................................................................................... 25
Therapie ........................................................................................................................................ 25
Recidief .......................................................................................................................................... 27
Follow-up van patiënten met cervixCA ........................................................................................ 27
4. Corpus uteri ........................................................................................................................................... 28
4.1. Endometrium ................................................................................................................................. 28
4.1.1. Goedaardige letsel van het endometrium ............................................................................. 28
Asherman syndroom ..................................................................................................................... 28
Poliepen......................................................................................................................................... 28
4.1.2. Endometriumhyperplasie ....................................................................................................... 29
Eenvoudige hyperplasie ................................................................................................................ 29
Complexe hyperplasie ................................................................................................................... 29
Atypische hyperplasie ................................................................................................................... 29
4.1.3. Endometriumcarcinoom ......................................................................................................... 30
Voorkomen.................................................................................................................................... 30
Risicofactoren................................................................................................................................ 30
Evolutie en metastasering ............................................................................................................ 31
Stadia ............................................................................................................................................. 31
Prognose ....................................................................................................................................... 32
Histologische types ....................................................................................................................... 32
Symptomen ................................................................................................................................... 32
Diagnose ........................................................................................................................................ 32

2

, Bilan ............................................................................................................................................... 33
Therapie ........................................................................................................................................ 34
Follow up ....................................................................................................................................... 34
4.2. Myometrium .................................................................................................................................. 34
4.2.1. Myomen .................................................................................................................................. 34
Eigenschappen .............................................................................................................................. 34
Epidemiologie................................................................................................................................ 35
Risicofactoren................................................................................................................................ 35
Therapie ........................................................................................................................................ 35
4.2.2. Gynaecologische sarcomen .................................................................................................... 36
Staging ........................................................................................................................................... 36
Histologie....................................................................................................................................... 36
Prognose ....................................................................................................................................... 36
Therapie ........................................................................................................................................ 36
4.3. Adenomyose................................................................................................................................... 37
4.3.1. Prevalentie .............................................................................................................................. 37
4.3.2. Anatomopathologie ................................................................................................................ 37
4.3.3. Symptomen en diagnose ........................................................................................................ 37
4.3.5. Behandeling ............................................................................................................................ 37
5. Ovariële tumoren .................................................................................................................................. 39
5.1. Symptomatologie, diagnose en behandeling van niet-neoplastische- en goedaardige
neoplastische ovariële tumoren ........................................................................................................... 39
5.1.1. Klachten................................................................................................................................... 39
5.1.2. Klinisch onderzoek .................................................................................................................. 40
5.1.3. Complicaties ............................................................................................................................ 40
5.1.4. Beleid ....................................................................................................................................... 41
5.2. Niet-neoplastische tumoren .......................................................................................................... 42
5.2.1. Folliculaire cyste ...................................................................................................................... 42
5.2.2. Corpus luteum cyste ............................................................................................................... 42
5.2.3. Polycystische ovaria (Stein Leventhal Syndrome) .................................................................. 42
5.2.4. Stromale hyperplasie en -hyperthecose ................................................................................ 42
5.2.5. Zwangerschapsluteoom .......................................................................................................... 43
5.2.6. Endometriosecyste ................................................................................................................. 43
5.3. Epitheliale neoplastische tumoren ................................................................................................ 43
5.3.1. Borderline tumoren ................................................................................................................ 43
5.3.2. (Invasief) ovariumcarcinoom .................................................................................................. 43
Voorkomen.................................................................................................................................... 43

3

, Etiologie......................................................................................................................................... 44
Evolutie en metastasering ............................................................................................................ 44
Histologische types ....................................................................................................................... 45
Prognose ....................................................................................................................................... 45
Symptomen ................................................................................................................................... 45
Preoperatief bilan ......................................................................................................................... 45
Therapie ........................................................................................................................................ 46
Follow up ....................................................................................................................................... 47
5.3.3. Kiemceltumoren...................................................................................................................... 47
Eigenschappen .............................................................................................................................. 47
Dysgerminoom .............................................................................................................................. 47
Endodermaal sinus tumor............................................................................................................. 48
Embryonaal carcinoom ................................................................................................................. 48
Niet gestationeel choriocarcinoom .............................................................................................. 48
Teratomen ..................................................................................................................................... 48
5.3.4. Sex cord stromale tumoren .................................................................................................... 48
Eigenschappen .............................................................................................................................. 48
Granulosa stromale tumoren ....................................................................................................... 49
Sertoli-stromale tumoren ............................................................................................................. 49
6. Bekkenbodem........................................................................................................................................ 50
7. Borst ...................................................................................................................................................... 51
7.1 Leerdoelen ...................................................................................................................................... 51
7.2 Anatomie ......................................................................................................................................... 52
7.3 Fysiologie ......................................................................................................................................... 53
7.4 Diagnostiek ...................................................................................................................................... 53
7.4.1 Anamnese ................................................................................................................................ 53
7.4.2 Klinisch onderzoek ................................................................................................................... 54
Algemeen ...................................................................................................................................... 54
Inspectie van beide borsten, axilla en borstbeen ........................................................................ 54
Palpatie van de borst .................................................................................................................... 55
Palpatie van de lymfeklierregio’s .................................................................................................. 55
7.4.3 Beeldvorming ........................................................................................................................... 56
Mammografie ............................................................................................................................... 56
Echografie ..................................................................................................................................... 58
MRI ................................................................................................................................................ 59
Screening naar metastasen .......................................................................................................... 59

4

, 7.4.4 Cyto- en histopathologisch onderzoek .................................................................................... 59
7.4.5 Triple diagnostiek ..................................................................................................................... 60
7.5 Goedaardige borstproblemen ........................................................................................................ 60
7.5.1 (Voelbare) massa ..................................................................................................................... 60
Fibroadenoom ............................................................................................................................... 61
Phyllodes tumor ............................................................................................................................ 61
Borstcyste ...................................................................................................................................... 62
Intraductaal papilloom .................................................................................................................. 62
Radial scar ..................................................................................................................................... 63
7.5.2 Infectieuze aandoeningen ....................................................................................................... 63
Ontstekingen tijdens lactatie ........................................................................................................ 63
Ontstekingen buiten de lactatieperiode....................................................................................... 63
7.5.3 Tepelvochtverlies ..................................................................................................................... 64
Fysiologisch ................................................................................................................................... 64
Pathologisch .................................................................................................................................. 65
7.5.4 Gynaecomastie......................................................................................................................... 65
7.5.5 Pijn aan de borst(en) ................................................................................................................ 66
Cyclische mastopathie .................................................................................................................. 66
Niet-cyclische mastopathie........................................................................................................... 67
7.6 Borstkanker ..................................................................................................................................... 67
7.6.1 Epidemiologie........................................................................................................................... 67
7.6.2 Etiologie en pathologie ............................................................................................................ 67
7.6.3 Risicofactoren .......................................................................................................................... 69
7.6.4 Familiaal risico en genetische factoren bij borstkanker .......................................................... 69
7.6.5 Beleid bij hoog risico ................................................................................................................ 70
Screening ....................................................................................................................................... 70
Preventieve heelkunde als primaire preventie ............................................................................ 70
Chemopreventie ........................................................................................................................... 71
7.6.6 Prognose van het mammacarcinoom ..................................................................................... 71
7.6.7 Klinische en pathologische stadiering bij borstkanker ............................................................ 72
7.6.8 Chirurgie bij niet-gemetastaseerde borstkanker .................................................................... 73
Inleiding ......................................................................................................................................... 73
Borstchirurgie ................................................................................................................................ 73
Okselchirurgie ............................................................................................................................... 74
Reconstructie ................................................................................................................................ 75
7.6.9 Radiotherapie bij niet-gemetastaseerde borstkanker ............................................................ 75

5

, Indicaties voor radiotherapie........................................................................................................ 75
Dosissen ........................................................................................................................................ 76
Technische aspecten ..................................................................................................................... 76
Nevenwerkingen van radiotherapie ............................................................................................. 76
7.6.10 Systeemtherapie bij niet-gemetastaseerde borstkanker ..................................................... 77
Soorten systeemtherapie ............................................................................................................. 77
Wanneer systeemtherapie gebruiken bij vroegtijdige borstkanker? .......................................... 79
7.6.11 Behandeling van in situ borstkanker ..................................................................................... 80
7.6.12 Opvolging na borstkanker ...................................................................................................... 80
7.6.13 Lokaal/locoregionaal herval................................................................................................... 81
7.6.14 Gemetastaseerde borstkanker .............................................................................................. 81
8. Infecties ................................................................................................................................................. 83
8.1 Definitie ........................................................................................................................................... 83
8.2 Inleiding ........................................................................................................................................... 83
8.3 Seksueel overdraagbare aandoeningen (SOA) ............................................................................... 83
8.3.1 Chlamydia trachomatis ............................................................................................................ 83
8.3.2 Herpes simplex virus ................................................................................................................ 84
8.3.3 Humaan papillomavirus ........................................................................................................... 84
8.3.4 Hepatitis B virus ....................................................................................................................... 85
8.3.5 Trichomonas............................................................................................................................. 85
8.4 Gynaecologische infecties............................................................................................................... 85
8.4.1 Vulvitis en bartholinitis ............................................................................................................ 85
8.4.2 Vaginitis .................................................................................................................................... 86
Bacteriële vaginose (niet-specifieke vaginitis, I)........................................................................... 87
Candidiasis (schimmels) ................................................................................................................ 88
Trichomoniasis .............................................................................................................................. 89
8.4.3 Cervicitis ................................................................................................................................... 89
8.4.4 Supracervicale infecties ........................................................................................................... 89
9. Endometriose ........................................................................................................................................ 92
9.1 Definitie ........................................................................................................................................... 92
9.2 Pathogenese van endometriose ..................................................................................................... 92
9.2.1. Retrograde menstruatie, coeloom metaplasie en inductietheorie ....................................... 92
9.2.2. Genetische factoren................................................................................................................ 92
9.2.3. Inflammatoire en immunologische factoren.......................................................................... 92
9.3. ((Prevalentie van endometriose)) .................................................................................................. 92
9.4. Diagnose van endometriose .......................................................................................................... 92

6

, 9.4.1. Symptomen ............................................................................................................................. 92
Pijn ................................................................................................................................................. 93
Subfertiliteit .................................................................................................................................. 93
Extrapelviene endometriose......................................................................................................... 93
9.4.2. Klinisch onderzoek .................................................................................................................. 93
9.4.3. Technische onderzoeken ........................................................................................................ 94
9.4.4. Geen serumtest voor endometriose ...................................................................................... 94
9.4.5. Laparoscopische en histologische aspecten .......................................................................... 94
9.4.6. Classificatie volgens de revised American Fertility Society (1997) ........................................ 95
9.5. Spontane evolutie .......................................................................................................................... 95
9.6. Behandeling van endometriose ..................................................................................................... 95
9.6.1. Chirurgische behandeling ....................................................................................................... 95
Pre-operatieve voorbereiding ...................................................................................................... 95
Principes ........................................................................................................................................ 95
Effect ............................................................................................................................................. 96
9.6.2. Medische behandeling............................................................................................................ 96
Progestagenen .............................................................................................................................. 96
Orale contraceptiva ...................................................................................................................... 96
LHRH agonisten ............................................................................................................................. 97
Levonorgestrel houdend IUD ........................................................................................................ 97
Efficiëntie van medische behandeling .......................................................................................... 97
9.7. Medisch begeleide bevruchting..................................................................................................... 97

INLEIDING
- Curretage
• = D&C = dilatatie en curretage
• Eerst dilatatie cervicaal kanaal tot ongeveer 10 mm
• Daarna curretage endometriu met currete met een diameter van normaalgezien 10 mm
• Vaak gefractioneerde curretage
o Eerst endocervicaal kanaal
o Daarna cavum van corpus van uterus
- Hysteroscopie
• Eerst dilatatie cervix, daarna scoop in uterus
• -> visualisatie kleine afwijkingen vb poliepen, hyperplasie van endometrium,
subendometriale myomen
• Cavum van uterus w opgeblazen onder druk met vloeistog
• Soms aanvulling van diagnostische hysteroscopie met operatieve hysteroscopie
o Biopsies, poliepectomie, verwijderen intra-uterien septum of volledige
resectie/coagulatie van endometrium (hysteroscopische endometriumablatie)

7

,- Laparoscopie
• Meestal via navel
• Opblazen abdomen met CO2
• Hysterectomie, lymadenectomie, oöforectomie
• Robot-geassisteerd: 3D en meer beweeglijke instrumenten + chirurg bedient zelf de
camera -> mogelijk om ingrepen uit te voeren die moeilijk via een gewone laparoscopie
kunnen
- Laparotomie
• Snedes
o Mediaan: van navel naar pubis
o Horiontaal (pfannenstiel of bikini insnede)
- Hysterectomie
• Via laparotomie (abdominaal) of via vaginale weg
• Of laparoscopisch geassisteerde vaginale hysterectomie
• Of totaal laparoscopisch +/- robot
- Totale hysterectomie = verwijderen corpus en cervix van uterus
- Subtotale hysterectomie = enkel verwijderen corpus uterus
• Kan niet vaginaal, wel via laparotomie of laparoscopisch
- Radicale hysterectomie (Wertheim-Meigs)
• Bij cervixCA
• Verwijderen: uterus + cervix + parametria + deel van vagina (4cm) + pelviene lymfeklieren
- Bilaterale salpingo-oöferectomie (BSO) en unilaterale salpingo-oöferectomie (USO)
• Verwijderen salpingen (tubae) en ovaria (ooferectomie)
- HT + BSO = totale hysterectomie met bilaterale salpingo-oöferectomie

8

, 1. VULVAIRE PATHOLOGIE

1.1. GYNATRESIE/STENOSE HYMEN/HEMATOCOLPOS
- Gynatresie = toestanden die gepaard gaan met afsluiting van de genitale tractus, op eender wlk
niveau
• Afsluiting kan verworven of congenitaal zijn
1.1.1. INDELING GYNATRESIE
- Congenitaal, thv:
• Hymen
o Stenose van hymen meest frequente congenitale pathologie -> S/ en R/ gelijkaardig
voor andere congenitale vormen
• Cervix
• Vagina
- Verworven, thv cervix door:
• Seniele genitale atrofie
• Maligne aandoeningen
• RT/cauterisatie
• HK
1.1.2. STENOSE VAN HET HYMEN
- D/
• Meestal pas na menarche
- S/ door opstapeling van menstrueel bloed
• Bij menstruatie -> onderbuikspijn, bij elke cyclus meer uitgesproken
• Zeer vele bloed opgestapeld -> uitzetting cavum uteri -> palpabele massa in onderbuik ->
distentie van blaas door urineretentie kan ontstaan
- Gevolgen
• Cyclische onderbuikspijn en zeer aanzienlijke hoeveelheid bloed w opgestapeld
• -> distentie van vagina (hematocolpos)
• -> daarna distentie van cervix, cavum uteri (hematometra)
• -> ten slotten ook distentie van tubae (hematosalpinx)
- R/
• Incisie/excisie van hymen en trage evacuatie van bloed onder strikt aseptische
omstandigheden

1.2. HEMATOOM VAN DE VULVA
- Oorzaken
• Traumatisch
• HK: ‘herstel’ operaties
• Episiotomie
• Ruptuur perineum
- S/
• Uitgesproken pijn: ernst afh van hoeveelheid opgestapeld bloed
• Reflexmatige inhibitie van mictie en/of defecatie (soms)
- R/
• Klein hematoom resorbeert spontaan

9

, • Grote bloedcollectie -> extirperen

1.3. NIET-NEOPLASTISCHE VULVAIRE AFWIJKINGEN
Oudere benamingen: vulvaire dystrofieën en krauroris vulvae (w niet meer gebruikt)
1.3.1. LICHEN SCLEROSUS
- Huidaandoening: vnl thv vulva en peri-anaal
- Verschrompeling, verdroging en lichenficatie van de huid
- D/
• Macroscopisch: dunne en witbleke huid, pigmentatie en haargroei verdwenen, atrofie
van labia (introïtus vaginae vernauwd)
• Klachten -> jeuk, dyspareunie, dysurie, secundaire infectie (krabletsels)
• Vulvoscopie met colposcoop en gerichte biopsie
• Hoger risico op ontwikkelen van CA (van plaveiselepitheel van vulva) -> jaarlijks grondige
inspectie van vulva
- DD/
• Infectie
• Vulvaire intra-epitheliale neoplasie (VIN)
• Allergische reacties
o Vrij frequent op condoom
o Zeep, wasproducten, parfums …
• NB vulvair uitdrogingseczeem
o Zeer frequent
o Door vaak wassen, zeep, parfums …
o R/
§ Zeer vermijden
§ Niet uitdrogende zeep (vb Balneum Hermal badolie en hydraterende crème)
- R/
• Lokale zeer sterke corticoide continue therapie: verlaagde incidentie van vulvaCA en
meest efficiënt tegen (vaak ondraaglijke) jeuk
o Vb dagelijks betamethasone of clobetasol
1.3.2. SQUAMEUZE HYPERPLASIE (LEUKOPLAKIE)
- Wit verheven letseltje -> biopsie (cave (pre)maligniteit
- R/
• Lokaal sterke corticoidecremes (vb hydrocortison, methylprednisolon)
1.3.3. ANDERE DERMATOSE
Zie cursus dermato
- Psoriasis
- Lichen planus
- …

1.4. CONDYLOMATA ACUMINATA
- Wratten thv vulva, vagina, perineum, anaal, cervicaal
- Meestal veroorzaakt door HPV 6 en 11
- Overdracht
• Venerisch

10

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller Gnkkuleuven. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $11.22. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

83637 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 14 years now

Start selling

Popular Universities in the United States

Popular books

Find notes and summaries for these qualifications

Summary

Volledige samenvatting gynaecologie boek 1

Document information

Subjects

Written for

Seller

Reviews received

Content preview