GN 4 PFD Flashcards
True about pelvic organ prolapse EXCEPT
a. POP is a condition characterized by failure of various anatomic structures to support the pelvic viscera
b. It is defined as the descent of one or more of the vaginal walls or cervix.
c. urethrocele, enterocele, and rectocele are examples of posterior vaginal wall prolapse.
d. cystocele is an example of anterior vaginal wall defect
C.
Anterior vaginal wall prolapse:
- cystocele
- urethrocele
- paravaginal defect
Posterior vaginal wall prolapse
- rectocele
- enterocele
True about POP EXCEPT
a. symptoms can include vaginal bulging, pelvic pressure, vaginal bleeding or discharge, low backache, need to replace the prolapse in order to void or defecate
b. POP can be asymptomatic. Symptoms are more common when the prolapse extends beyond the hymen.
c. POP usually involves only one wall of the vaigina
d. AOTA
C; usually involves more than one wall of the vagina
True about POP
a. POP is common in nulliparous women
b. prevalence is 20-40%
c. symptomatic POP prevalence is close to 3%
d. pelvic support structure defects are not associated with vaginal childbirth-related injury
C.
a. common in parous women
b. prevalaence is 30-50%
c. pelvic support structure defects have been associated with age, vaginal childbirth-related injury (neurologic or msucular or both), obesity, diabetes, connective tissue disorders, genetics/family history, and neurologic diseases
support of midvagina
a. Level I
b. Level II
c. Level III
B
Level II - support of the mid-vagina is provided by connective tissue attachments to the arcus tendineus fasciae pelvis on the lateral pelvic side walls
Support of vaginal apex
a. Level I
b. Level II
c. Level III
Level I - support of the vaginal apex and cervix provided by the uterosacral and cardinal ligaments and associated connective tissue
The ff provide level III support EXCEPT
a. perineal membrane
b. perineal muscles
c. attachments through endo-pelvic connective tissue
d. connective tissue attachments to the arcus tendineus fasciae pelvis on the lateral pelvic side walls
D
3 layes of vagina
NLM
Nonkeratinizing stratified epithelium
Lamina propria
Muscularis
True about pelvic organ support
a. Anteriorly, the vagina supports the base of the bladder and the ureter
b. Th recutm is located posterior to the vagina behnid the rectovaginal septum anteriorly.
c. The perineal body is fused with the vaginal muscularis
d. AOTA
C
A. bladder and urethra
B. superiorly
Classic symptoms of prolapse (4)
Belated Happy Birthday Po
Vaginal..
Bleeding
Heaviness and pressure
Bulge
Pain, pelvic
T/F back pain and pelvic pain are reliably associated with prolapse
F
Urinary symptoms in POP can include (4)
urinary incontinence, difficulty voiding, slow urinary stream, or a sensation of incomplete bladder emptying
SUDS Slow urinary stream Urinary incontinence Difficulty voiding Sensation of incomplete bladder emptying
Bowel symptoms in POP include: constipation, straining, incomplete evacuation, fecal incontinence, or splinting (reducing the prolapse) to achieve bowel movements can be present
CSI Full Series Constipation Straining Incomplete evacuation Fecal incontinence Splinting
Sexual symptoms in POP may include
DID
Discomfort
Irritation
Decreased Sexual desire
Prolapse into the upper barrel of the vagina
a. first degree
b. second degree
c. third degree
d. fourth degree
A
Prolapse through the introitus
a. first degree
b. second degree
c. third degree
d. fourth degree
C
Prolapse to the introitus
a. first degree
b. second degree
c. third degree
d. fourth degree
B
Complete eversion of the vagina
a. first degree
b. second degree
c. third degree
d. fourth degree
D
Baden-Walker System normal position of vagina a. Grade 0 b. Grade 1 c. Grade 2 d. Grade 3 e. Grade 4
A
Descent to the level of the hymen
a. Grade 0
b. Grade 1
c. Grade 2
d. Grade 3
e. Grade 4
C
Descent halfway to the hymen
a. Grade 0
b. Grade 1
c. Grade 2
d. Grade 3
e. Grade 4
B
Descent halfway past the hymen
a. Grade 0
b. Grade 1
c. Grade 2
d. Grade 3
e. Grade 4
D
Maximum possible descent
a. Grade 0
b. Grade 1
c. Grade 2
d. Grade 3
e. Grade 4
E
an objective, site-specific system for describing, quantifying, and staging pelvic support and was developed to enhance both clinical and academic communication with respect to individual patients and populations of patients
Pop-Q
POP-Q
is a point located in the midline of the anterior wall 3 cm proximal to the urethral meatus and is roughly the location of the urethrovesical crease.
Point Aa
POP-Q: _______
represents either the
most distal edge of the cervix or the leading edge of the vaginal cuff if a hysterectomy has been performed.
Point C
POPQ: ______ represents the location of the posterior fornix (pouch of Douglas) or the posterior point of attachment of the uterosacral ligaments (there is debate among the experts) in a woman with a cervix.
Point D
POP-Q: ______ represents the most distal position of the anterior vaginal wall between Aa and the cervix or cuff.
Point Ba
POP-Q: ______ is a point located in the midline of the posterior vaginal wall 3 cm proximal to the hymen.
Point Ap
POP-Q: ______ which is the length of the perineal body between the posterior vagina and rectum
PB
POP-Q: ______ which is the genital hiatus measurement from the urethra to the posterior vagina, are measured during strain and do not have positive or negative values because they are not compared to the hymen.
GH
Which component of POP-Q measured during strain and do not have positive or negative values because they are not compared to the hymen
PB and GH; all the others are measured as cm wrt hymen, (-) if above, (+) if below
POP-Q: no prolapse
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
A
POP-Q: complete eversion/procidentia
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
E
POP-Q: Prolapse more than 1 cm above and 1cm below the hymen
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
C
POP-Q: most distal prolapse is more than 1cm above (inside) the hymen
a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4
B
True about the diagnosis of POP
a. Pelvic organ prolapse is best measured with a patient straining in the lithotomy position
b. To observe and measure anterior vaginal wall prolapse, a retractor or posterior wall blade of a Graves speculum is used to depress the posterior vaginal wall.
c. surgical management of prolapse is being considered, the physician may want to perform a preoperative prolapse reduction standing stress test to evaluate for stress urinary incontinence
d. AOTA
D
True about management of POP
a. Treatment of anterior vaginal wall prolapse may be nonoperative or operative depending on patient preferences and goals
b. if patient is not bothered by the prolapse, it can be left alone and managed expectantly
c. Kegel exercises can decrease risk of prolapse progression and can be effective at improving the sensation of pressure from mild POP
d. Pelvic floor physical therapy can also treat associated urinary bowel and sexual dysfunction
e. AOTA
E
True about management of pelvic organ prolapse
a. Operative repair of anterior vaginal wall prolapse is generally performed in conjunction with the repair of all other pelvic support defects.
b. It is unusual for anterior supports of the vagina to relax without an accompanying relaxation of the apical compartment
c. Repair therefore usually consists of an anterior colporrhaphy as well as correction of uterine descensus or apical defect posthysterectomy.
d. AOTA
D
To test for post operative voiding dysfuction, the bladder is retrograde filled with 300 mL of sterile saline, and then the catheter is removed. This is voiding trial is called.
Back fill
To test for post operative voiding dysfuction, the catheter is removed, and the bladder is allowed to fill spontaneously . This voiding trial is known as
auto fill
in general patients are Post operative restrictions: patient is advised to avoid straining from consti- pation, heavy lifting, and strenuous activity for about ______
6 weeks
Advantage of using biologic or synthetic grafts in treatment of anterior vaginal wall prolapse
risk of recurrent prolapse symptoms and anterior vaginal wall prolapse on examination are decreased
Disadvantage of using biologic or synthetic grafts in treatment of anterior vaginal wall prolapse
longer operative times, greater blood loss, prolapse
The prevalence of posterior vaginal wall prolapse in community- dwelling women in the United States ranges from ___ to ___ and ___ to ___ in urogynecology clinics, depending on the definition used
from 18% to 40% and 9% to 76%
Signs and Symptoms of posterior vaginal wall prolapse (3)
PVC
Pelvic pressure
Vaginal bulge
Constipation
Examples of posterior vaginal wall prolapse (2)
ER
Enterocele
Rectocele
The following are non-operative management (first line) of posterior vaginal wall prolpase EXCEPT
a. at least 30 g of fiber
b. adequate hydration
c. regular exercise
d. allowing time for defecation after meals
e. NOTA
A. 25g
Operative management of posterior vaginal wall prolapse usually involves (2)
Posterior colporrhaphy
Perineorrhaphy
_____ is a herniation of the pouch of Douglas (cul-de-sac) between the uterosacral ligaments into the rectovaginal septum containing small bowel
Enterocele
What are the usual contents of enterocele?
Small Bowel
Omentum
True about uterine prolapse EXCEPT
a. a.k.a Descensus Procidentia
b. Prolapse of the uterus and cervix into or through the barrel of the vagina associated with injuries of level I support structures
c. Uterine prolapse is almost always associated with rectocele, cystocele and enterocele
d. NOTA
C. rectocele, cystocele, at times, enterocele
In elderly women who are no longer sexually active, a simple and effective procedure for reducing prolapse is an obliterative procedure called a
colpocleisis
allows for the removal of a triangular piece of vaginal wall beginning at the cervical reflection or 1 cm above the vaginal scar at the base of the triangle, with the apex of the triangle just beneath the bladder neck anteriorly and just at the introitus posteriorly. This modification of the Le Fort operation is called
Goodall-Power Modification
_______ is performed by dissecting the vaginal epithelium off the underlying fibromuscular tissue all the way down through the perirectal space to the right ischial spine and then clearing off the sacrospinous ligament medial to the ischial spine
Sacrospinous ligament suspension
Operative risks of sacrospinous colpopexy include injury to which arteries?
PI
pudendal and inferior gluteal arteries
Operative risks of sacrospinous colpopexy include injury to which nerves?
PS
pudendal and sciatic
