gyn1 Flashcards
what is stress incontinence?
occurs in patients with weak urethral sphincter.
anything that increases abdo pressure - coughing, laughing, causes leakage of urine
give 2 non-pharma treatments of stress incontience?
- lifestyle changes - weight loss, smoking, caffeine, avoid straining
- pelvic floor exercises (physio)
(duloxetine can be used alongside physio)
how do pelvic floor exercises work?
pelvic floor muscle contraction -> urethral compression -> increased urethral pressure -> reduced leakage
what surgical options for stress incontinence?
sling
suspension - restores pressure to the urethra and supports urethra
what causes overactive bladder?
involuntary contractions of detrusor muscle -> urgency
3 symptoms of Oab
Urgency
frequency
nocturia
key in door urgency
epithelium of detrusor?
smooth muscle with transitional epithelium
innervation of detrusor?
sacral parasympathetic innervation
investigations for incontinence?
bladder diary
urinalysis
residual urine measuremen
ePAQ questionnaire
what info is obtained from bladder diary?
freq
quantity
fluid intake
diurnal variation
non pharma treatments of oab?
lifestyle changes
bladder drill
pads
what drugs are used for oab
oxybutynin
mirabegron
botox
how does oxybutynin work
Anticholinergic - M2/3 receptor antagonist. reduces detrusor innervation
what are side effects of oxybutynin
- dry mouth
- constipation
- blurred vision
- cognitive impairments
how does mirabegron work?
beta 3 agonist. relaxes detrusor and increases capacity of bladder
how does botox work in oab?
blocks aCH and so reduces detrusor muscle contraction
give 3 symptoms of prolapse
pain
lump
discomfort
sexual symptoms
what is the treatment for prolapse?
reassurance
symptom mgmt
vaginal pessaries
surgery if symptoms severe
symptoms of cystocele?
incontinence, straining and hesitancy
symptoms of rectocele
- difficulty opening bowels, constipation, straining
what is the treatment for a genital tract fistula?
surgery
can affect bladder colon or rectum
symptoms foul discharge, gas pus stool leaking from vag
what are fibroids?
benign smooth muscle tumours of the uterine myometrium
what hormone stimulates fibroid development?
oestrogen
how are fibroids classified?
according to their position
intramural
submucosal
subserosal
what type of fibroid is most common?
intramural (confined to myometrium)
where are subserosal fibroids?
outwards from uterus
where are submucosal fibroids
growing into the uterine cavity
4 risk factors for fibroids?
obesity
early menarche
fam hx
inc age
4 symptoms of fibroids
menorrhagia pain subfertility pressure symptoms on bladder etc can cause anaemia
investigations for fibroids
pelvic USS
hysteroscopy
what is the treatment for fibroids?
conservative: watch and wait
medical: hormone: GnRH, POP
surgical: hysteroscopic resection, myomectomy, hysterectomy
what is the gold standard tr for fibroids?
hysterectomy - if young and wants kids, myomectomy
what class of drug is duloxetine?
snri
how are endometrial polyps investigated?
TVUSS
how are endometrial polyps removed?
hysteroscopy + polypectomy
