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Block 14 module 7 > Pelvic organ prolapse > Flashcards

Pelvic organ prolapse Flashcards

1
Q

what is pelvic organ prolapse

A

downward displacement of one or all pelvic organs from its normal location resulting in Vaginal protrusion or bulge

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2
Q

POP involves herniating what organs?

A 
Bladder
Urethra
Rectum
Uterus
Small bowel
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3
Q

why POP is common in menopause

A

bcoz lack of hormonal support

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4
Q

why POP is related to parity

A

the more the woman has delivered (esp NSVD) more chance for her to prolapse

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5
Q

components of Levator ani muscles

A

pubococcygeus
puborectalis
iliococcygeus

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6
Q

innervations of levator ani muscles

A

pudendal nerve
perineal nerve
inferior rectal nerve

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7
Q

this is utilized as an anchor pt for prolapsed organ in the mgt

A

sacrospinous ligament

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8
Q

Level I support system for the uterus and vagina

A

utersacral/cardinal ligament complex, w/c serve to maintain the vaginal lengh and axis

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9
Q

Level II support system for the uterus and vagina

A

consists of paravaginal attachments of the lateral vagina and endopelvic fascia to the arcus tendineus that maintain the midline position of the vagina

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10
Q

Level III support system for the uterus and vagina

A

made up muscles and con tis surrounding the distal vagina and perineum

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11
Q

muscle that is most stretched during the 2nd stage of labor that causes direct injury

A

pubococcygeus

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12
Q

neurologic injury involves injury to the

A

pudendal nerve

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13
Q

vaginal delivery, chronic straining and w/ defacation in constipation can lead to what kind of injury

A

neurologic injury (stretching injury to pudendal nerve)

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14
Q

if you want to locate the pudendal nerve this is a good landmark

A

ischial spine

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15
Q

in identifying the pudendal nerve, after you have located the ischial spine what should you look for next

A

sacrospinous ligament. there, behind the sacrospinous ligament is the pudendal nerve.
sacropspinous ligament is attached to the ischial spine

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16
Q

mechanisms involved in vaginal wall injury

A

site specific defects
smooth muscle dysfunction
con tis abnormalities

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17
Q

w/c is worse among the site specific defects

A

displacement type

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18
Q

in this defect the structure is distorted but the organs are still attached to the pelvic side wall

A

distention type

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19
Q

in this defect there is loss of con tis attachment of lateral vaginal wall to pelvic side wall

A

displacement type

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20
Q

this is responsible for the anteflexed position so there is loss of the normally anteflexed or anteverted position of the uterus

A

round ligament

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21
Q

in this defect there is abnormality in the attachment of lateral vagina to pelvic side wall

A

smooth muscle dysfxn

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22
Q

vaginal wall injury that causes POP among menopausal women and those with Ehler Danlos and Marfan syndrome

A

Con tis Abnormalities (less collagen content & con tis d/o)

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23
Q

Risk factors for POP

A 
multiparity
Age
Race
Increased ab pressure
Con tis dse
24
Q

why are caucasians more prone to POP while blacks are less prone

A

Caucasians usually have gynecoid pelvis which has a wider pubic arch;
blacks have narrow

25
Q

conditions that would lead to increased abdominal pressure that puts px at risk for POP

A 
obesity
chronic constipation
chronic coughing
repetitive heavy lifting
inhaled chem in tobacco
26
Q

types of anterior wall prolapse

A

cystocele
cystourethrocele
urethrocele

27
Q

types of posterior wall prolapse

A

rectocele

enterocele

28
Q

types of middle wall/apical compartment prolapse

A

uterine prolapse

vaginal vault prolapse

29
Q

occurs when the bladder drops from its normal place into the vagina

A

cystocele

30
Q

cystocele is most common in

A

elderly

31
Q

cystocele is caused by

A

rupture of the pubovesical fascia

32
Q

how does cystocele cause problems in urination

A

it may cause a kink in the urethra

33
Q

most common prolapse in women

A

cystourethrocele

34
Q

what happens in cystourethrocele

A

both bladder and the urethra prolapse together in the vaginal wall

35
Q

prolapse of urethra outward to vaginal wall

A

urethrocele

36
Q

in urethrocele w/c is prolapsing: urethral canal or meatus

A

canal the meatus is still present below

37
Q

Px came in with cc of a heavy feeling in the vagina as if something is falling out, she also feels constipated. PE showed bulging rectum towards the vagina. What is the mechanism in this disorder?

A

this is a rectocele, it occurs when the rectum loses it support and bulges into the back wall of the vagina

38
Q

prolapse of the portion of the small bowel behind the uterus toward the pouch of douglas due to weakened support

A

enterocele

39
Q

enterocele often occurs at the same time with

A

rectocele or uterine prolapse

40
Q

differentiate enterocele from rectocele

A

Entero is a separate bulge above the rectocele

rectocele is lower than enterocele

41
Q

True hernia of the peritoneal cavity

A

enterocele

42
Q

true hernia of the pelvic cavity

A

cysocele and rectocele

43
Q

cause of uterine prolapse

A

poor cardinal or uterosacral ligament apical support; relaxation of the pelvic floor muscles esp levator ani

44
Q

degree of uterine prolapse wherein the cervix sticks to the vaginal introitus/thru the vaginal barrel to the region of the introitus

A

2nd degree

45
Q

degree of uterine prolapse where the cervix droops into the vagina/ upper barrel of the vagina

A

1st degree

46
Q

degree of uterine prolapse where the cervix and uterus prolapse out thru the introitus

A

3rd degree

47
Q

px undergo vaginal hysterectomy what could be a common complication

A

vaginal vault prolapse

48
Q

mgt objective in POP

A

restore normal anatomy

49
Q

what is a vaginal pessary

A

plastic device placed in the vagina to help support the bladder, vagina, uterus or rectum

50
Q

standard nonsurg treatment for POP

A

Vaginal pessary

51
Q

PFMT/kegel exercises strengthen which muscles

A

pubococcygeous muscles

52
Q

types of conservative mgt for POP

A

Vaginal pessary
PFMT
px education and lifestyle modification

53
Q

Surginacl procedure for anterior or posterior wall prolapse

A

vaginal colporrhapy
rectopubic and paravaginal defect repair
transvaginal permanent mesh replacement

54
Q

surg procedure for uterine preservation

A

modified manchester

uterosacral vaginal hysteropexy

55
Q

surg procedure for post hysterectomy vaginal vault prolapse

A

sacrocolpoplexy
sacrospinous fixatoin
uterosacral plication
colpcleisis

Block 14 module 7 (6 decks)

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