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Year 3 Repro (JK) > Pelvic organ prolapse > Flashcards

Pelvic organ prolapse Flashcards

1
Q

Prolapse

A

protrusion of an organ or structure beyond its normal anatomical confines

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2
Q

Female POP

A

descent of pelvic organs through or towards vagina

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3
Q

% of multiparous and nulliparous women

A

multi: 12-30% and 2% nulliparous

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4
Q

Asymptomatic prolapse

A

50%

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5
Q

Why must abdominopelvic cavity walls be flexible?

A

accommodate volume and pressure

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6
Q

What is the pelvic floor?

A

The soft tissues that close the space between the pelvic bones

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7
Q

What happens if the pelvic floor is normal?

A

all pelvic viscera in position at rest and with increased intra-abdominal pressure

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8
Q

6 dynamic pelvic organs

A

bladder, uterus, vagina, rectum, anus, urethra

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9
Q

3 layers of pelvic floor

A

endopelvic fascia
pelvic diaphragm
urogenital diaphragm

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10
Q

What 3 visceral structures does the endopelvic fascia surround?

A

uterosacral ligaments
pubocervical fascia
rectovaginal fascia

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11
Q

What is endopelvic fascia?

A

fibromuscular connective type tissue

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12
Q

2 muscles in pelvic diaphragm

A

levator ani and coccygeus

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13
Q

Urogenital diaphragm

A

superficial and deep transverse perineal muscles

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14
Q

Significance of fibromuscular connective tissue of endopelvic fascia

A

fibro-muscular can stretch but connective does not it breaks

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15
Q

Medial attachments of uterosacral/cardinal ligaments

A

cervix, lateral vaginal fornices, uterus, pubocervical and rectovaginal fascia

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16
Q

Lateral attachments of uterosacral/cardinal ligaments

A

sacrum and fascia overlying piriformis muscle

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17
Q

Palpation of uterosacral/cardical ligaments

A

down traction on cervix and if intact allows limited cervix side-side movements

18
Q

Where does uterosacral/cardinal ligaments tend to break?

A

medially - cervix

19
Q

What is the pubocervical fascia the main support for?

A

anterior vaginal wall

20
Q

Where does pubocervical fascia tend to break?

A

lateral attachments or medially in front of cervix

21
Q

Type of tissue that makes up rectovaginal fascia

A

fibromusculo elastic tissue

22
Q

Upper and lower defects of rectovaginal fascia leads to…

A

upper - enterocoele

lower - perineal body descent and rectocoele

23
Q

POP risk factors

A

advancing age - obesity - parity - forceps - big baby- pelvic surgeries - hormonal - hysterectomy - constipation - exercise - heavy lifting

24
Q

urethrocoele

A

Prolapse of lower anterior vaginal wall involving urethra only

25
Q

cystocoele

A

Prolapse of upper anterior vaginal wall involving bladder

26
Q

Uterovaginal prolapse

A

prolapse of uterus, cervix and upper vagina

27
Q

enterocoele

A

prolapse of upper posterior wall of vagina containing loops of small bowel

28
Q

rectocoele

A

prolapse of lower posterior vaginal wall involving rectum bulging forwards into vagina

29
Q

vaginal symptoms of POP

A 
pressure 
heaviness 
sensation of a bulge or protrusion 
difficult inserting tampons 
seeing or feeling a bulge or protrusion
30
Q

bowel symptoms of POP

A

splint/push around vagina to start defaecation
digital evacuation to complete emptying
urgency
incomplete emptying or straining
incontinence of flatus or liquid/solid stool

31
Q

bladder symptoms of POP

A

urinary incontinence
frequency/urgency
weak or prolonged stream/hesitancy
manual reduction of prolapse to start or complete emptying

32
Q

Assessment of POP

A

examine abdomen
record position eg left lateral
QOL
POPQ score

33
Q

3 investigations and use

A

MRI/USS - levator ani thickness
urodynamics - UI or SI
IVU or renal USS - suspect ureteric obstruction

34
Q

4 preventions of POP

A

avoid constipation
treat chronic lung disease
smaller family size
pelvic floor strength exercises

35
Q

PFMT

A

increase pelvic floor strength for mild prolapse in young women

36
Q

Supplementation of PFMT

A

perinometer
biofeedback
vaginal cores
electrical stimulation

37
Q

Materials of pessaries

A

silicone, lucite, rubber, plastic

38
Q

Advantages of silicone pessaries

A

long shelf life
resistance to autoclaving and recurrent cleaning
non-absorbent towards secretions and odors
inert
hypoallergenic

39
Q

vaginal pessaries vs surgery

A

no real difference

40
Q

Aim of surgical treatment

A

relieve symptoms
restore and maintain bladder and bowel function
maintain vaginal capacity for sexual function

41
Q

What to remember in surgical treatment

A

prophylactic antibiotics and VTE

Year 3 Repro (JK) (33 decks)

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