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Obs & Gynae > Pelvic Organ Prolapse > Flashcards

Pelvic Organ Prolapse Flashcards

1
Q

What is the pelvic floor made up of?

A

Endo-pelvic fascia - uterosacral / cardinal etc.
Pelvic Diaphragm - levator ani
Urogenital diaphragm

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2
Q

What is the uterosarcral ligament?

A

Allows side to side movement of uterus
Breaks medially
Extends medially from uterus to lateral of sacrum

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3
Q

What is the pubocervical ligament

A

Supports anterior vaginal wall
Breaks laterally causing bladder prolapse
Merges centrally with cardinal ligament and cervix

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4
Q

What is the rectovaginal ligament

A

Breaks centrally
Merges with cardinal and uterosacral ligament
Lateral with levator ani

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5
Q

What causes pelvic organ prolapse?

A

Weakness of pelvic floor
Break in fascial support / pelvic structure
Nerve damage
- Increased risk with hysterectomy / pelvic surgery
Increase in intra-abdominal pressure

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6
Q

What is the main support of the pelvic floor

A

Levator ani

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7
Q

What are the symptoms of pelvic organ prolapse?

A 
Asymptomatic
Sensation of bulge 
Pressure / pain
Heaviness
Can't insert tampon
Urinary / faecal incontinence (cystocele) 
Frequency / urgency / hesitancy / weak stream / incomplete emptying 
Need to reduce prolapse to defaecate
Bleeding 
Sexual dysfunction 
Pain
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8
Q

What are the RF

A 
Age 
Menopause 
High parity /  Pregnancy 
Vaginal Birth / instrumental 
Large baby
Obesity 
Previous pelvic surgery

Constipation
Weight lifting
Chronic lung disease - cough
Ascites / mass

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9
Q

What is a urethrocele

A

Prolapse of anterior vaginal wall due to urethra descent

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10
Q

What is a Cystocele

A

Prolapse of anterior vaginal wall due to bladder descent

Most common

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11
Q

What is a uterovaginal prolapse

A

Prolapse of uterus, cervix and upper vagina

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12
Q

What is an enterocoele

A

Prolapse of posterior wall containing small bowel

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13
Q

What is a rectocele

A

Prolapse of posterior wall involving rectum
Particularly associated with constipation / urinary obstruction
Have to move to defaecate

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14
Q

What is a vault

A

Vaginal vault after hysterectomy as nothing to hold up

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15
Q

How do you Dx pelvic organ prolapse?

What is used to grade

A 
Examination
VE to find if anterior or posterior 
Valsalva to find maximal descent
Test muscles 
POPQ to grade
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16
Q

How do you investigate complications

A 
USS
MRI 
Urodynamic studies
IVU
Renal USS
17
Q

How do you Rx pelvic organ prolapse

A 
Avoid constipation / laxatives
Weight loss  
Address chest pathology
Pelvic floor muscle training
Vaginal oestrogen cream 
Treat associated Sx e.g. incontinence  
Pessaries to hold it up - change every 4 months 
Surgery (Hysterectomy)
18
Q

What are the aims of Rx

A

Maintain sexual function
restore bladder and bowel
relieve symptoms

19
Q

What are the complications of POP

A

Obstructed ureters leading to hydronephrosis and renal failure
Embarrassment
Difficult exercise / walking
Sexual dysfunction

20
Q

What type of hysterectomy is available

A

Abdominal
Laparotomy
Transvaginal

21
Q

What are the indications of hysterectomy

A 
Malignancy
FIbroids 
Heavy bleeding
Endometriosis
PPH is rare
22
Q

What ligament can be damaged in hysterectomy

A

Uterosacral

23
Q

What are main ligament supporting the uterus

A

Uterosacral
Cardinal
Round ligament

24
Q

What is the cardinal body

A

Muscles of urogenital diaphragm and superficial transvere

25
Q

What is anococcygeal

A

All leavator ani and muscles join + external anal sphicnter

26
Q

What discharge is common with pessaries / other SE

A

Pink

Vaginal irritation / erosion - oestrogen cream helps

27
Q

What typically causes urinary incontinence

A

Cystocele

28
Q

What is Rx for vaginal fault

A

Sacrocoloplexy

Suspends vaginal to sacral promontory

29
Q

What is Rx for cytocele

A

Colporrhagry

Vaginal wall repaired

30
Q

What is Rx for uterine prolapse

A

Hysterectomy

Sacrohysteropaxy

31
Q

What do you ask in Hx

A 
Onset, duration, progress
Any Rx
Any RF
Other Sx 
FH prolapse 
Medical and surgical Hx
Obstetric Hx
Sexual Hx
Medication
Social 
Allergies
32
Q

What do you do if relapse after surgery

A

Conservative Rx

Obs & Gynae (23 decks)

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