Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3: Reproduction > Pelvic organ prolapse > Flashcards

Pelvic organ prolapse Flashcards

1
Q

what is prolapse?

A

Protrusion of an organ or structure beyond its normal anatomical confines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a female POP?

A

the descent of the pelvic organs towards or through the vagina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

prevalence?

A

2% for symptomatic prolapse to 50% for asymptomatic prolapse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In the UK, pelvic organ prolapse accounts for 20% of women on the waiting list for major?

A

gynaecological surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does the pelvic floor consist of?

A

all the soft tissue structures that close the space between the pelvic bones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is maintained if the pelvic floor is normal?

A

pelvic viscera will be maintained in their position both at rest and in periods of increased intra-abdominal pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 3 distinct layers of the pelvic floor

A

Endo-pelvic Fascia
Pelvic Diaphragm
Urogenital Diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe the Endo-pelvic Fascia?

  • what ligaments are present
A

network of fibro-muscular connective-type tissue that has a “hammock-like” configuration and surrounds the various visceral structures (Uteroscaral ligaments / Pubocervical Fascia / Rectovaginal Fascia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe the pelvic diaphragm?

A

layer of striated muscles with its fascial coverings (Levator ani & coccygeus).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

describe the Urogenital Diaphragm?

A

the superficial & deep transverse perineal muscles with their fascial coverings.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

endometriosis- pelvic fascia - describe the connective tissue?

A

does not stretch or attenuate instead it breaks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Utero-sacral/ Cardinal Complex ligament palpated?

A

down traction on the Cervix and if intact allows limited side-side movement of the cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how does the Utero-sacral/ Cardinal Complex tend to break?

A

medially (around the cervix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Utero-sacral/ Cardinal Complex lies medially to? (5)

A

Uterus, Cervix, Lateral Vaginal Fornices & Pubocervical & Rectovaginal Fascia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Utero-sacral/ Cardinal Complex lies laterally to?

A

the sacrum & fascia overlying the Piriforms muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pubocervical Fascia - what kind of fibre?

  • what does it do?
A

Trapezoidal Fibro-muscular tissue

  • Provide the main support of the anterior vaginal wall.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pubocervical Fascia - centrally merges with?

A

Base of Cardinal ligaments & Cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pubocervical Fascia - lies laterally with?

A

Arcus Tendineus Fascia Pelvis (White line).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pubocervical Fascia lies distally to?

A

Urogenital Diaphragm (under SP).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

where do the Pubocervical Fascia tend to break at?

A

lateral attachments or immediately in front of the cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Rectovaginal Fascia - made of what tissue?

A

Fibro-musculo- elastic tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

where does the Rectovaginal Fascia tend to break?

upper vs lower defect

A

If upper defect: Enterocele.

If lower defect: perineal body descent & Rectocele.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Rectovaginal Fascia - lies centrally to?

A

merge with the Base of Cardinal/ uterosacral ligaments & peritoneum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Rectovaginal Fascia - laterally fuses with?

A

fascia over the levator ani.

25
Q

Rectovaginal Fascia - joins firmly to what distally ?

A

Perineal Body.

26
Q

Endopelvic Support - level 1 - what 2 ligaments

A

Utero-sacral ligaments

Cardinal ligaments

27
Q

Endopelvic Support - level 2?

A

Para-vagina to arcus tendineus fascia: Pubocervical/ Rectovaginal fascia

28
Q

Endopelvic Support - level 3?

A

Urogenital Diaphragm

Perineal body

29
Q

Risk factors of POP? (4)

A 
Pregnancy and Vaginal birth
- Forceps Delivery 
Large baby (> 4500 gm) 
Prolonged Second Stage 
- Advancing Age 
- Obesity
30
Q

strongest RISK FACTOR OF POP?

A

Parity

31
Q

how can previous pelvic procedure effect POP?

A

Continence procedures - ELEVATES BALDDER NECK

  • Burch colposuspension
  • hysterectomy
32
Q

WHAT IS Burch colposuspension?

A

by fixing the lateral vaginal fornices to the ipsilateral iliopectineal ligaments, leaves a potential defect in the posterior vaginal wall, which predisposes to rectocele and enterocele formation

33
Q

Other Risk Factors for POP?

A
  • Hormonal factors
  • Quality’ of Connective Tissue
  • Constipation
  • Occupation with Heavy Lifting
  • Exercise
  • Weight lifting, high-impact aerobics and long-distance running increase the risk of urogenital prolapse.
34
Q

what is a Urethrocele prolapse?

A

Prolapse of the lower anterior vaginal wall involving the urethra only.

35
Q

what is a cystocele prolapse?

A

Prolapse of the upper anterior vaginal wall involving the bladder.

36
Q

what is a Uterovaginal prolapse?

A

This term is used to describe prolapse of the uterus, cervix and upper vagina.

37
Q

what is a Enterocele prolapse?

A

Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel

38
Q

what is a Rectocele prolapse?

A

Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina.

39
Q

Typical symptoms in women with pelvic organ prolapse - Vaginal (5)

A
  • Sensation of a bulge or protrusion
  • Seeing or feeling a bulge or protrusion
  • Pressure
  • Heaviness
  • Difficulty in inserting tampons
40
Q

Typical symptoms in women with pelvic organ prolapse – Urinary

A
  • Urinary Incontinence
  • Frequency/ Urgency
  • Weak or prolonged urinary stream/ Hesitancy/ Feeling of incomplete emptying
  • Manual reduction of prolapse to start or complete voiding
41
Q

Typical symptoms in women with pelvic organ prolapse – Bowel (5)

A
  • Incontinence of flatus, or liquid or solid stool
  • Feeling of incomplete emptying/ Straining
  • Urgency
  • Digital evacuation to complete defecation
    • Splinting, or pushing on or around the vagina or perineum, to start or complete defecation
42
Q

Assessment of POP (3)

A
  • Examination to exclude pelvic mass
  • Record the position of examination: left lateral Vs - Lithotomy Vs Standing.
    Quality of Life
43
Q

Objective Assessment: (3)

A

Baden- Walker- Halfawy Grading
POPQ Score
Others

44
Q

gold standard test?

A

POPQ Score

45
Q

Pelvic floor evaluation values? ( 0,1,2,3,5)

A

Stage 0(TVL – 2 cm )

Stage I(< - 1cm)

Stage II (> - 1cm < + 1cm)

Stage III (> _ 1cm but + TVL – 2cm )

46
Q

Investigations for POP (3)

- why do them

A

USS / MRI: Allow identification of fascial defects/ measurement of Levator ani thickness (research only).

Urodynamics: concurrent UI or to exclude Occult SI.

IVU or Renal USS (if suspicion of ureteric Obstruction).

47
Q

Prevention of prolapse (4)

A

Avoid constipation.
Effective management chronic chest pathology (COAD & asthma).
Smaller family size.
Improvements in antenatal and intra-partum care: Antenatal and post-natal pelvic floor muscle training.

48
Q

Treatment of POP - Pelvic floor muscle training (PFMT): - WHY?? (5)

A
  • Increase the pelvic floor strength & bulk  relieve the tension on the ligaments
  • cases of mild prolapse.
  • younger women who have not yet completed their family.
  • No role in advanced cases.
  • Cannot treat fascial defects.
49
Q

Education about pelvic floor exercises may be supplemented with the use of ? (4)

A

perineometer

biofeedback, vaginal cones and electrical stimulation.

50
Q

what are pessaries made from?

A

silicone, Lucite, rubber or plastic.

51
Q

why is silicone advantageous ? (5)

A
  • Long Shelf-life
  • Resistance to autoclaving and repeated cleaning
  • Non-absorbent towards secretions and odors
  • Inertness
  • Hypoallergenic nature.
52
Q

do women prefer surgery of pessary?

A

pessary

53
Q

exclusions for POP surgery? (2)

A
  • Previous POP surgery

- Unable to retain pessary for 2 weeks.

54
Q

with getting surgery - what will you see at 12 months?

A

No significant difference in bowel, urinary, sexual symptoms

55
Q

At I year follow-up successful pessary treatment is as effective as ?

A

surgery

56
Q

Aim of surgical treatment for POP (3)

A
  • Relieve symptoms,
  • Restore/maintain bladder & bowel function and
  • Maintain vaginal capacity for sexual function.
57
Q

treatment for POP (3) - what should you remember

A
  • Prophylactic Antibiotics.
  • Thrombo-embolic prophylaxis.
  • Postoperative Urinary Vs SPC.
58
Q

Prolapse occur due to progressive …?

A

weakness of the pelvic floor muscles followed by breakdown in fascial support.

59
Q

How man women are affected and what % are asymptomatic

A

50% of multiparous women with 10% symptomatic.

Year 3: Reproduction (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions