Brainscape's Knowledge GenomeTM

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


See full index

3RD YEAR SYSTEMS: Repro > Prolapse > Flashcards

Prolapse Flashcards

1
Q

What is a Female pelvic organ prolapse?

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
2
Q

What are the 3 distinct layers of the pelvic floor?

A
  • Endopelvic Fascia
    • Collective name for the fibro-muscular connective-type tissue that attaches the bladder, urethra, vagina and uterus to the pelvic walls
    • Can stretch due to fibro-muscular component
  • Pelvic Diaphragm / floor
    • Layer of striated skeletal muscles
  • Urogenital Diaphragm
    • 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
3
Q

What is said to be the critical structure responsible for uterine and apical vaginal support?

A

The uterosacral-cardinal ligament complex (made up of the uterosacral ligament and the cardinal ligament)

  • This tends to break medially (around the cervix)
  • Attachments:
    • Medially to the uterux, cervix, pubocervical/rectovaginal fascia and lateral vaginal fornices
    • Laterally to the sacrum and fascia overlying the Piriformis muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the Pubocervical Fascia and what is it’s function?

A

Trapezoidal fibro-muscular tissue.

  • Function: provides the main support of the anterior vaginal wall
  • Attachments:
    • Centrally - merge with the base of the cardinal ligaments and Cervix
    • Laterally - Arcus tendineus fascia pelvis (white in image)
    • Distally - urogenital diaphragm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the rectovaginal fascia and how does it tend to break?

A

Fibro-musculo-elastic tissue that separates the rectum and vagina.

  • Attachments:
    • Centrally - merges with the Base of cardinal/uterosacral ligaments and peritoneum
    • Laterally - fuses with fascia over the levator ani
    • Distally - firmly to the perineal body
  • Tends to break centrally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What results if there is an upper defect in the rectovaginal fascia?

A

Enterocele

  • Descending of the small intestine into the lower pelvic cavity.
  • When this occurs, the small intestine pushes on the top part of the vagina, creating a bulge
  • Form of POP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What results if there is a lower defect in the rectovaginal fascia?

A

Perineal body descent and rectocele

  • a herniation (bulge) of the front wall of the rectum into the back wall of the vagina.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What structures are involved in each level of Endopelvic support? (There are 3 levels in total)

A
  • Level 1
    • Utero-sacral ligaments
    • Cardinal ligaments
  • Level 2
    • Para-vagina to arcus tendineus fascia: Pubocervical/ Rectovaginal fascia
  • Level 3
    • Urogenital Diaphragm
    • Perineal body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the strongest risk factor for the development of Pelvic organ prolapse?

A

Parity => pregnancy (over 24 weeks) i.e live born or still born

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

Risk factors of Pelvic Organ Prolapse

A
  • Parity
  • Forceps Delivery
  • Large baby (> 4500 gm)
  • Prolonged Second Stage of Labour
  • Advancing age
  • Obesity
  • Previous pelvic surgery
    • Continence procedures i.e Burch colposuspension
    • Hysterectomy
  • Hormonal factors
  • Quality of connective tissue
  • Constipation
  • Occupation with heavy lifting
  • Exercise i.e weight lifting, high-impact aerobics and long-distance running
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define urethrocele, cystocele and uterovaginal prolapse

A
  • Urethrocele: Prolapse of the lower anterior vaginal wall involving the urethra only.
  • Cystocele: Prolapse of the upper anterior vaginal wall involving the bladder.
  • Uterovaginal prolapse. This term is used to describe prolapse of the uterus, cervix and upper vagina.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anterior wall prolapse

A

Anterior vaginal wall collapses and bladder descends because of this

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

Posterior vaginal wall prolapse

A

Posterior vaginal wall collapses and rectum falls forwards

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

What is apical prolapse/uterine prolapse/enterocele?

A

Where the uterus falls down the vaginal canal

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

What are some typical vaginal symptoms in women with pelvic organ prolapse? (5)

A
  • Sensation of a bulge or protrusion
  • Seeing or feeling a bulge or protrusion
  • Pressure
  • Heaviness
  • Difficulty in inserting tampons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some typical urinary symptoms in women with pelvic organ prolapse? (4)

A
  • Urinary incontinence
  • Frequency/urgency
  • Weak or prolonged urinary stream/hesitancy/feeling of incomplete emptying
  • Manual reduction of prolapse to start or complete voiding
17
Q

What are some typical bowel symptoms in women with pelvic organ prolapse? (5)

A
  • Incontinence of flatus, or liquid, or solid stool
  • Feeling of incomplete emptying/ straining
  • Urgency
  • Digital evacuation to complete defecation - the use of fingers to aid in the removal of stool from the rectum.
  • Splinting, or pushing on or around the vagina or perineum, to start or someplete defecation
18
Q

What is considered the ‘gold standard’ scoring tool for POP?

A

POPQ

  • Used to assess the degree of prolapse of pelvic organs
  • Score from 0-4
  • Measures nine points in the vagina. The hymen is the reference point to which the other points are compared. The prolapsed organs are measured in centimeters to the hymen.
  • The woman should be in the dorsal lithotomy position (as if giving birth) but may be standing or lying down flat - record this !
19
Q

Which investigations are done for POP? (5)

A
  • USS/MRI - allow identification of fascial defects
  • Urodynamics - concurrent urinary incontinence or to exclude occult Stress Incontinence (occult meaning it has no other recognisable associated signs/symptoms)
  • IVU or Renal USS - if suspicion of ureteric obstruction
20
Q

How can you prevent POP?

A
  • Avoid constipation
  • Effective management of chronic chest pathology (COPD and asthma)
  • Smaller family size
  • Improvements in antenatal and intra-partum care - Antenatal and post-natal pelvic floor muscle training - thought to be protective
21
Q

Treatment of POP

A
  • Physio
    • pelvic floor muscle training - increase the pelvic floor strength & bulk to relieve the tension on the ligaments
    • Used in cases of mild prolapse and in younger women who have not yet completed their family.
    • No role in advanced cases! Cannot treat fascial defects
  • _​_May also be given things like:
    • Perineometer - instrument for measuring the strength of voluntary contractions of the pelvic floor muscles
    • Vaginal cones - weighted devices designed to increase the strength of the pelvic floor muscles
  • Pessaries - non-surgical treatment - support or space filling pessaries - device inserted into vagina. At I year follow-up successful pessary treatment is as effective as surgery - it is the woman’s choice
  • Surgery
22
Q

Aims of POP surgery

A
  • Relieve symptoms
  • Restore/maintain bladder and bowel function
  • Maintain vaginal capacity for sexual function

3RD YEAR SYSTEMS: Repro (34 decks)

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