structural abnormalities of vagina

Question 1

a 45-year-old female complaining of pressure in the pelvis and vagina along with discomfort when straining. She also feels that her bladder hasn’t fully emptied after urinating. What does this women have?

Answer 1

Cystocele

Question 2

Describe a cystocele?

Answer 2

anterior vaginal prolapse of the posterior bladder wall into the vagina

Question 3

What types of symptoms would you suspect in someone with a cystocele

Answer 3

1. feeling of incomplete voiding
2. feeling of pressure
3. discomfort when straining

Question 4

How can you Diagnose a cystocele?

Answer 4

with a POP-Q: pelvic organ prolapse quantification): quantifies the extent and location of defects

Can also do ultrasound or MRI

Question 5

Can you use a VCUG test for evaluating a cystocele?

Answer 5

yeah

Question 6

What is the Tx for cystocele?

Answer 6

flexible pessary ring

Can also do kegels to prevent it

Question 7

What kind of therapy after menopause helps keep vaginal tone?

Answer 7

estrogen

Question 8

a 50-year-old female with pelvic pressure reports and a sensation of a mass present in the vagina. She reports chronic constipation and a sensation that the rectum is not completely emptied following a bowel movement. Occasionally, she experiences episodes of fecal incontinence. What does this patient likely have?

Answer 8

a rectocele

Question 9

What is a rectocele?

Answer 9

herniation of the rectum into posterior portion of the vaginal wall

Question 10

What kinds of symptoms would you suspect in a patient with a rectocele?

Answer 10

pelvic pressure + bowel symptoms

Symptoms include a soft bulge of tissue in the vagina that may or may not protrude through the vaginal opening

Question 11

How can you diagnose a rectocele?

Answer 11

POP-Q (pelvic organ prolapse quantification): quantifies the extent and location of defects

Question 12

What test should someone with a rectocele get?

Answer 12

a colonoscopy to rule out cancer

Question 13

Tx for rectocele?

Answer 13

Kegel exercises, pelvic floor retraining, behavioral changes, bowel regimen, pessary, surgical repair or repair with mesh augmentation

Question 14

How would you expect a patient with ovarian torsion to present?

Answer 14

sudden onset of sharp and usually unilateral lower abdominal pain, in 70% of cases accompanied by nausea and vomiting

Question 15

What is the diagnostic test of choice for ovarian torsion?

Answer 15

ultrasound with doppler flow

Question 16

What is the gold standard diagnostic test for ovarian torsion?

Answer 16

laparoscopy

Question 17

What is the Tx for ovarian torsion?

Answer 17

laparoscopic surgery to uncoil the ovary

Question 18

What is uterine prolapse?

Answer 18

This is when uterus descends towards or into the vagina

Question 19

Why does a uterine prolapse happen?

Answer 19

This occurs because the pelvic floor muscles and ligaments get weak and can no longer support the uterus

Question 20

Symptoms of uterine prolapse?

Answer 20

Vaginal fullness, abdominal pain worse late in the day, after prolonged standing. Relieved by lying down.

Question 21

Describe the different grades of uterine prolapse?

Answer 21

0 degree: No descent

1st degree: To the upper vagina/descent between normal and ischial spine

2nd degree: To the introitus/between ischial spines and hymen

3rd degree: Cervix is outside the introitus/within hymen

4th degree (sometimes referred to as procidentia): Uterus and cervix entirely outside the introitus/through the hymen

Question 22

How do you diagnose a uterine prolapse?

Answer 22

Diagnosis is confirmed by a speculum or bimanual pelvic examination

Question 23

Tx for symptomatic patient with uterine prolapse?

Answer 23

treated with a pessary if the perineum can structurally support a pessary

Severe or persistent symptoms and 3rd - or 4th-degree prolapse require surgery