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3a > WH: Vaginal + Vulval Disorders > Flashcards

WH: Vaginal + Vulval Disorders Flashcards

1
Q

What is urinary incontinence ?

A

It is the involuntary loss of control of urination

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2
Q

what are the main 2 types of urinary incontinence ?

A
  • Stress
  • Urgency
    (mixed)
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3
Q

What is urge incontinence ? also known as ?

A

urge incontinence (overactive bladder)
- overactivity of detrusor muscle of bladder

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4
Q

what will patients with urge incontinence often complain of ?

A

sudden feeling to urine + rush to the toilet
(when they gotta go, they gotta go)

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5
Q

what is stress incontinence ? due to?

A

due to weakness of the pelvic floor + sphincter muscles => allows mine to lead when increased pressure on bladder (increased intraabdominal pressure)

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6
Q

what will patients with stress incontinence complain of?

A

leakage of urine when laughing, coughing or surprised

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7
Q

What is mixed incontinence ?

A

symptoms of both stress + urge incontinence

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8
Q

What is overflow incontinence ?

A

obstruction to outflow of urine => chronic urinary retention => overflow + leakage of urine

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9
Q

What is overflow incontinence caused by ? (4)

A
  • Anticholinergic meds
  • Fibroids
  • Pelvic tumours
  • Neurological disorders (MS, Diabetic neuropathy)
  • posterior POP (+faecal loading)
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10
Q

RF for urinary incontinence ? (6)

A
  • Increasing age
  • Post-menopausal
  • increased BMI
  • prev pregnancy + vaginal deliveries
  • POP
  • neurological disorders
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11
Q

What investigations are done for urinary incontinence ?

A
  • Bladder diary
  • Urine dipstick (to exclude infection)
  • Post-void residual bladder vol
  • urodynamic testing
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12
Q

what info is there in a bladder diary ?

A
  • fluid intake
  • urination vol
  • incontinence vol
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13
Q

Management of stress incontinence ?

A
  • Lifestyle: avoid caffeine, alcohol, smoking, dietetics + overfilling bladder
  • Weight loss
  • Supervised pelvic floor exercises
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14
Q

Urge incontinence management ?

A
  • Bladder retraining
  • Anticholinergic meds (oxybutymin)
  • Incasive procedures
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15
Q

what does bladder retraining involve ?

A

gradually increase the time between voiding

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16
Q

SE of anticholinergic medications? (3) give example of this type of drug

A

oxybutymin
SE:
- dry mouth
- dry eyes
- urinary retention

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17
Q

What is pelvic organ prolapse ?

A

Descent of pelvic organs into the vagina

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18
Q

POP pathophysiology ?

A

as a result of lengthening + weakness of muscles + ligaments surround the uterus, rectum + bladder

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19
Q

name the pelvic organs from anterior to posterior

A

ant
- bladder
- vagina
- rectum
post

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20
Q

what is an anterior compartment prolapse ?

A

weakenes anterior vaginal wall
- cystolcele
- urethrocele

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21
Q

what is a cystolcele ?

A

bladder prolapse into vagina

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22
Q

what is a urethrocele + cystocele called ?

A

cystourethrocele

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23
Q

what is a middle compartment prolapse ? (2)

A
  • uterine prolapse
  • Vault prolapse (post hysterectomy)
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24
Q

what is a posterior compartment POP ? (3)

A

involvement of posterior vaginal wall
- Enterocele
- Rectocele
-

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25
Q

What is enterocoele? be specific

A

(posteirorcompartment)
small bowel prolapse
- usually pouch of Douglas

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26
Q

what is rectocele and what can its cause?

A

rectum prolapse
- causes constipation + faecal loading => urinary retention (due to urethral compression)

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27
Q

POP RF? (6)

A

things that weaken + stretch ligaments
- Postmenopausal
- Multiple vaginal deliveries (increasing parity)
- Instrumental/prolonger/traumatic deliveries
- Obesity
- Hypertension
- DM

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28
Q

POP presentation ? (3)

A
  • feeling of something coming down/dragging heavy sensation
  • Urinary symptoms (incontinence, urgency, frequency, weak stream, retention)
  • Sexual dysfunction: pain, altered sensation, reduced enjoyment
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29
Q

what would you do for POP examination ?

A

sims speculum
(support anterior wall to see rectocele (vice versa)

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30
Q

how many grades of uterine prolapse are there ? which is worse ?

A

grade 0 - 4
- grade 0: normal
- grade 4: full descent with eversion of the vagina

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31
Q

what are the 3 general categories for POP management ?

A
  • Conservative
  • Pessaries
  • Surgery
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32
Q

what is involved in conservative POP management ?

A
  • Physiotherapy
  • Weight loss
  • Lifestyle changes (reduce caffeine)
33
Q

Conservative management of POP is not proving effective. what next ? explain

A

Vaginal pessaries: provide extra support to pelvic organs

34
Q

what might be needed in combo with vaginal pessaries ?

A

oestrogen cream helps protect vaginal walls from potential irritation

35
Q

surgical POP management complications ?

A
  • Pain, bleeding, infection, DVT
  • Damage to bladder or bowel
  • Recurrence of prolapse
  • Altered experience of sex
36
Q

what are other names for renal stones ?

A
  • renal calculi
  • Urolithiases
  • Nephrolithiasis
37
Q

what are renal calculi ?

A

(kidney stones)
- hard stones that form in the renal pelvis

38
Q

what is the renal pelvis ?

A

where urien collects before travelling down ureters

39
Q

key complications of kidney stones ?

A
  • Obstruction (=> AKI)
  • Infection (=> obstructive pyelonephritis)
40
Q

What can hypercalcaemia cause ?

A
  • Renal stones
  • Painful bones
  • Abdo groans
  • Psychiatric moans
41
Q

causes of hypercalcaemia ? (3)

A
  • Calcium supplementation
  • Hyperparathyroidism
  • Cancer (myeloma, breast, lung)
42
Q

where do urolithiasis often get stuck ?

A

usually at veseco-uteric junction

43
Q

What types of kidney stones are there ? (made of) most common ?

A
  • Calcium based: Calcium oxalate (most common)
  • Other: uric acid
44
Q

RF for calcium based kidney stones ?

A
  • Hypercalcaemia
  • low urine output
45
Q

Renal stones presentation ?

A
  • Asymptomattic
  • renal cold (unilateral loin to groin pain - excruciating)
  • haematuria
  • Nausea + vomiting
  • low urine output
  • Symptoms of sepsis
46
Q

what investigations for renal stones ? gold standard ?

A
  • Urine dipstick (Haematuria)
  • abdo x ray: will show calcium based stones
  • CT KUB: (gold standard)
47
Q

Kidney stones management ?

A
  • Analgesia: NSAIDs (IM diclofenac)
  • Antiemetics

depends on size
- <5mm: watchful waiting: pass without intervention
- >5mm surgical intervention.

48
Q

what surgical intervention for renal stones ?

A
  • Extracorporeal shock wave lithotripsy (ESWL): shock waves break stone into smaller parts
  • Percutaneous nephrolithotomy (PCNL)
49
Q

what can you do to reduce risk of recurrent stones ?

A
  • increase oral fluid intake (add fresh lemon)
  • reduce dietary salt
50
Q

What is Atrophic vaginitis ? related to lack of what ?

A

dryness + atrophy of vaginal mucosa related to lack of oestrogen
(occur in women from menopause onwards)

51
Q

describe he relationship between oestrogen and Atrophic vaginitis ?

A

low oestrogen => thinking + reduced elasticity + drying of epithelial lining in vagina + urinary tract => prone to inflammationphic

52
Q

atrophic vaginits presentation ? (4)

A

post menopausal
- itching
- dryness
- dyspareunia
- bleeding

53
Q

what might be seen OE in atrophic vaginitis ? (3)

A
  • pale mucosa
  • thin skin
  • dryness
54
Q

atrophic vaginits Mx ?

A

vaginal lubricants 9cream, pessary, tablet)

55
Q

What is lichen sclerosis ?

A

Chronic inflam skin condition affecting labia, perineum, perianal (anogenital region)

56
Q

how is lichen sclerosis diagnosed ? (2)

A

usually made clinically
- vulval biopsy can confirm

57
Q

lichen sclerosis presentation ? age?

A

45-60 woman with vulval itching + skin changes

58
Q

lichen sclerosis Mx ?

A

cannot be cured
- potent topical steroids

59
Q

what is the main concerning complication associated with lichen sclerosis ?

A

5% risk of developing squamous cell carcinoma of the vulva

60
Q
A
61
Q

Where are bartholins glands located ?

A

located deep to posterior aspect of labia major (4 + 8 o’clock)

62
Q

what causes bartholins cyst ?

A

build up of mucuc secretions in duct => gland blocked => cyst development

63
Q

what causes bartholins abscess ?

A

bartholins cyst 9small + tender) get infected => bartholins abscess (hot, tender, red, potentially daring pus)

64
Q

what is the most likely infective organism in bartholins abscess ?

A

E.Coli

65
Q

bartholins abscess RF?

A

Hx of prev cyst
sexually active

66
Q

bartholins cyst clinical features ?

A

often asympotmattic
- if large: valvular pain, superficial dyspareunia
- abscess: acute onset of pain, difficulty passing uric

67
Q

how is botholins cyst diagnosed ?

A

made clinically based on H + E
- consider cyst biopsy to exclude vuval carcinoma

68
Q

bartholins cyst Mx? abscess ?

A

small or asymptomatic: no Tx
- resolve with good hygiene, analgesia
- abscess: Abx, swab pus/fluid, STI check, surgical drainage

69
Q

what is FGM ?

A

surgically chaining genital of a female for no-medical reasons

70
Q

what do you do if there is patient with FGM ?

A

it is illegal (FGM act 2003): so legal require for healthcare professional to report it to the police
(report all <18 cases, risk assess for >18)

71
Q

where is FGM common ? highest rates ?

A

highest rates in Somalia, Ethiopia, Sudan

72
Q

what are the different types of FGM ? (4)

A

1) removal of part/all of clitoris
2) removal of part/all of clitoris + labia minor
3) narrowing of closing of the vaginal orrifice (infibulation)
4) all other

73
Q

complications of FGM ? immediate and long term ?

A

immediate: pain, bleeding, infection, swelling, incontinence, retention
long term: infection, PID, UTI, dysmenorrhoea, sexual dysfunction, dysparaenia, infertility , psychological

74
Q

What is most common type of vulval cancer ? cell type ?

A

90% are squamous cell carcinomas

75
Q

vulval cancer RF ?

A
  • advancing age (>75)
  • Immunosuppression
  • HPV infection
  • Lichen sclerosis
76
Q

what is vulval intraepithelial neoplasia ? can lead to what ?

A

premalignant condition of squamous epithelium fo the skin
- can precede vulval cancer

77
Q

Mx of vulval intraepithelial neoplasia ?

A

specialist
- watch + wait
- wide local excision
- laser ablation

78
Q

vuval cancer presentation ?

A

(>75)
- vulval lump
- ulceration
- bleeding
- pain
- itching
- groin lymphadenopathy

79
Q

vulval cancer Mx ?

A
  • biopsy, sentinel node biopsy, further imaging
  • wide local excision, chemo, radiotherapy

3a (43 decks)

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