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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
What is enterocoele? be specific
(posteirorcompartment) small bowel prolapse - usually pouch of Douglas
26
what is rectocele and what can its cause?
rectum prolapse - causes constipation + faecal loading => urinary retention (due to urethral compression)
27
POP RF? (6)
things that weaken + stretch ligaments - Postmenopausal - Multiple vaginal deliveries (increasing parity) - Instrumental/prolonger/traumatic deliveries - Obesity - Hypertension - DM
28
POP presentation ? (3)
- feeling of something coming down/dragging heavy sensation - Urinary symptoms (incontinence, urgency, frequency, weak stream, retention) - Sexual dysfunction: pain, altered sensation, reduced enjoyment
29
what would you do for POP examination ?
sims speculum (support anterior wall to see rectocele (vice versa)
30
how many grades of uterine prolapse are there ? which is worse ?
grade 0 - 4 - grade 0: normal - grade 4: full descent with eversion of the vagina
31
what are the 3 general categories for POP management ?
- Conservative - Pessaries - Surgery
32
what is involved in conservative POP management ?
- Physiotherapy - Weight loss - Lifestyle changes (reduce caffeine)
33
Conservative management of POP is not proving effective. what next ? explain
Vaginal pessaries: provide extra support to pelvic organs
34
what might be needed in combo with vaginal pessaries ?
oestrogen cream helps protect vaginal walls from potential irritation
35
surgical POP management complications ?
- Pain, bleeding, infection, DVT - Damage to bladder or bowel - Recurrence of prolapse - Altered experience of sex
36
what are other names for renal stones ?
- renal calculi - Urolithiases - Nephrolithiasis
37
what are renal calculi ?
(kidney stones) - hard stones that form in the renal pelvis
38
what is the renal pelvis ?
where urien collects before travelling down ureters
39
key complications of kidney stones ?
- Obstruction (=> AKI) - Infection (=> obstructive pyelonephritis)
40
What can hypercalcaemia cause ?
- Renal stones - Painful bones - Abdo groans - Psychiatric moans
41
causes of hypercalcaemia ? (3)
- Calcium supplementation - Hyperparathyroidism - Cancer (myeloma, breast, lung)
42
where do urolithiasis often get stuck ?
usually at veseco-uteric junction
43
What types of kidney stones are there ? (made of) most common ?
- Calcium based: Calcium oxalate (most common) - Other: uric acid
44
RF for calcium based kidney stones ?
- Hypercalcaemia - low urine output
45
Renal stones presentation ?
- Asymptomattic - renal cold (unilateral loin to groin pain - excruciating) - haematuria - Nausea + vomiting - low urine output - Symptoms of sepsis
46
what investigations for renal stones ? gold standard ?
- Urine dipstick (Haematuria) - abdo x ray: will show calcium based stones - CT KUB: (gold standard)
47
Kidney stones management ?
- Analgesia: NSAIDs (IM diclofenac) - Antiemetics depends on size - <5mm: watchful waiting: pass without intervention - >5mm surgical intervention.
48
what surgical intervention for renal stones ?
- Extracorporeal shock wave lithotripsy (ESWL): shock waves break stone into smaller parts - Percutaneous nephrolithotomy (PCNL)
49
what can you do to reduce risk of recurrent stones ?
- increase oral fluid intake (add fresh lemon) - reduce dietary salt
50
What is Atrophic vaginitis ? related to lack of what ?
dryness + atrophy of vaginal mucosa related to lack of oestrogen (occur in women from menopause onwards)
51
describe he relationship between oestrogen and Atrophic vaginitis ?
low oestrogen => thinking + reduced elasticity + drying of epithelial lining in vagina + urinary tract => prone to inflammationphic
52
atrophic vaginits presentation ? (4)
post menopausal - itching - dryness - dyspareunia - bleeding
53
what might be seen OE in atrophic vaginitis ? (3)
- pale mucosa - thin skin - dryness
54
atrophic vaginits Mx ?
vaginal lubricants 9cream, pessary, tablet)
55
What is lichen sclerosis ?
Chronic inflam skin condition affecting labia, perineum, perianal (anogenital region)
56
how is lichen sclerosis diagnosed ? (2)
usually made clinically - vulval biopsy can confirm
57
lichen sclerosis presentation ? age?
45-60 woman with vulval itching + skin changes
58
lichen sclerosis Mx ?
cannot be cured - potent topical steroids
59
what is the main concerning complication associated with lichen sclerosis ?
5% risk of developing squamous cell carcinoma of the vulva
60
61
Where are bartholins glands located ?
located deep to posterior aspect of labia major (4 + 8 o'clock)
62
what causes bartholins cyst ?
build up of mucuc secretions in duct => gland blocked => cyst development
63
what causes bartholins abscess ?
bartholins cyst 9small + tender) get infected => bartholins abscess (hot, tender, red, potentially daring pus)
64
what is the most likely infective organism in bartholins abscess ?
E.Coli
65
bartholins abscess RF?
Hx of prev cyst sexually active
66
bartholins cyst clinical features ?
often asympotmattic - if large: valvular pain, superficial dyspareunia - abscess: acute onset of pain, difficulty passing uric
67
how is botholins cyst diagnosed ?
made clinically based on H + E - consider cyst biopsy to exclude vuval carcinoma
68
bartholins cyst Mx? abscess ?
small or asymptomatic: no Tx - resolve with good hygiene, analgesia - abscess: Abx, swab pus/fluid, STI check, surgical drainage
69
what is FGM ?
surgically chaining genital of a female for no-medical reasons
70
what do you do if there is patient with FGM ?
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
where is FGM common ? highest rates ?
highest rates in Somalia, Ethiopia, Sudan
72
what are the different types of FGM ? (4)
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
complications of FGM ? immediate and long term ?
immediate: pain, bleeding, infection, swelling, incontinence, retention long term: infection, PID, UTI, dysmenorrhoea, sexual dysfunction, dysparaenia, infertility , psychological
74
What is most common type of vulval cancer ? cell type ?
90% are squamous cell carcinomas
75
vulval cancer RF ?
- advancing age (>75) - Immunosuppression - HPV infection - Lichen sclerosis
76
what is vulval intraepithelial neoplasia ? can lead to what ?
premalignant condition of squamous epithelium fo the skin - can precede vulval cancer
77
Mx of vulval intraepithelial neoplasia ?
specialist - watch + wait - wide local excision - laser ablation
78
vuval cancer presentation ?
(>75) - vulval lump - ulceration - bleeding - pain - itching - groin lymphadenopathy
79
vulval cancer Mx ?
- biopsy, sentinel node biopsy, further imaging - wide local excision, chemo, radiotherapy

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