Repro: Test 2: 18. Lao : Pelvic Floor Prolapse

Front 1

What is the major risk factor for pelvic floor prolapse?

(objective)

Back 1

MULTIPARITY

others:
advanced age, estrogen deficiency, obesity, neurogenic dysfunction of pelvic floor, CT disorders, chronically increased intra-abdominal pressure

Front 2

Define the following forms of prolapse:

Cystocele
Cystourethrocele
Uterine Prolapse
Rectocele
Enterocele

(objective)

Back 2

CYSTOCELE: downward displacement of the bladder
CYSTOURETHROCELE: cystocele that includes the urethra
UTERINE PROLAPSE: descent of the uterus and cervix into the vaginal canal toward the vaginal introitus
RECTOCELE: protrusion of the rectum into the posterior vaginal lumen
ENTEROCELE: herniation of the small bowel into the vaginal lumen

Front 3

THE LEVATOR MUSCLE consists of 3 parts...what are they?

Back 3

iliococcygeus,
pubococcygeus,
puborectalis

Front 4

what are some of the prohylaxis tx for enterocele?

Back 4

decrease intra-abdominal pressure (obesity, girdles, smoking)

Front 5

pt presents with a feeling of pressure that they describe it like they are sitting on an egg. They also have a low backache heaviness that worsens as the day progresses...what do they have?

Back 5

pelvic floor prolapse

Front 6

What is stress incontinence?

What is it associated with?

Back 6

you cough, sneeze, etc and you piss your pants

assoc with prolapse

Front 7

What is splinting?

*

Back 7

Need to reduce prolapse or change position to initiate voiding (SPLINTING)

pt might say they have to stick a finger in their vagina to have a bowel movement

Front 8

what is an important aspect of the pelvic exam when you are evaluating a pt for prolapse?

Back 8

stand on floor with one foot elevated perform rectovaginal exam with vasalva.

Front 9

when giving a urethral Q tip test for a prolapse exam, what is a positive exam?

Back 9

anything above 30 degrees is considered positive

shows stress incontinence

Front 10

What is a medical tx of enterocele?

Back 10

Estrogen cream

Front 11

what is uterine prolapse due to?

Back 11

Usually due to injury to the endopelvic fascia (cardinal/ utersacral ligaments) and relaxation of the musculature of the pelvic floor (levator ani)

Birth injury

Front 12

Uterine prolapse tx? (2- non surgical)

Back 12

PESSARY: for poor surgical candidates (mall plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature)

VAGINAL ESTROGEN: improves tissue quality (should give with progesterone)

note: KEGEL’S: little value

Front 13

what is one of the main surgical tx for uterine prolapse

Back 13

Mesh augmentation

Front 14

What is the GOLD STANDARD for uterine prolapse?

****

Back 14

Abdominal Sacrocolpopexy

mesh to tac the vagina to the sacrum, to hold it up

Done with robotics

good for young active pt with severe prolapse (pt still working, doing regular activities)

Front 15

what is a COLPOCLEISIS? who is it indicated in?

Back 15

closure of the vagina to tx prolapse

only good for women who aren't going to be having sex...because that would be pretty difficult after this

Front 16

STRESS URINARY INCONTINCENCE = ?

Back 16

Loss of urine during activities resulting in increased intra-abdominal pressure.
Abdominal pressure overcomes urethral closure pressure.
Most commonly associated with urethral hypermobility due to prior birth injury.

Front 17

what are some of the nonsurgical tx for stress incontinence?

(objective)

Back 17

Intake restriction and timed voiding.
Kegel’s exercises if mild.
Pessary with incontinence ring.

Front 18

What is the gold standard surgical tx for stress incontinence?

**

Back 18

Burch: Gold standard. Invasive via abdominal approach.

Front 19

with mesh, what medical tx that should be used post surgical

Back 19

Estrogen

Front 20

complications of mesh?

Back 20

exposure of the mesh

or erosion, erodes into the bladder or rectum