Repro Test 2 - Lao - Pelvic Floor Prolapse

Front 1

What are the risk factors for pelvic floor prolapse?

Back 1

Multiparity, advanced age, E2 deficiency, obesity, neurogenic dysfunction of pelvic floor, connective tissue disorder, chronically increased intra-abdominal pressure

Front 2

Define Cystocele

Back 2

Downward displacement of the bladder

Front 3

Define Cystourethrocele

Back 3

Cystocele that includes the urethra

Front 4

Define uterine prolapse

Back 4

Descent of uterus and cervix into vaginal canal toward vaginal interoitus (=opening)

Front 5

Define Proccidentia

Back 5

Complete uterine prolapse

Front 6

Pelvic support includes what?

Back 6

Uterosacral ligament, cardinal ligament, levator ani muscle, endopelvic fascia

Front 7

How do the bony structures fuse to the pelvic organs?

Back 7

connective tissue

Front 8

Where does the levator ani muscle join to the obturator muscle?

Back 8

at the arcus tendineus

Front 9

What are the 3 parts of the levator ani muscle?

Back 9

iliococcygeus, pubococcygeus, puborectalis

Front 10

What sits within the levator muscle?

Back 10

urethra, bladder base, vaginal tube, and anorectum

Front 11

What constitutes the pelvic floor?

Back 11

levator complex of muscles and surrounding connective tissue, vessels and nerves

Front 12

What are the Delancey's levels of support?

Back 12

Level 1 = connective tissue fibers extending both toward head (cephaled) and dorsally (toward sacrum)

Level 2 = Lateral attachment to arcus tendineus fascia of pelvis

Level 3 = Lateral and Anterior attachments of CT to lateral arcus tendineus fascia and posterior pubic symphysis

Front 13

A pt presents with the feeling of pressure like siting on an egg and low backache heaviness that worsens throughout the day. Dx?

Back 13

pelvic prolapse

Front 14

You examine a pt. and on PE find Hypermobile bladder neck with urinary stress incontinence anteriorly, What type of prolapse is this?

Back 14

Anterior

Front 15

What will we find on PE of large anterior prolapse type?

Back 15

Vaginal vault eversion with urinary retention

Front 16

What will we find on PE of Posterior prolapse?

Back 16

Rectocele = can cause constipation and sexual impairment with any compartment

Front 17

What are some of the urinary complaints of a cystocele?

Back 17

Stress incontinence, frequency, urgency, urge incontinence, hesitancy, weak pr prolonged stream, incomplete voiding, need to reduce prolapse or change position to initiate voiding (splinting)

Front 18

How do symptoms of cystocele differ from those of enterocele and rectocele?

Back 18

Cystocele = Stress incontinence, frequency, urgency, urge incontinence, hesitancy, weak pr prolonged stream, incomplete voiding, need to reduce prolapse or change position to initiate voiding (splinting)

Enterocele and Rectocele = Difficulty/Discomfort, Incontinence of flatus/ stool, urgency, incomplete emptying, rectal protrusion during or after defecation, need to reduce prolapse to defecate

Front 19

What are some of the sexual symptoms we can see with prolapsed pts?

Back 19

pain, change in orgasmic response, incontinence

Front 20

Define Enterocele

Back 20

Herniation of bowel and lining of peritoneal cavity through the cul-de-sac of Douglas

Front 21

What embryologic factor may lead a pt to have an enterocele?

Back 21

congenitally deep cul-de-sac = bowel may naturally dissect down

Front 22

What are the dif. types of enterocele?

Back 22

1 = congenital - post. to vaginal vault mostly without vault eversion
2 = Pulsion = Due to cervical prolapse which brings the anterior margin of cul-de-sac down
3 = Traction = Prolapsed organs exert tension on vaginal vault. Preceded by cystocele and rectocele
4 = Iatrogenic = Surgically induced

Front 23

Pt has a heavy feeling in their pelvic area especially when bearing down when standing (due to the pull of gravity which stretches the mesentery), backache, and dyspareunia

Back 23

These are all pretty general symptoms but I guess they mean Enterocele

Front 24

What are the clinical manifestations of Enterocele?

Back 24

Vaginal dryness, ulceration, bleeding, bowel difficulty, post-evacuation discomfort

Front 25

If a pt has the same symptoms as Enterocele (Vaginal dryness, ulceration, bleeding, bowel difficulty, post-evacuation discomfort, Difficulty/Discomfort, Incontinence of flatus/ stool, urgency, incomplete emptying, rectal protrusion during or after defecation, need to reduce prolapse to defecate) PLUS sitting on a lumf feeling, more urinary symtoms, and SYMPTOM RELIEF BY LYING DOWN, what do they have?

Back 25

Uterine Prolapse

Front 26

How do you Dx pelvic floor prolapse?

Back 26

best performed with standing or straining with recto-vaginal exam (thumb inrectum)

Defacography = to view mobility of rectum ie rectal floor pressure