Reproduction System- Geriatric Gynecology By Knepp

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Reproduction System- Geriatric Gynecology by Knepp

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Reproduction System- Geriatric Gynecology by Knepp

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Four most common complaints a lady walks in with

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Pain
Bleeding
Itching
Masses

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Before you take a history, what do you do with a geriatric patient?

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take their mental status.
test their memory.

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What's the name of the traditional physical examination position?

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dorsal lithotomy. but their are limitations, such as if there's a prolapse, it may be better to have the pt. standing up.

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Visual changes

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-gray or diminished pubic hair
-diminished subq fat in mons pubis and labia majora

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Uterine prolapse is due to? what is an eversion of the entire uterus and vagina called?

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Uterine prolapse
-Due to defects or weakness of the cardinal or uterosacral ligaments.
-Procidentia is an eversion of the entire uterus and vagina.
-Degree of prolapse is referred to by Grades I through IV.

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How are uterine prolapses graded?

TEST QUESTION!

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Grade I – Extends into the proximal half of the vagina.
Grade II – Extends into the distal half of the vagina.
Grade III – Protrudes beyond the vaginal introitus with standing or Valsalva.
Grade IV – Protrudes beyond the vaginal introitus at rest.

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What the heck is a cystocele? weakness from what? what's the difference between a small and a large one?

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Protrusion of bladder throught the ANTERIOR vaginal wall.
Result of weakness of the pubocervical fascia.
Small cystoceles can cause urinary incontinence.
Large cystoceles can cause obstructive voiding symptoms.

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What's the giveaway that you're dealing with a uterus or a bladder prolapse?

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look for the cervix.

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Ok so what's a rectocele? caused by weakness where? what are some complications?

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-Protrusion of the rectum through the POSTERIOR vaginal wall.
-Caused by weakness of the perirectal fascia.
-Can complicate defecations and lead to constipation.
-Sometimes produces need to reduce the rectocele in order to defecate.

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What is the only true hernia that we're going to talk about? what is it due to? Who are these more common in?

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Enterocele
-Only true hernia of the various forms of prolapse.
-Due to herniation of small bowel and peritoneum between the uterosacral ligaments and the recto-vaginal space.
-More common in women who have undergone hysterectomy.

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Management options

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Biobehavioral Therapy: Pelvic floor muscle exercises (kegal only early); Biofeedback; Electrical Stimulation

Pessary: device manually inserted to trap the cervix to prevent prolapse.

Topical Estrogen Replacement: skin atrophy from loss of estrogen; use a topical estrogen cream which is absorbed locally

Surgery: Anterior and/or posterior colporrhaphy; Hysterectomy; Colpoclesisis

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Vaginitis and Vulvovaginitis

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Bacterial and other infectious vaginosis
-Same risks as any age group
-Gardnerella vaginalis
-Trichomonas vaginalis

Sexually transmitted diseases

Candidal vulvovaginitis
-Immunocompromised

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Atrophic Vaginitis is caused by what? what are the presentations?

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Decreased estrogen postmenopause:
-Thins vaginal mucosa
-Telangietasias
-Vaginal fluid becomes more alkaline which leads to loss of Lactobacillus
-Increases risk of UTI’s
-Can produce dyspareunia
-Topical estrogen cream, one gram via vaginal cream q bedtime is an effective therapy
-Aggravated by contact irritants/ contact dermatitis

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Incontinence when the bladder is full and you cough is called?

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stress. due to increased abdo pressure that overcomes a weakened abdo sphincter.

urge incontinence- bladder involuntary contracts; SNS, PNS, local inflammation

overflow incont- not able to empty bladder, too full causing leakage... urethral obstruction,BPH; more common in mans.

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American Cancer Society and Breast Cancer

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Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.

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American Cancer Society and Cervical cancer

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Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.

Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

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American Cancer Society and Endometrial (uterine) cancer

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The American Cancer Society recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary non-polyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35.

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it's hard to palpate the ____ so it's tough to screen, detect and stop this type of cancer.

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ovaries