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50 Cards in this Set
- Front
- Back
What's the definition of urinary incontinence?
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Complaint of loss of urine without control
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What's the definition of pelvic organ prolapse?
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Loss of normal support of vaginal walls
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What are some conditions that can cause prolapse/incontinence?
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Pregnancy (HIGHEST RISK.)
Delivery Myopathy Neuropathy Surgery |
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What are some risk factors for prolapse/incontinence?
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Obesity
Smoking Pulmonary disease Constipation Extreme recreational/occupational activities |
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What's the prevalence of incontence in women?
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25-45%!
ASK YOUR PATIENTS. |
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What are the different phases of normal voiding?
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Filling
Voiding |
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What is the effect of sympathetic firing on the bladder?
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Contraction of the smooth and striated muscles of the sphincters
Inhibition of bladder contraction |
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What nerves carry sympathetic information to the bladder?
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Hypogastric nerve
Pudendal nerve |
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What part of the brain monitors bladder storage?
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Rostral pons
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What happens as the bladder fills?
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More and more afferent firing
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What part of the nervous system causes bladder contraction?
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Parasympathetic firing.
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What types of receptors are responsible for normal voiding?
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Cholinergic, muscarainic receptors in the detrusor smooth muscle
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What types of receptors are in the urinary sphincter?
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Alpha receptors
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What are the changes that occur to the bladder as you age?
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Decreased detrusor contractility (increased residual volume)
Urethral sphincter coaptation decreases Also, there's more urine volume at nightttime |
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What is a cause of more urine volume at nighttime?
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Decreased ADH
More renal bloodflow due to edema |
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What's the presentation of UTI or pyelonephritis?
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Acute onset
Burning with urination Running to the bathroom, small volumes Hematuria Fever, back pain Related to intercourse |
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What are some conditions that you want to rule out with relation to incontinence?
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UTI
Pyelonephritis Interstitial cystitis/painful bladder syndrome Bladder cancer |
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What's the presentation of interstitial cystitis/painful bladder syndrome?
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Frequent small-volume voiding
Younger Burning with filling "I never leak" |
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What's the presentation of someone with bladder cancer?
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Long-term smoker
No pain No stones Urinates often, with urgency |
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What are the different kinds of urinary incontinence?
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Urgency urinary incontinence
Stress urinary incontinence Mixed urinary incontinence Overflow incontinence Functional incontinence |
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What are some complaints in incontinence?
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Urgency
Spasms |
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What's the definition of overflow incontinence?
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Detrusor hyperactivity with impaired contractility: dribbling on the way to the toiled
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What are the symptoms of overflow incontinence?
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Weak urinary stream
Dribbling Intermittency Hesitancy Frequency Nocturia |
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How do you check for overflow incontinence?
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If there's a large post-residual volume, there's a good chance that someone has it.
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What are some key points in a history of urgency urinary incontinence?
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Onset
Time course PMH Leakage: triggers, pad use, number of leaks Diet Meds |
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What are the tests that you can run for incontinence?
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Cough stress test
Urine dip PVR testing Voiding diary Urodynamic testing |
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What are some treatments for urinary urge incontinence?
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Behavioral:
-Cut down on certaince substances: caffeine, nicotine, artifical sweetners -Timed voiding Pelvic floor muscle therapy: -Kegel exercises -PT |
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What are some meds that we can use for urinary urge incontinence?
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Anticholinergics (muscarinic receptor antagonists)
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What is the effect of giving cholinergics?
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INcrease bladder capacity
Decrease urgency |
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What are the side effects of the anticholinergics?
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Dry eye
Dry mouth Constipation Most people stop taking them because of the side effects. |
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What don't you give to treat incontinence?
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Estrogen!
It makes it worse. |
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What are specialized drugs for the treatment of incontinence?
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Beta-3 adrenoreceptor agonists
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What is the effect of using the beta-3 receptor agonists?
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Enhancing storage function and relaxing the urinary bladder
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What's an injection that works well in iincontinence
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Botox!
It works well - too well. Retention resulted. |
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What are some other treatments of incontinence?
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Interstim
Tibila nerve stimulation Augmentation cystoplasty |
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What happens in augmentation cystoplasty?
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Insertion of intestine into the bladder.
Not done. |
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What's the definition of stress urinary incontinence?
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Loss of urine involuntarily with effort/physical exertion
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What's the cause of stress urinary incontinence?
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Increase in abdominal pressure causes urine to leak out due to a failure in urethral integrity
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What are the treatment options for stress urinary incontinence?
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No meds!
Surgery Weight loss!!! Bulking injections |
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What kinds of surgeries are done for stress incontinence?
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Retropubic sling
Transobturator sling |
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What are the different types of prolapse?
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Cystocele
Rectocele Enterocele Uterine prolapse Vaginal vault prolapse |
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What are the muscles that support the contents of the pelvus?
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Levator ani muscles
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What is cystoele?
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Dropping of the bladder wall into the anterior wall of the vagina
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What happens when the anterior the vaginal wall prolapses?
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Cystocele
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What happens when the posterior the vaginal wall prolapses?
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Rectocele
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What is an enterocele?
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True hernia of the pelvus: small intestine is involved
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Will surgery for a rectocele cure the problem of constipation?
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NO.
There are other factors that cause the issues, not the rectocele |
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What are the treatments for prolapses?
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Pesaries: something that holds the bulge in.
Surgery!: |
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What are the aims of prolapse surgery?
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Restore normal anatomy!
SURGERY FTW!!!!!!!!!!! |
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What shouldn't you give to patients for prolapse?
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Mesh.
It's horrid: Infection Contraction Exposure Pain |