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Flashcards in Pelvic Floor Deck (66)
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1
Q

What are the posterior and anterior fornices of the vagina?

A

Portion anterior/posterior to the cervix within the vaginal canal

2
Q

Where does the ureter sit in relation to the uterus?

A

Very close to the lateral aspect

3
Q

What are the three muscles that comprise the levator ani from anterior to posterior?

A
  • Coccygeus
  • Pubococcygeus
  • Iliococcygeus
4
Q

What are the s/sx of pelvic floor prolapse? (4)

A
  • Pelvic pressure/pain
  • Bulging from the vagina
  • Dyspareunia
  • Difficulties voiding
5
Q

What is level I vaginal support?

A

Connective tissue support to the upper vagina

6
Q

What is level II vaginal support?

A

Fascial crucus in mid vagina

7
Q

What is level III vaginal support (anterior and posterior)?

A

Anterior = Fusion of anterior vagina and urethra muscles involved in urethral support

Posterior = Fusion of posterior vagina and perineal body

8
Q

What is rectal splinting?

A

Applying pressure to the perineum in order to have a BM

9
Q

What are anterior compartment prolapse?

A

Cystoceles or bladder herniation through the vaginal wall

10
Q

What are are posterior compartment prolapse?

A

Rectocele, or posterior compartment prolapse

11
Q

What is apical vaginal prolapse?

A

Vaginal vault prolapse (head of the uterus prolapse in)

12
Q

What is uterine prolapse?

A

Prolapse of uterus through the vagina

13
Q

What is the dove sign on pelvic examination?

A

Flattening of the anterior surface of the anus–indicative of perineal injuries

14
Q

What happens if there is loss of level 1 vaginal support?

A

Connective tissue support to the upper vagina is lost, resulting in uterine or vaginal vault prolapse

15
Q

What are the ligaments that are fused when a hysterectomy has been performed, in order to form the vaginal cuff? What happens if these are weakened from chronic coughing/straining?

A
  • Uterosacral ligament

- Wear down, and may cause loss of the vaginal vault support

16
Q

What, generally speaking, is vaginal vault prolapse?

A

Vaginal walls (not uterus) prolapsing out of the vagina

17
Q

What is an enterocele?

A

Prolapse of the intestines that can occur with uterine prolapse

18
Q

What does failure of the level 2 vaginal support cause?

A

Mid level loss of support from CT between bladder/vagina and vagina/rectum (cystoceles, rectoceles)

19
Q

Loss of the level 3 vaginal support results in what (anterior/posterior)?

A

Hypermobile urethra in anterior part lost

Loss of posterior causes perineocele

20
Q

Bulging of the perineum with coughing indicates what pathology of the aginal?

A

Loss of the posterior vagina and perineal body

21
Q

What is a hypermobile urethra?

A

A urethra that is greater than 30 degrees from the horizontal by Q-tip test

22
Q

Why are pelvic support issues more common among women of advancing age?

A

Tissues become less resilient and accumulated stresses have an additive effect

23
Q

There is an (__)x increase in prolapse 2 vaginal deliveries.

A

8x

24
Q

What percent of women have anal incontinence after one delivery? Two?

A

35%

45%

25
Q

A birth weight of more than (__)kg is a risk factor for the development of fecal incontinence

A

4 kg

26
Q

What is the risk associated with episiotomies?

A

Increased risk of anal incontinence

27
Q

What stage of labor that, if prolonged, will increase the risk of fecal incontinence?

A

2nd stage

28
Q

What fetal position will increase the risk for fecal incontinence?

A

Occiput posterior (OP)

29
Q

True or false: delivery with forceps decreases the risk for fecal incontinence

A

False–increases

30
Q

True or false: the first delivery has the greatest risk for the development of fecal incontinence

A

True

31
Q

Does induction of labor have an effect on the incidence of fecal incontinence?

A

Yes, increases

32
Q

Do epidurals increase the risk of fecal incontinence?

A

Yes

33
Q

What is the effect of early pushing, and active restraining of the head on the incidence of fecal incontinence?

A

Both increase

34
Q

What happens to the urethra when the bladder loses it support?

A

The mobility of the urethra increases as it pulls away from its attachment to the pubic symphysis

35
Q

True or false: the degree of incontinence is often NOT commensurate with the degree of pelvic relaxation

A

True

36
Q

What happens to the severity of urinary incontinence with later stages of uterine prolapse?

A

Improves, since now have functional obstruction in the outflow tract that can simulate continence

37
Q

What type of incontinence is more common in women? Men?

A
Women = Stress
Men = Urge
38
Q

What happens to the lining of the urethra as women lose estrogen? What is the significance of this?

A

Thins–meaning urinary incontinence is much more likely later in life

39
Q

How does the loss of the angle of the urethra affect urinary incontinence?

A

Loss will mean that there is a straight shot out of the bladder

40
Q

What are the etiologies urge incontinence? (3)

A
  • Urinary tract or vaginal infections
  • Bladder tumors/stones
  • Neuro causes
41
Q

What is the physiological cause of urge incontinence?

A

Detrusor overactivity presents with the feeling that she must run to the bathroom frequently and urgently

42
Q

What is the muscarinic receptor on the bladder?

A

M3

43
Q

What is overflow incontinence?

A

Over-distention of the bladder leads to urine dribbling out

44
Q

What are the etiologies of overflow incontinence? (2)

A
  • Obstructive (fecal impaction)

- Non-obstructive (MS, other neuro issues)

45
Q

Why is it that the bladder does not empty completely during voiding with overflow incontinence?

A

Inability of the detrusor muscle to contract

46
Q

What is functional incontinence?

A

Urine loss caused by factors outside the urinary tract

47
Q

What are the etiologies of functional incontinence?

A
  • Dementia
  • Injury (fistula)
  • Decreased mobility
48
Q

How common is pelvic organ prolapse?

A
  • 11% of women will have prolapse in the life

- Half of women over age 50

49
Q

What are the clinical tests to assess for pelvic organ prolapse?

A

-measuring post void residual

50
Q

What should you always screen for when seeing pelvic organ prolapse?

A

UTIs

51
Q

What is grade I uterine prolapse?

A

Prolapsed tissue descends halfway to the hymen

52
Q

What is grade II uterine prolapse?

A

Prolapsed tissue extends to the levels of the hymen

53
Q

What is grade III uterine prolapse?

A

Prolapsed tissue extends outside the hymen with straining

54
Q

What is grade IV uterine prolapse?

A

Prolapsed tissue extends outside the hymen without straining

55
Q

What is the major non-surgical option for pelvic organ prolapse?

A

Referral to PT for pelvic floor exercises

56
Q

What is the success rate for PT for pelvic floor exercises?

A

85%

57
Q

What are pessaries?

A

Objects inserted into the vagina to improve pressure on the bladder

58
Q

What are the objectives for vaginal vault surgery, besides the obvious?

A

-Preserve normal vaginal axis

59
Q

What is the ligament that is often used as an anchor to attach the uterus to in case of POP?

A

Sacrospinous ligament

60
Q

What is the inferior rectal nerve a branch of?

A

Pudendal nerve

61
Q

What is the perineal nerve a branch of?

A

Pudendal nerve

62
Q

What provides the primary support to the pelvis?

A

Pelvic diaphragm (levator ani muscles)

63
Q

What are the three mechanisms that the vagina relies on for support?

A
  • Closure of the vagina at its introitus
  • Vertical suspension of the vagina by the uterosacral ligament
  • The flap effect created by the near horizontal position of the vagina
64
Q

What are the three major anatomical landmarks that are used to anchor the uterus?

A
  • Iliococcygeus
  • Sacrospinous fixation
  • Uterosacral ligament suspension
65
Q

What other repair often accompanies Rectocele repairs?

A

Perineoplasties

66
Q

What test should be done postop for cystoscopy?

A

Voiding trial bladder scan for cystoscopy