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Pelvic Organ Prolapse Flashcards

1
Q

What is prolapse?

A

Protrusion of an organ or structure beyond its normal anatomical confines

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2
Q

What is female POP?

A

The descent of the pelvic organs towards or through the vagina

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3
Q

What are some dynamic organs of the pelvic cavity?

A 
Rectum
Anus
Uterus
Bladder
Urethra
Vagina
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4
Q

Which structures make up the endo-pelvic fascia?

A

Uterosacral ligaments
Pubocervical fascia
Rectovaginal fascia

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5
Q

What is the pelvic diaphragm?

A

Levator ani
Coccygeus
Layer of striated muscles with its fascial coverings

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6
Q

What is the urogenital diaphragm?

A

The superficial & deep transverse perineal muscles with their fascial coverings

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7
Q

What are the 3 layers of the pelvic floor?

A

Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm

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8
Q

What structure provides the main support to the anterior vaginal wall?

A

Pubocervical fascia

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9
Q

Is the rectovaginal fascia rigid or elastic?

A

Elastic

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10
Q

Where does the pubocervical fascia tend to break?

A

At lateral attachments to the arcus tendineus fascia pelvis

Or immediately in front of cervix

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11
Q

Where does the utero-sacral fascia tend to break?

A

Tend to break medially (around the cervix)

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12
Q

What could an upper defect in the rectovaginal fascia lead to?

A

Probably enterocele

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13
Q

What would a lower defect in the rectovaginal fascia lead to?

A

Perineal body descent

Rectocele

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14
Q

What are some risk factors for pelvic organ prolapse?

A

Pregnancy and vaginal birth
Advancing age
Obesity
Previous pelvic surgery

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15
Q

What are some factors of pregnancy which could increase risk of prolapse?

A

Forceps delivery
Large baby
Prolonged second stage

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16
Q

What are some previous pelvic surgeries which could increase risk of pelvic organ prolapse?

A

Continence procedures
(Burch colposuspension)
Hysterectomy

17
Q

What kind of prolapse can weight lifting, high impact aerobics and long distance running predispose you to?

A

Urogenital

18
Q

What is a urethrocele?

A

Prolapse of the lower anterior vaginal wall involving the urethra only

19
Q

What is a cystocele?

A

Prolapse of the upper anterior vaginal wall involving the bladder

20
Q

What is a uterovaginal prolapse?

A

Prolapse of the uterus, cervix and upper vagina

21
Q

What is an enterocele?

A

Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel

22
Q

What is a rectocele?

A

Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina

23
Q

What are the typical symptoms in women with vaginal pelvic organ prolapse?

A 
Seeing one
Bulging/protruding sensation
Pressure
Heaviness
Difficulty inserting tampons
24
Q

What are some typical symptoms in women with urinary pelvic organ prolapse?

A 
Urinary Incontinence
Frequency/ Urgency
Weak or prolonged urinary stream
Feeling of incomplete emptying
Manual reduction of prolapse to start or complete voiding
25
Q

What are the typical symptoms in women with bowel pelvic organ prolapse?

A

Incontinence of flatus
Irregular stool consistency
Urgency
Difficulty completing defecation

26
Q

What are some objective assessments used for pelvic organ prolapse?

A

POPQ score

Baden-Walker-Halfway Grading

27
Q

How would a suspected ureteric obstruction in pelvic organ prolapse be investigated?

A

IVU

Renal USS

28
Q

What are some possible uses of urodynamics in pelvic organ prolapse?

A

Concurrent UI or to exclude Occult SI

29
Q

What are some good investigations for assessing fascial defects?

A

USS

MRI

30
Q

What are some steps which can be taken to reduce risk of pelvic organ prolapse?

A

Avoid constipation
Manage chest pathologies well
Smaller family size

31
Q

What is the goal of pelvic floor muscle training (PFMT)?

A

Increase pelvic floor strength and bulk to relieve tension on the ligaments

32
Q

What are some exclusions for vaginal pessaries?

A

Previous POP surgery

Unable to retain pessary for 2 weeks

33
Q

What is a vaginal pessary?

A

Plastic device in the shape of a circle that fits into your vagina to support uterine prolapse

Reproduction (25 decks)

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