Structural Abnormalities

Question 1

what are the 4 structural structural abnormalities we need to know

Answer 1

cystocele (bladder prolapse)
rectocele
ovarian torsion
uterine prolapse

Question 2

45 yo f c/o pressure in the pelvis and vagina, discomfort when straining, and feeling of incomplete bladder emptying after urination

Answer 2

cystocele (bladder prolapse)

Question 3

anterior vaginal prolapse of the posterior bladder wall into the vagina

Answer 3

cystocele (bladder prolapse)

Question 4

5 causes of cystocele

Answer 4

childbirth
constipation
violent caughing
heavy lifting
other pelvic muscle strain

Question 5

6 sx of cystocele

Answer 5

pressure in pelvis/vagina
discomfort when straining
incomplete bladder empting
urinary incontinence
“sitting on a beachball”
“something is falling out

Question 6

cystoceles are worse w. _ and relieved w. _

Answer 6

worse w. valsalva
better w. redundancy

Question 7

dx for cystocele

Answer 7

-POP-Q: pelvic organ prolapse quantification
-US
-MRI
-voiding cystourethrogram (VCUG)
-Q-tip testing
-cystometogram

Question 8

tx for cystocele (3)

Answer 8

pessary
surgery
mesh augmentation

Question 9

prophylaxis for cystocele (2)

Answer 9

kegels
estrogen post menopause

Question 10

50 yo f c/o pelvic pressure, sensation of mass in the vagina, chronic constipation, feeling of incomplete bowel emptying; occasional fecal incontinence

Answer 10

rectocele

Question 11

rectocele is herniation of the _ into the _

Answer 11

rectum into the posterior wall of the vagina

Question 12

rf for rectocele

Answer 12

childbirth
any pressure on the rectal wall

Question 13

2 mc sx of rectocele

Answer 13

pelvic pressure
bowel sx
also:
lbp
mass in the vagina

Question 14

dx for rectocele (2)

Answer 14

pop-q
colonoscopy to r.o ca

Question 15

tx for rectocele

Answer 15

kegels
pelvic floor training
bowel regimen
pessary
surgery
mesh augmentation

Question 16

23 yo f in ED c.o sharp, non-radiating LLQ pain w. worsening intensity x 3 hr - nausea, denies diarrhea, urinary sx, or vaginal d.c - afebrile, tachycardia, tachypnea, elevated bp, left adnexal tenderness - negative chandelier’s sign, negative bHCG

Answer 16

ovarian torsion

Question 17

ovarian torsion refers to rotation of the ovary at its _ to such a degree as to occlude the _ and/or _

Answer 17

pedicle
artery and/or vein

Question 18

2 common sx of ovarian torsion

Answer 18

sudden sharp unilateral lower abd pain
n/v

Question 19

dx for ovarian torsion:

mc:
gs:

Answer 19

mc: doppler US abdomen
gs: laparoscopy

Question 20

tx for ovarian torsion

Answer 20

laparoscopic surgery

Question 21

63 yo G5P5 f w. 3 day hx of increased pelvic pressure and a bulge in her vagina when she coughs - also c/o incomplete bladder emptying, constipation, lbp

Answer 21

uterine prolapse

Question 22

uterus descends towards the vagina

Answer 22

uterine prolapse

Question 23

cause of uterine prolapse

Answer 23

weak pelvic floor muscles -> weak ligaments -> uterus protrudes thru vaginal opening

Question 24

abdominal pain associated w. uterine prolapse is worse _ and better with _

Answer 24

-worse: later in the day after prolonged standing
-better: with lying down

Question 25

grading scale for uterine prolapse

Answer 25

-0 degree: no descent
-1st degree: to the upper vagina/descent btw normal and ischial spine
-2nd: to the introitus/btw ischial spines and hymen
-3rd: cervix is outside the introitus/w.in the hymen
-4th (procidentia): uterus and cervix entirely outside the introitus/thru the hymen

Question 26

dx for uterine prolapse

Answer 26

-speculum or bimanual exam
-bx any ulcers

Question 27

what sx indicates need for further work up w. uterine prolapse

Answer 27

urinary incontinence

Question 28

tx for uterine prolapse

Answer 28

-asymptomatic 1st or 2nd degree: no tx
-symptomatic 1st or 2nd degree: +/- pessary
-severe/persistent 3rd or 4th degree: hysterectomy w. colporrhaphy and suspension of vagina