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CP2 OBGYN > Urogaenocology > Flashcards

Urogaenocology Flashcards

(60 cards)

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1
Q

Sx cystitis (6)

A 
Freq + nocturia 
Dysuria 
Urgency 
Haematuria 
Smelly urine 
Strangury
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2
Q

Sx pyelonephritis (6)

A 
Loin pain 
Rigors 
Vomiting 
Fever 
Dysuria 
TachyC
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3
Q

Why is pregnancy is predisposing factor to cystitis?

A

Progesterone –> marked dilation of calyces, renal pelvis + ureters
VUR occurs >

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4
Q

Why must you treat UTI’s in pregnancy ASAP?

A 
--> premature labour 
Sepsis 
Anaemia 
LBW 
Incr perinatal morbiidity, mortality
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5
Q

Why are post partum women particularly vulnerable to UTI’s? (3)

A

Trauma to bladder
Incomplete emptying
Intro of bacteria via catheter

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6
Q

What must be done to women’s urine if post partum and you suspect UTI?

A

MSU

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7
Q

Ix Upper UTI (5)

A 
Urine dipstick 
Midsstream MCS
USS (scarring/obstruction) 
CT/IV urography 
MSU
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8
Q

General advice for Tx UTIs (5)

A 
Drink plenty of fl 
Wipe - front --> back 
Don't wear occlusive underwear 
Do not delay urination 
D-mannose, cranberry / urine alkalising products
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9
Q

1st line Mx - non-pregnant women - UTI

A

PO nitrofurantoin - 100mg b.d 3 days

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10
Q

2nd line Mx - non-pregnant women - UTI

A

Fosfomycin

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11
Q

1st line Mx - pregnant women - UTI

A

Immediate Abx prescription nitrofurantoin 100mg b.d 7 days

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12
Q

2nd line Mx - pregnant women - UTI

A

Amoxicillin or cefalexin

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13
Q

Clinical relevance of round ligament - compositino

A

No mm fibres

Buut lymphatic - spread cancer to vulva

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14
Q

Inn of urinary continence

A

Pudendal nn S2-4

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15
Q

What are the pelvic floor muscle names (5)

A

Levator ani
Internal obturator
Piriform mm
Superficial + deep perineal mm

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16
Q

Urethrocoele

A

Prolapse of urethra into vagina

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17
Q

Cystocoele

A

Prolapse of upper anterior wall of vagina

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18
Q

Enterocoele

A

True hernia of the pouch of Douglas

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19
Q

Rectocoele

A

Weakness in levator ani mm –> bulge in mid post vaginal wall

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20
Q

1st degree uterine descent

A

If cervix is half way down vagina

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21
Q

2nd degree uterine descent

A

If cervix reaches vaginal opening

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22
Q

3rd degree uterine descent

A

If out of body

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23
Q

Where must the bladder neck be in order for a woman to be continent?

A

Above levator ani muscle

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24
Q

what are the 5 things a woman must have to have urinary continence?

A 
Functioning sphincter 
Properly positioned bladder neck
Thick urethral mucosa 
Compliant bladder 
Higher centre control
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25
RF genuine stress incontinence (5)
``` Increasing age Increasing parity Genital prolapse Postmenopausal status Prev pelvic floor surgery ```
26
RF - destrusor instability (5)
``` Age Hx of nocturnal eneuresis Neurological Hx Previous incontinence surgery Dx Hx ```
27
Central neurological causes of voiding difficulties (2)
CVA | PD
28
Spinal neurological causes of voiding difficulties (2)
SC injury | MS
29
Peripheral neurological causes of voiding difficulties (2)
Prolapsed IV disc | Peripheral autonomic neuropathy
30
Which places are the ureters most commonly damaged following hysterectomy?
Segment closest to bladder + in pelvis (distal 1/3 ureter)
31
Congenital causes of genital prolapse (2)
Spina bifida | Connective tissue disorder
32
Acquired causes of genital prolapse
Obstetric factors PM atrophy Chronically raised IAP Iatrogenic
33
q to ask - stress incontinence
Do you leak when you cough/sneeze?
34
q to ask - urge incontinence
Do you struggle to get to the toilet in time?
35
q to ask - dribbling incontinence?
Is it coming out all the time?
36
What is a red flag with urinary incontinence?
Haematuria
37
What is the key phrase with prolapse
Something coming down/dragging
38
PS cystocoele
UTI Have to pee uphill NO haematuria
39
PS uterine prolapse
Pain on sex Back ache Lower abdo dragging pain No PMB
40
PS rectocoele
Constipation Digitation No rectal bleeding or tenesmus
41
Obstetric factors - prolapse (5)
``` Prolonged labour Precipitate labour Instrumental delivery Fetal macrosomia Incr parity ```
42
Which 2 drugs should you think about when pt has affected destrusor function
AntiD - Imipramine | Major tranqs
43
Ix - urinary continence
Urodyanmics - mainstay Cystoscopy If suspect fistula - radio + dye
44
Complications urinary incontinence (3)
Psychological issues Excoriation/soreness bulba Overdistention bladder --> denervation + necrosis detrusor mm
45
Ix prolapse
MSU | Urodtamics
46
Conservative Mx - stress incontinence (4)
Decr wt Stop smoking/address chronic cough Decr fl intake if excessive Pelvic floor mm training
47
Medical Mx stress incontinence
Duloxetine | Injectable periurethral bulking agents
48
Surgical Mx stress incontinence
TVT TOT (mid-urethral sling procedure)
49
What is TVT
Tension-free vaginal tape tape in U shape under mid-urethra Tension adjusted to prevent leakage minimally invasive
50
What is TOT
Trans-obturator tape
51
Benefit TOT over TVT
TOT - < chance bladder perf
52
Conservative Mx - destrusor instability (3)
Decr fl/avoid caffiene Review meds Bladder training
53
Medical Mx - destrusor instability
Anticholinergics oestrogens Botulinum toxin A
54
Surgical Mx destrusor instability
Clam augementation ileocystoplasty
55
Mx - prolapse prevention
early recognition obstructed labour Avoid long 2nd stage labour Pelvic floor exercises post birth
56
Tx - prolapse
Lose weight Stop smoking Physiotherapy Pessaries
57
Risks - pessaries (4)
Ulceration Painful Urinary retention Fall out
58
Apical/uterine prolapse - surgical Mx (2)
Vaginal hysterectomy | Hysteropexy
59
Vaginal vault prolapse - surgical Mx (2)
Sacrocolpopexy | Sacrospinous fixation
60
Vaginal wall prolapse - surgical Mx
Colporrhapy - anterior for cystoecoele | Posterior for rectocoele

CP2 OBGYN (21 decks)

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