ch 7 (benign disorder of female reproductive tract)

___ ___ ___ is the abnormal descent or herniation of the pelvic organs from their original attachment sites or their normal position in the pelvis.

A: pelvic organ prolapse

Pelvic organ prolapse has shown a correlation with o____, increased a___, and increased p___.

A: obesity, age, parity (number of times woman gave birth)

There are 4 common types of POP (pelvic organ prolapse) Match them:

1) Rectocele,

2) uterine prolapse,

3) enterocele, and

4) cystocele

Description: 1) bladder drops into vagina

2) rectum sags and bulges into the vagina

3) small intestine bulges into the vagina

4) uterus drops into vagina

A: 1) cystocele - bladder drops into vagina

2) Rectocele - rectum sags and bulges into the vagina

3) enterocele - small intestine bulges into the vagina

4) uterine prolapse - uterus drops into vagina

There are stages of uterine prolapse match them: 1) stage 0

2) stage 1

3) stage 2

4) stage 3

5) stage 4

Description 1) vagina is completely everted or the prolapsed organ is more than 2 cm below the hymenal ring

2) prolapsed organ is less than 1 cm above or below the hymenal ring

3) no descent of pelvic structure during straining

4) prolapsed descending organ is more than 1 cm above the hymenal ring

5) prolapsed organ extends over 1 cm below the hymenal ring

A: 1) stage 0 - no descent of pelvic structure during straining

2) stage 1 - prolapsed descending organ is more than 1 cm above the hymenal ring

3) stage 2 - prolapsed organ is less than 1 cm above or below the hymenal ring

4) stage 3 - prolapsed organ extends over 1 cm below the hymenal ring

5)stage 4 - vagina is completely everted or the prolapsed organ is more than 2 cm below the hymenal ring

Causes of POP include obesity, increased age, increased parity, m_____, family history or increased a____ p_____.

A: menopause, abdominal pressure

Conservative measures in treating POP include p_____ f____ m____ exercises, avoidance of s____, and lifestyle changes which are all first line management of POP.

A: pelvic floor muscle, straining

Another management device for POP is the c____ s____.

A: colpexin sphere

Pelvic floor muscle exercises are also the first line treatment of stress and urge ___ and also widely used for anal incontinence.

A: UI

In POP, _____ may improve the tone, natural thickness, and vascularity of the supporting tissue in perimenopausal and menopausal patients but data is insufficient to advise it as routine treatment.

A: HRT

A vaginal p_____ is a synthetic support device insert in the vagina to provide support to the bladder and other pelvic organs as a corrective measure for UI and/or POP.

A: pessary

The advantages of a pessary is that is c____ effective and minimally invasive. Long term use of it on the other hand can led to p___ n____.

A: cost, pressure necrosis

There are 2 types of surgery for POP _____ surgery which is for patients who have comorbidities that put them at high risk for requiring an extensive surgery and for patients who do not plan to have sexual intercourse in the future. _____ surgery is to correct specific defects to restore normal anatomy and preserve function. However surgery is not an option for patients who have no s______, have a plan to give b_____ to more children, and have BMI greater than ___.

A: obstructive, reconstructive, symptoms, birth, 40

***The classic symptoms of POP is a feeling of d______, a l___ in the vagina, or something "c______ d_____"

A: dragging, lump, coming down

Some lab test may ordered to determine cause of POP which include a _____ to rule out bacterial infection, urine ______ to identify the specific organisms if present, and measurement of postvoid urine.

A: urinalysis, culture

In education patient on how to reduce risk factors for POP, you should teach them to choose foods high in ____ and increase f_____ to prevent constipation. Your —— intake should be 2___ - 3____ g/day, and f—— should be _____ 8oz glasses daily.

A: fiber, fluids, 20 - 35, 8

When teaching patient how to preform pelvic floor exercise the first step is to squeeze the muscles in your r____ and if you trying pass gas, then stop and start u___ flow to help identify the pubococcygeus muscle, then tighten the pubococcygeus muscle for a count of _____ and then r____, contract and r—— the pubococcygeus muscle rapidly ____ times and try to bring the entire pelvic floor and bear down ____ times. You should repeat these exercises ___ times a day.

A: rectum, urinary,, 3, relax, 10, 10, 5

Anther thing to avoid to reduce risk of POP us to avoid h____ i_____ a____ like jogging or humping repeatedly.

A: high impact aerobics

You should educate on pessary use, such as the common side effects of vaginal discharge, bleeding, erosions, and odor. Vaginal discharge and odor can be reduced by using a pH lowering product like t_____ gel, also low dose vaginal e____ cream can be used to hep reduce the discharge, odor, erosion and bleeding. Also in caring for the pessary, make sure the remove the pessary every __ - _ weeks and leave it out the vagina for _ night, cleaning it with s___ and w____ then insert it back in with lubricant, and have regular follow up examinations every 6 - 12 months.

A: trimo-san, estrogen, 1 - 2, 1, soap and water

If the POP is having surgery educate them that the foley catheter will be in place for up to ___ week and the might not be able to urinate due to swelling after it has been removed.

A: 1

___ _____ is the involuntary leakage of urine. There are 3 types match them:

1) urge

2) stress

3) mixed

Description: 1) accidental leakage of urine that occurs with increased pressure on bladder form coughing, sneezing, laughing, or physical exertion

2) precipitous loss of urine, preceded by a strong urge to void

3) bit of both

A: urinary incontinence

1) stress - accidental leakage of urine that occurs with increased pressure on bladder form coughing, sneezing, laughing, or physical exertion

2) urge - precipitous loss of urine, preceded by a strong urge to void

3) mixed - bit of both

Symptoms of urge incontinence include n____, and a ___ amount of urine lost, and symptoms of stress incontinence include a ___ amount of urine loss due to activity that raises intra-abdominal pressure.

A: nocturia, large, small

Incontinence can develop due to the bladder muscles becoming overactive due to weakened s____ muscles, they bladder muscles can also be too w___ to contact the nervous system properly or the signals nervous system to the urinary structures are interrupted. A major factor that can cause sphincter muscles weakness is ____ loss in females.

A: sphincter, weak, estrogen

Conservative treatment for UI include bladder training to establish normal voiding intervals which are every __ - ___ hours, _____ to strengthen pelvic floor muscles, a p_____, and topical vaginal ___ cream.

A: 3 - 5, PEME, pessary, estrogen

Some drug medications that can help with stress incontinence include a p______ injection that injects a bulking agent to form a bulge that brings iteral walls closer together, and d______ to increase uterine sphincter concentrations.

A: periurethral, duloxetine

How could you measure post void residuals (2 things)?

A: ultrasound, catheter

In educating the patient on how to manage UI you should tell them to limit fluids to ____L per day, reduce intake of foods and fluids that are bladder irritants such as c_____, c____, c____ beverages, and c____ fruits. You should also control blood g___ levels to prevent polyuria.

A: 2, chocolate, caffeine, carbonated, citrus, glucose

____ are small, usually benign mucous membrane growths. There are many kinds including cervical, endocervical, endometrial (which includes uterine fibroids, genital fistulas, Bartholin cysts, and ovarian cysts).

A: polyps

The treatment of polyps usually includes a simple removal with small f___, and then cauterized or lasered to prevent bleeding or polyp reoccurrence. because many polyps are infected an ____ may be ordered. Although polyps are rarely cancerous a ____ should be taken to a lab for testing.

A: forceps, antibiotic, biopsy

The most common clinical manifestations of endometrial polyps include i_____ a_____ b_______.

A: irregular, acyclic bleeding

___ ____ are benign tumors composed of smooth muscle and fibrous connective tissue in the uterus. They are classified into 4 types match them:

1) subserosal fibroids

2) intramural fibroids

3) submucosal fibroids

4) cervical fibroids

Descriptions: 1) grow within the wall of the uterus

2) lie underneath the outermost peritoneal layer of the uterus and grow outside the uterus

3) located in cervix

4) grow from immediately below the inner uterine surface into the uterine cavity

A: uterine fibroids

1) subserosal fibroids - lie underneath the outermost peritoneal layer of the uterus and grow outside the uterus

2) intramural fibroids - grow within the wall of the uterus

3) submucosal fibroids - grow from immediately below the inner uterine surface into the uterine cavity

4) cervical fibroids - located in cervix

Fibroids are _____ dependent thus grow rapidly in childbearing years and shrink during menopause.

A: estrogen

Fibroids are the most common indication for a h_______.

A: hysterectomy

Uterine fibroid symptoms include heavy or painful menses, a feeling of _____ or pressure in the lower p_____, u______ frequently, pain during s_____ i_____, lower back pain and infertility.

A: fullness, pelvis, urinating, sexual intercourse

Drugs to manage uterine fibroids include birth control pills, a p____ releasing intrauterine device, oe t_____ acid, GnRH antagonists such as drugs that end in ______ like e______ , GnRH agonists such as leu____, naf____, or gos____ which stop ovulation or production of estrogen.

A: progestin, tranexamic, -olix, elagolix, leuprolide, nafarelin, goserelin

Another method that uses ultrasound to create coagulative necrosis which destroys fibroids is known as m______ r______-g______ focused ultrasound. it can also be e_____

A: magnetic resonance guided, expensive

u___ a_____ e____ is a treatment option for fibroids in which polyvinyl alcohol pellets are injected into selected blood vessels via a catheter to block circulation to fibroid causing it to shrink and resolve symptoms, and requires contrast dye and could or could not impact fertility.

A: uterine artery embolization

There 2 surgeries one can get done for fibroids which are h_____ and m______.

Match them

1) m______

2) h__________

Description:

1) surgical removal of uterus but terminates ability to have children

2) removal of fibroid alone and leaves healthy uterus intact to preserve fertility.

A: hysterectomy, myomectomy

1) hysterectomy - surgical removal of uterus but terminates ability to have children

2) myomectomy - removal of fibroid alone and leaves healthy uterus intact to preserve fertility, new growth of fibroids can occur

____ ______ are abnormal communication between the female genital tract and the urinary system or rectum. Common types include 3 match them:

1) urethrovaginal

2) vesicovaginal

3) rectovaginal

Descriptions 1) communication between the bladder and genital tract

2) communication between the urethra and the vagina

3) communication between the rectum or sigmoid colon and vagina

A: urogenital fistulas,

1) vesicovaginal - communication between the bladder and genital tract

2) urethrovaginal - communication between the urethra and the vagina

3) rectovaginal - communication between the rectum or sigmoid colon and vagina

The best management for fistulas is to prevent them from forming during a hysterectomy or recognizing a repairing it during surgery. However if they are there then small fistulas will heal with a ______ placement, and big ones need s_____ repair.

A: stent, surgical

___ ____ are swollen, fluid filled, saclike structures that result when one of the ducts of the Bartholin gland becomes blocked. Small cysts without symptoms do not require treatment (except a sitz bath with analgesic for discomfort and antibiotic for infection) but bigger cysts can get a ___ _____ with a balloon tip (preferred first choice). If symptoms are present there could be pain when w____ or s______, u_____ edema, and dyspareunia.

A: Bartholin cysts, word catheter , walking, sitting, unilateral

An ______ ______ is a fluid filled sac that forms on the ovary. There are 2 types match them:

1) follicular cysts

2) corpus luteum cysts

Descriptions: 1) ails to generate after 14 days and may cause pain or delay next menstural period but resolve without intervention

2) found in ovaries of prepubertal female and usually are self limiting and resolve spontaneously

A: ovarian cysts

1) follicular cysts - found in ovaries of prepubertal female and usually are self limiting and resolve spontaneously

2) corpus luteum cysts - fails to generate after 14 days and may cause pain or delay next menstural period but resolve without intervention

Polycystic ovary syndrome is a endocrine condition in females of reproductive age that is due to elevated m___ s___ h____, failure of the ovary to release e____, ovarian e_____ or cyst formation.

A: male sex hormone, eggs, enlargement

Diagnosis of polycystic ovary syndrome is based on presence of the following:

1) hyper______

2) ovarian d_____

3) detection of specific polycystic ovarian morphology.

A: hyperandrogenism, dysfunction

Common therapies for polycystic ovary syndrome includes oral _______, anti_____ agents, and s____. A l_________ may be needed to remove cysts is they are large and pressing on surrounding structures.

A: contraceptives, antidiabetic agents, statins, laparoscopy

Common signs of polycystic ovary syndrome include H_____, alo____, menstrual irregularity and infertility, polycystic ovaries and M_____ syndrome.

A: hirsutism, alopecia, metabolic syndrome