Term
| when to refer to urogyn for incontinence - 5 |
|
Definition
| uncertain diagnosis after basic evaluation, lack of correlation between symptoms and clinical findings, hematuria without infection, neurologic disease, failure to respond to therapy, long term voiding dysfunction after sling |
|
|
Term
| when to refer to urogyn for mesh - 6 |
|
Definition
| pain with non-exposed mesh, erosion into bladder/urethra/vagina, large volume exposure, granulation tissue, sinus tracts, exposure from transabdominal mesh |
|
|
Term
| when to refer to urogyn for sacrocopopexy complications - 3 |
|
Definition
| osteomyelitis, disciitis, de novo visceral pain (may require complete excision) |
|
|
Term
| what is a gardner duct cyst |
|
Definition
| mesonepheric/wolfian remnant with a serous or mucinous cyst |
|
|
Term
| signs of a gardner duct cyst |
|
Definition
|
|
Term
| location gardner duct cyst |
|
Definition
|
|
Term
| risks of urethral diverticula = 2 |
|
Definition
|
|
Term
| signs of a urethra diverticulia |
|
Definition
| 3cm distal on anterior vagina, adult, dysuria, dysparunea, post void dribbling, urethral discharge |
|
|
Term
| diagnosis of urethral diverticulia |
|
Definition
|
|
Term
| treatment of urethral diverticulia |
|
Definition
| diverticulectomy (closed in many layers) +/- flap, autologous sling if SUI (although must educate that it isn't as good as a MUS and would have to wait 6wk pos diverticulectomy for MUS) |
|
|
Term
|
Definition
| 4 and 8 o clock inside hymen |
|
|
Term
|
Definition
|
|
Term
| when to biopsy bartholins, why |
|
Definition
| increased adenocarcinoma, biopsy >40yo |
|
|
Term
| %>60yo with adenocarcinoma if bartholins |
|
Definition
|
|
Term
| location of the skenes gland |
|
Definition
|
|
Term
| function of the skenes gland |
|
Definition
|
|
Term
|
Definition
| prolapse of the urethra that isn't circumfrential |
|
|
Term
|
Definition
| circumfrential prolapse of the urethra |
|
|
Term
| risks for urethral caruncle |
|
Definition
|
|
Term
| signs of urethral caruncle, other than the caruncle - 3 |
|
Definition
| bleeding, dysuria, urinary obstruction |
|
|
Term
| signs a urethral caruncle could be a malignancy - 4 |
|
Definition
| >2cm, firm, extension to surrounding tissues, inguinal adenopathy |
|
|
Term
| treatment of urethral caruncle - 2 |
|
Definition
| estrogen or 2-3mo (daily for 2w then 2x/wk), surgical excision if refractory |
|
|
Term
| complication of caruncle excision 1 |
|
Definition
|
|
Term
| % of reproductive age women with asymptomatic bacturia |
|
Definition
|
|
Term
| % of women >65yo with asymptomatic bacturia |
|
Definition
|
|
Term
| % of women who get multiple UTIs a year |
|
Definition
|
|
Term
| % of women who get 1 UTI a year |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| pregnancy, DM, obesity, sickle cell, sex, specmicide, catheters, hygiene, GU abnormalities |
|
|
Term
| risk of infection per day with a catheter in place |
|
Definition
|
|
Term
| % of symptomatic infection when a catheter is in place |
|
Definition
|
|
Term
| management of catheter UTI |
|
Definition
| only treat if symptomatic |
|
|
Term
| 4 options for UTI prevention and their effectiveness |
|
Definition
| E3 (UTI 6 to 0.5% in PMP), Macrobid 95%, methamine salts and vitamin C (?), cranberry and vitamin C (not juice) (helps some but least effective) |
|
|
Term
| if a PMP women does not respond to estrogen for recurrent UTI what do you do |
|
Definition
|
|
Term
| how long can you try Macrobid for UTI prevention |
|
Definition
|
|
Term
| contraindications to macrobid |
|
Definition
| chronic interstitial lung disease in elderly |
|
|
Term
| methamine salts and vitamin C MOA for UTI prevention |
|
Definition
| turn urine to formaldehyde and vitamin C increases the acidity which kills bacteria |
|
|
Term
| SE of methamine salts - 3 |
|
Definition
| hematuria, dysuria, GI acidity |
|
|
Term
|
Definition
|
|
Term
| define noctournal polyuria |
|
Definition
| >35% of volume is voided at night |
|
|
Term
|
Definition
| excess fluids, CHF, venous insufficiency, medications, OSA, RLS, desmopressin, bladder outlet obstruction |
|
|
Term
|
Definition
|
|
Term
| treatment of noctournal polyuria and nocturia |
|
Definition
| both just address cause, in polyuria you can do desmopressin if refractory |
|
|
Term
| complication of desmopressin |
|
Definition
|
|
Term
| rate of recognized and total 4MLL |
|
Definition
|
|
Term
| rate of anal incontinence post delivery |
|
Definition
| 40% - but most is resovled within 6wk |
|
|
Term
| define the laceration grades |
|
Definition
1- skin mucosa
2- perineal body, bulbocavernosis
3A- <50% EAS
3B- >50% EAS
3C- EAS and IAS
4- anal epithelium |
|
|
Term
| level A and B evidence prevention for perineal laceration |
|
Definition
level A - warm compresses
level B - perineal massage |
|
|
Term
| perineal massage - evidence for laceration prevention |
|
Definition
| may reduce 3-4MLL when done in the second stage of labor, but not 1-2MLL or overall rate of laceration |
|
|
Term
| perineal support - evidence for laceration prevention |
|
Definition
| insufficient evidence, one trial showed no help, one trial showed helped prevent OASIS |
|
|
Term
| warm compresses - evidence for laceration prevention |
|
Definition
| reduces 3-4MLL but not total laceration rate |
|
|
Term
| supine or upright birth positions - evidence for laceration prevention |
|
Definition
| decreased episotomy and operative delivery but increased 2MLL |
|
|
Term
| lateral position - evidence for laceration prevention |
|
Definition
| with delayed pushing decreased overall incidence of laceration, but not alone |
|
|
Term
| delayed pushing - evidence for laceration prevention |
|
Definition
| with lateral position decreased overall incidence of laceration, but not alone |
|
|
Term
| risk factors for perineal laceration in order from highest to lowest - 14 |
|
Definition
| FAVD+midline > FAVD > VAVD > midline > big baby > primip > OP > Asian > epidural > augmentation > mother had OASIS > sister had OASIS > induction > other: shoulder dystoica |
|
|
Term
| recurrence rate of 3-4MLL |
|
Definition
|
|
Term
| which has more midline vs mediolateral - bleeding |
|
Definition
|
|
Term
| midline vs mediolateral - 3-4MLL |
|
Definition
|
|
Term
| which has more midline vs mediolateral - pain |
|
Definition
| mediolateral - dysparunena later as well |
|
|
Term
| which has more midline vs mediolateral - difficult repair |
|
Definition
|
|
Term
| preferred episotomy by ACOG |
|
Definition
|
|
Term
| 2 alternative episotomy types |
|
Definition
|
|
Term
| what is reattached in a paravaginal repair |
|
Definition
| pubocervical fascia to arcus tendinous |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| suture usedin 4MLL on rectal mucosa |
|
Definition
|
|
Term
| suture used in 4MLL on IAS |
|
Definition
|
|
Term
| suture used in 4MLL on EAS |
|
Definition
|
|
Term
| suture used in 4MLL on second degree |
|
Definition
|
|
Term
| acute complications of OB lacerations - 4 |
|
Definition
| hematoma, abscess, dehiscinence, necrotizing fasciitis |
|
|
Term
| chronic complications of OB lacerations - 3 |
|
Definition
| incontinence, dysparunea, fistula |
|
|
Term
| risk factors for OASIS top 2 |
|
Definition
| #1 FAVD (3x VAVD), #2 VAVD |
|
|
Term
| non-top 4 risk factors for OASIS - |
|
Definition
| primip, Asian,Hispanic, AMA, big baby, prolonged second stage, midline episotomy, OP 2x, low BMI, lithotomy/squatting 2x |
|
|
Term
| rate of OASIS in OB lacerations |
|
Definition
|
|
Term
| rate of laceration breakdown |
|
Definition
|
|
Term
| signs of laceration breakdown - 7 |
|
Definition
| pain, bleeding, discharge, occurs within 7-14d, incontinence, fistula, cloaca |
|
|
Term
| risks factors for laceration breakdown - 13 |
|
Definition
| smoking, FAVD, infection, midline episotomy, obesity, 4MLL, intercourse, hematoma, bleeding, prolonged second stage, edema, poor nutrition, poor surgical skills |
|
|
Term
| initial management before repair of laceration breakdown - 5 |
|
Definition
| debriment, betadine scrub, antibiotics, estrogen topical, bowel regimen |
|
|
Term
| benefits to immediate laceration repair after breakdown |
|
Definition
|
|
Term
| risks to immediate laceration repair after breakdown - 2 |
|
Definition
| infection may cause you to delay anyways, edema makes surgery hard |
|
|
Term
| how do you treat infection of an OB laceration |
|
Definition
|
|
Term
| benefits of delayed laceration repair - 2 |
|
Definition
|
|
Term
| risks of delayed laceration repair - 3 |
|
Definition
| longer time in pain and with incontinence, longer time until return to sexual activity |
|
|
Term
| boundries of a vulvar hematoma |
|
Definition
| pubic fascia of the thigh or colles fascia, ischiopubic ramus, anal fascia, superficial transverse perineal muscle, urogenital diaphragm, perianal fascia |
|
|
Term
| risks for vulvar hematoma - 9 |
|
Definition
| primip, operative delivery, big baby, prolonged second stage, vulvar varicosities, lacerations, coagulopathy, multiples, episotomy |
|
|
Term
| complications of a vulvar hematoma - 5 |
|
Definition
| recurrence, persistence, skin pressure necrosis, necrotizing fasciitis, secondary infection |
|
|
Term
| treatment of vulvar hematoma |
|
Definition
if <5cm and stable - mark borders, ice, pressure, analgesia, foley, I/Os
if >5cm or unstable - I+D antibiotics, close dead space, drain and pack |
|
|
Term
| management of recurrent or persistent vulvar hematoma |
|
Definition
|
|
Term
| associated condition with ecopic ureter |
|
Definition
| 80% have a duplicated collecting system |
|
|
Term
|
Definition
| bud of the mesonepheric duct |
|
|
Term
| male signs of ectopic ureter - 2 |
|
Definition
|
|
Term
| female signs of ectopic ureter - 1 |
|
Definition
| incontinence only if past the sphincter |
|
|
Term
|
Definition
|
|
Term
| % of ureter injuries in GYN surgeries |
|
Definition
|
|
Term
| % of GYN surgeries with ureter injuries |
|
Definition
|
|
Term
| % of ureter injuries unrecognized |
|
Definition
|
|
Term
| risks for ureter injury - 8 |
|
Definition
| EBL >800, big uterus, long surgery, obesity, TVH with POP, radical surgery, prior radiation, endometriosis, prior pelvic surgery |
|
|
Term
| symptoms of ureter injury - 10 |
|
Definition
| colicky flank pain, ileus, nausea, vomiting, elevated Cr and CRP, hematuria, leukocytosis, oliguria, fistula |
|
|
Term
| dyes used for ureter flow visualization - 6 |
|
Definition
| indio carmine, methylene blue, indocycanin green, Na flouricine, D10 bladder instillation, pyridium pre-op |
|
|
Term
| which dye for cysto can cause UTI |
|
Definition
|
|
Term
| imaging for ureter injury gold standard |
|
Definition
|
|
Term
| why do obese people have higher ureter injury |
|
Definition
| in 12% of them it is 0.5cm closer to the cervix |
|
|
Term
| prevention of ureter injury - 2 |
|
Definition
| stents (pollack, 5-6F), supracervical hysterectomy, development of vesicouterine space away from the vagina |
|
|
Term
| 5 steps to working up no jets |
|
Definition
1 - dyes, fluids, time
2 - remove a stictch
3 - IVP
4 - place drains if needed (nephrostomy, JP retroperitoneal, foley)
5 - repair |
|
|
Term
| what type of suture is used to repair the ureter |
|
Definition
|
|
Term
| 2 ways to repair the upper 1/3 of the ureter |
|
Definition
if <50% and no tension - stent for 4-6wk
if >50% or on tension - transureterouretal anastomosis (connect it to the other ureter?) |
|
|
Term
| management of ureter injury in middle 1/3 of the ureter |
|
Definition
| ureteroureteral anastomosis - just reconnect it |
|
|
Term
| management of injury in the lower 1/3 of the ureter |
|
Definition
| ureteroneocystotomy - connect it to the bladder |
|
|
Term
| 4 types of ureterneocystoyomy |
|
Definition
| submucosal tunneling, fish mouth, psoas hitch, biori flap |
|
|
Term
| explain submucosal tunneling |
|
Definition
| tunnel for 3-5cm in oblique direction and attach ureter to the bladder in oval shape |
|
|
Term
| explain fish mouth procedure |
|
Definition
| cut the bladder from 9 to 3 and then squish it in the opposite direction of your cut to make a tube to attack to the ureter off tension |
|
|
Term
|
Definition
| sew the bladder to the psoas to keep the ureter off tension |
|
|
Term
|
Definition
| psoas hitch plus a transverse bladder flap made into a tube to connect to the ureter |
|
|
Term
| signs of bladder injury 5 |
|
Definition
| fistula, uroma, hydroureter, hydronephrosis, abscess, urine ascites |
|
|
Term
| types of bladder injury where you can just drain the bladder, no repair |
|
Definition
|
|
Term
| what do you do if you cant reach the bladder injury to repair it |
|
Definition
| interntional anterior cystotomy |
|
|
Term
| after you made an injury in the trigone (or <1cm from the uteter) and urology fixed it, how will the patient follow up |
|
Definition
| foley 7d, image BEFORE pulling |
|
|
Term
| what size dome injury can you repair |
|
Definition
|
|
Term
| when you make a dome injury >2cm and uroogy repairs it what is the folloe up for the patient |
|
Definition
| foley for 1-3d, can you image before pull, but if you check urine and there is no microhematuria you don't have to |
|
|
Term
| how do you repair a dome injury |
|
Definition
| running locking the mucosa, imbricating the seromuscular layer, prove its water tight, use 3-0 delayed absorbable |
|
|
Term
| follow up after <2cm dome injury |
|
Definition
|
|
Term
| #1 cause of a fistula in the USA |
|
Definition
|
|
Term
| rate of a fistula with hysterectomy |
|
Definition
|
|
Term
| #1 cause of fistula in the world |
|
Definition
|
|
Term
|
Definition
| GYN surgery, OB trauma, bladder injury, cancer, radiation, early coitus after surgery, IBD, infection, malnutrition, UAE, diverticulitis, adhesions, athlerosclerosis, DM, endometriosis, fibroids |
|
|
Term
| when does a fistula usually happen |
|
Definition
| 7-10d after insult/surgery up to 30d |
|
|
Term
|
Definition
| discharge, hematuria, fever, pain, infection, incontinence, vaginal flatus |
|
|
Term
| diagnosis of vesicovaginal fistula - 7 |
|
Definition
| pyridium, methylene blue, CT urogram, reterograde pyelogram, Cr serum > urine, fistulogram, vaginoscopy |
|
|
Term
| explain the pydirium methylene blue test for vesicovaginal fistula |
|
Definition
| give pyridium if tampon is orange it could be bladder or ureter fistula, drain bladder, give methylene blue if blue it is a bladder fistula, if white or orange ureter fistula |
|
|
Term
| #1 location of a vesicovaginal fistula |
|
Definition
| high vault - 75% of post-hyst fistulas |
|
|
Term
| if someone has a high vault vesicovaginal fistula what do you need to check RIGHT AWAY |
|
Definition
| the ureter, 15% chance the ureter is injured/fistula too |
|
|
Term
| treatment if a small vesicovaginal fistula |
|
Definition
| <1cm expecting management, 15% heal in 2-3wk, drain the bladder for 4-6wk |
|
|
Term
| when do you repair a larger vesicovaginal fistula |
|
Definition
| if infected treat and repair in 8-12wk, if not repair within 1-2wk |
|
|
Term
| 2 ways to repair a vesicovaginal fistula >1cm and the indication for each |
|
Definition
| modified latzko - supratrigonal, interposition flap - complicated fistula |
|
|
Term
|
Definition
| remove vesicovaginal fistula tract and use anterior posterior vaginal to make a partial colpocliesis |
|
|
Term
| explain interposition flap |
|
Definition
| martius bulbocavernosis fat pad graft used to repair complicated fistulas |
|
|
Term
| after repair of fistula >1cm what is the follow up - 4 |
|
Definition
| foley 2wk, estrogen topical, stool softeners, pelvic rest |
|
|
Term
| complications of a vesicovaginal fistula repair - 5 |
|
Definition
| hemorrhage, ureter obstruction, breakdown, recurrence, incontinence |
|
|
Term
| options for treatment of a ureterovaginal fistula - 5 |
|
Definition
| stents, diversion, reimplantation, anastomosis,nephrostomy |
|
|
Term
| 3 types of vesicouterine fistula |
|
Definition
1- Yousef - amenorrhea, menorrhea, continence
2 - dual flow - normal menses, menorrhea, and vaginal urine
3 - normal menses and menuria |
|
|
Term
| diagnosis of a rectovaginal fistula |
|
Definition
| vaginal bubbles when air is instilled in the rectum |
|
|
Term
| treatment of small rectovaginal fistula |
|
Definition
|
|
Term
| what population is a fibrin plug used for |
|
Definition
| rectovaginal fistula in patients with IBD first line |
|
|
Term
| management of a rectovaginal fistula that is >0.5cm - 4 ways and why |
|
Definition
distal location - transperitoneal
mid to high location - latzjo
high location - abdominal
proximal location - goligher, York, or mason |
|
|
Term
| what do you dissect into when doing a transperitoneal fistula repair and what kind of fistula is it |
|
Definition
| rectovaginal fistula >0.5cm, rectovaginal septum |
|
|
Term
|
Definition
| repair of a rectovaginal fistula >0.5cm that is via vagina, rectal, or perineal approach |
|
|
Term
| what is a York or mason repair |
|
Definition
| repair of a rectovaginal fistula that is >0.5cm that is of a transphincter approach |
|
|
Term
| diagnosis of a colovaginal fistula - 7 |
|
Definition
| methylene blue intraperitoneal, cystoscopy, barium enema, fistulogram, bud of granulation tissue at top of vagina, CT, MRI |
|
|
Term
| treatment of a colovaginal fistula - 3 |
|
Definition
| resection of part of colon, diversion colostomy, repair of vaginal defect |
|
|
Term
| causes of chronic urinary retention - 9 |
|
Definition
| DM, CVA, MS, anticholinergics, muscle relaxers, antidepressants, a adrenergics, B adrenergics, antihistamines |
|
|
Term
| signs of chronic urinary retention - 7 |
|
Definition
| painless, hesitancy, post void dribbling, frequency, straining, overflow incontinence, UTI |
|
|
Term
| evaluation of chronic urinary retention - 4 |
|
Definition
|
|
Term
| long term complications of catheter - 2 |
|
Definition
|
|
Term
| if long term catheter what screening is needed |
|
Definition
|
|
Term
| treatment options for chronic urinary retention - 6 |
|
Definition
| self cath, stop causative meds, a-blockers, cholinergics, neuromodulation, behavorial modification |
|
|
Term
| what a-blockers are used for chronic urianry retention - 2 |
|
Definition
| Tamsulosin, phenoxybenzamine |
|
|
Term
| what cholinergics are used for chronic urinary retention - 1 |
|
Definition
|
|
Term
| early signs of acute urinary retention - 5 |
|
Definition
| unable to void, incomplete voiding, pain, post void dribbling, frequency |
|
|
Term
| late signs of acute urinary retention - 5 |
|
Definition
| renal failure, hydronephrosis, pyelonephritis, bladder stones |
|
|
Term
| evaluation for acute urinary retention - 8 |
|
Definition
| PVR >150, UA, UCx, cysto if concern for urethral issue, consider if injury (VCUG, CT, IVP, uroflo) |
|
|
Term
| cause of acute urinary retention - detrusor - 6 |
|
Definition
| trauma, edema, anesthesia, anticholinestergic, inflammation, decreased function due to infection |
|
|
Term
| 5 steps in mamagement of acute urinary retention |
|
Definition
1 - immediate decompression
2 - if PP can self cath or foley for 1-2d
3- foley 2-7d then trial
4 - foley or self cath for 7d then trial
5 - self cath for 14d then trial |
|
|
Term
|
Definition
|
|
Term
| complications of overfilled bladder 2 and at how many cc |
|
Definition
| 750cc bladder hemorrhage and IVC compression |
|
|
Term
| medication options for non-obstructive acute urinary retention - 5 |
|
Definition
| bethanechol, prostigmin, prazosin, Tamsulosin, valium |
|
|
Term
| contraindications to bethanechol |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how is prazosin used for urinary retention |
|
Definition
|
|
Term
| which medication for acute urinary retention is best for contracted pelvic floor |
|
Definition
|
|
Term
| % women with painful bladder syndrome |
|
Definition
|
|
Term
| age of women with painful bladder syndeom |
|
Definition
|
|
Term
| define painful bladder syndrome |
|
Definition
| pain perceived to be from the bladder for >6wk without other cause |
|
|
Term
| define interstitial cystitis |
|
Definition
| urgency, frequency, nocturia, pain on filling, relief with emptying, without cause |
|
|
Term
| possible causes of painful bladder syndrome |
|
Definition
| autoimmune, infection, defective urethral GAG barrier |
|
|
Term
| markers that make us think that IC is autoimmune - 3 |
|
Definition
| c-fibers, mast cells, substance P |
|
|
Term
| why does the GAG layer defect lead to IC - 3 |
|
Definition
| increased permability, increased sensitivity of pain receptors, increased inflammation |
|
|
Term
| lab association with painful bladder syndrome |
|
Definition
| 50% have microscopic hematuria |
|
|
Term
| other associations with painful bladder syndrome - 12 |
|
Definition
| anxiety, CPP, dysparunea, depression, sleep dysfunction, social difficulities, sexual difficulities, catastrophizing, OAB, vestibulitis, vulvydenia, fibromyalgia |
|
|
Term
| things that can cause flares of painful bladder syndrome - 7 |
|
Definition
| menstruation, sex, allergy, stressors, acidic food, caffeine, alcohol |
|
|
Term
| 5 possible ways to didagnosis painful bladder syndrome |
|
Definition
| urinary biomarkers (experimental), PUF questionarre, K sensitivity test, cystoscopy, O'Leary santac symptom scale |
|
|
Term
| what is the gold standard for IC diagnosis |
|
Definition
|
|
Term
| signs of cystoscopy for IC - 3 |
|
Definition
| glomerulrizations (hemorrhage, petechiae), hunners ulcers 20% |
|
|
Term
| what 3 tests for IC have a high association with eachother |
|
Definition
| PUF questionarre, K sensitivity test, cystoscopy |
|
|
Term
| how does a K sensitivity test work |
|
Definition
| deficient GAG layer causes bladder to be sensitive to KCL normal bladder isn't, if >/=2 pain difference from filling with water and KCl it is positive |
|
|
Term
| what is the PUF questionarre - 6 |
|
Definition
| pain, urgency, frequency, nocturia, sexual issues, quality of life |
|
|
Term
| what are the 2 biomarkers for IC |
|
Definition
| glycoprotein 5 decreased, antoproliferative factor increased |
|
|
Term
| conservative treatment for IC - 4 |
|
Definition
| pelvic PT 39% effective, stress reduction, diet changes (acids, caffeine, alcohol), fluid restrictions |
|
|
Term
| what do they do at pelvic PT that works at 39% effectiveness for IC |
|
Definition
|
|
Term
| % of IC that has triggers for symptoms |
|
Definition
|
|
Term
| surgical treatments for IC - 4 |
|
Definition
| hydrodistention, urinary diversion, sacral neuromodulation, augmentation cystoscopy |
|
|
Term
| minimally invasive treatments for IC - 4 |
|
Definition
| pentosane Na, intravesticular instillation of medication, stabilization of mast cells, decreasing neuro sensitivity |
|
|
Term
|
Definition
| heparinoid replaces GAG layer |
|
|
Term
|
Definition
| alopecia, bleeding, diarrhea, nausea, headache |
|
|
Term
| effectiveness of pentosane Na for IC |
|
Definition
|
|
Term
| meds you can do intravesicular for IC - 4 |
|
Definition
| pentosane Na, DMSO, heparin, lidocaine, NaHCO3 |
|
|
Term
| meds you can use to stabilize mast cells for IC - 3 |
|
Definition
|
|
Term
| meds you can use to decrease neuro hyperactivity in IC - 3 |
|
Definition
| amytruptline, doxepin, gabapentin |
|
|
Term
| % of women with bladder cancer |
|
Definition
|
|
Term
| % of asymptomatic hematuria that is bladder cancer |
|
Definition
|
|
Term
| % of asymptomatic hematuria that has a cause |
|
Definition
|
|
Term
| % of asymptomatic hematuria without a cause that will be cancer |
|
Definition
|
|
Term
| if someone without risks has asymptomatic hematuria what is their risk of cancer |
|
Definition
|
|
Term
| if someone with risks has asymptomatic hematuria what is their risk of cancer |
|
Definition
|
|
Term
| risks specific to women for bladder cancer - 5 |
|
Definition
| >60yo, smoker, gross hematuria, >25 RBC, painless |
|
|
Term
| toxins that can cause bladder cancer - 4 |
|
Definition
| cyclophosphamide, benzenes, aromatic amines, food coloring |
|
|
Term
| genetic conditions that can cause bladder cancer - 3 |
|
Definition
| retinoblastoma, cowden, lynch |
|
|
Term
| general risks for bladder cancer - 13 |
|
Definition
| male, >50yo, smoker x3, gross hematuria, pelvic RT, chemo, FHX, irritative voiding, analgesia abuse, chronic UTI, white x2, genetic conditions, toxins |
|
|
Term
| #1 cause of asymptomatic hematuria - 3 things |
|
Definition
| GYN contamination, UTI, stone |
|
|
Term
| dyes that can cause false positive asymptomatic hematuria - 4 |
|
Definition
| beets, cyclophosphamide, chlorpromazine, hydrochloride |
|
|
Term
| medical conditions that can cause false positive asymptomatic hematuria - 3 |
|
Definition
| myoglobinemia, porphyria, rhabdo |
|
|
Term
| every day things that can cause asymptomatic hematuria - 4 |
|
Definition
| exercise, sex, trauma, viruses, menses |
|
|
Term
| drugs that can cause asymptomatic hematuria (not false) - 4 |
|
Definition
| anticoagulants, NSAIDS, chemo, rads |
|
|
Term
| urologic conditions that can cause asymptomatic hematuria - |
|
Definition
| nephritis, nephropathy, diveritcula, stone, pyelo, renal cell carcinoma, transitional cell carcinoma, renal emboli, obstruction, trauma, reflux, infection, cystolithiasis, IC, irritant, foreign body, urethritis |
|
|
Term
| gyn conditions that can cause asymptomatic hematuria - 7 |
|
Definition
| caruncle, fistula, atrophy (bladder, vaginal), PMP bleeding, menses, cervicitis |
|
|
Term
| asymptomatic hematuria screening |
|
Definition
|
|
Term
| SS for dipstick for asymptomatic hematuria |
|
Definition
|
|
Term
| definition of dipstick RBC measurement |
|
Definition
trace 0-3 RBC/HPF
1+ is 6-10
2+ is 10-20
3+ is 40-60 |
|
|
Term
| asymptomatic hematuria definition |
|
Definition
| >/= 3+ RBC per HPF without other cause |
|
|
Term
| if someone has >/=3RBC/HPP but also has WBC, bacteria, nitrites, before you can diagnose asymptomatic hematuria you need |
|
Definition
|
|
Term
| signs of glomerular disease in urine testing - 3 |
|
Definition
| casts, dysmorphic RBC, protein >1000 in 24h |
|
|
Term
| management of asymptomatic hematuria age of discrimination |
|
Definition
|
|
Term
| management of asymptomatic hematuria <50yo no risks |
|
Definition
|
|
Term
| asymptomatic hematuria management >50yo or with risks - 6 |
|
Definition
| cystoscopy, BUN, Cr, CrCl, CT urogram if concern for stone |
|
|
Term
| what do you do if asymptomatic hematuria persists with negative work up |
|
Definition
| yearly UA (DC when normal x2y), yearly microscopy, repeat full work up q3-5y |
|
|
Term
| define fecal incontinence |
|
Definition
|
|
Term
|
Definition
|
|
Term
| risks for fecal incontinence - 16 |
|
Definition
| age, loose stool, DM, BMI >30, 3-4MLL, UI, chronic illness, psych meds, CVA, MS, dementia, behavorial, radiation, IBF, cholecystectomy |
|
|
Term
| physiology of fecal incontinence - 11 |
|
Definition
| motility, consistency, compliance, sensation, sphincter, pelvic floor, neuropathy, CNS, overflow, psych, inflammation |
|
|
Term
| inicidence of fecal incontinence |
|
Definition
|
|
Term
| age with most fecal incontinece |
|
Definition
|
|
Term
| cause of most fecal incontinence |
|
Definition
| atraumatic deinnervation 15-50% |
|
|
Term
| exam for fecal incontinence - 5 |
|
Definition
| bulbocavernosis reflexes, clitoral wink, dovetail (no creases), DRE for masses/tone, fistula exam if nothing else is showing anythinig |
|
|
Term
| studies for fecal incontinence - 6 |
|
Definition
| EMG, manometry, pudendal nerve terminal motor latency test, fistula work up, colonoscopy, balloon explusion |
|
|
Term
| complications of fecal incontinence - 3 |
|
Definition
| effect on daily living, institutionalization, perianal dermatitis |
|
|
Term
| 7 steps in working up and treating fecal incontinence |
|
Definition
1 - treat stool looseness
2 - biofeedback
3 - anal manometry, if weak US
4 - balloon explusion test
5 - rectal sensation test
6 - sacral neuromodulation
7 - surgery |
|
|
Term
| if the rectal sensation test is positive for defect what do you treat with |
|
Definition
|
|
Term
| effectiveness of biofeedback for fecal incontinence |
|
Definition
| 80% effective, increases strength |
|
|
Term
| what do you use to treat loose stool when treating fecal incontinence - 4 |
|
Definition
| loperamide, immodium, fiber, fluid management |
|
|
Term
| if in the work up of fecal incontinence the anal manometry shows weakness what do you do next |
|
Definition
| endoanal US for internal sphincter, 2D US or MRI for external sphincter, scars, atrophy |
|
|
Term
| surgery for fecal incontinence - 4 |
|
Definition
| sphincteroplasty, dextranometer, neosphincter / gracilis flap, colostomy |
|
|
Term
| success rate of sphincteroplasty |
|
Definition
|
|
Term
| success rate of dextranometor |
|
Definition
| 50% only short term, no long term studies |
|
|
Term
| prevalence rectal prolapse |
|
Definition
|
|
Term
| #1 cause of fecal incontinence |
|
Definition
|
|
Term
| risks for rectal prolapse |
|
Definition
| colpocliesis - makes normally low pressure vaginal higher than rectum |
|
|
Term
| signs of rectal prolapse - 6 |
|
Definition
| increased pressure, sensation of incomplete emptying, fecal incontinence, rectal bleeding, bowel incarceration, ulceration |
|
|
Term
| if someone has rectal prolapse what do you have to rule out |
|
Definition
| colonoscopy to make sure there isn't a lead point mass |
|
|
Term
| treatment of rectal prolapse - 3 |
|
Definition
| early surgery! intrabdominal rectopexy with mesh, transperitoneal surgery (altemeier, delorme) |
|
|
Term
| when do you choose altemeier or delorme |
|
Definition
| altemeier is the best, delorme is for elderly or with comorbidities |
|
|
Term
|
Definition
| full thickness circumfrential incision above the dental line, bowel resection and reanastamosis |
|
|
Term
|
Definition
| mucosal stripping via submucosal rectal dissection, plication of the muscular layer, anastomosis of mucosa, proximal to dentate line |
|
|
Term
| cause of autonomic hyperreflexia |
|
Definition
| cord injury above T6 with viable distal cord |
|
|
Term
| physiology autonomic hyperreflexia |
|
Definition
| increased sympathetic response |
|
|
Term
| irritants for autonomic hyperreflexia - 4 |
|
Definition
| bladder filling, catheterization, bowel distention, GI procedures |
|
|
Term
| symptoms autonomic hyperreflexia - 4 |
|
Definition
| HTN, HA, flushing, bradycardia |
|
|
Term
| treatment of autonomic hyperreflexia - 4 |
|
Definition
| stop the thing causing it, treat HTN (a-blocker, nitrate, hydralazine) |
|
|
Term
| when does spinal shock happen |
|
Definition
|
|
Term
|
Definition
| atonic bladder that wont empty |
|
|
Term
| treatment of spinal shock |
|
Definition
| indwelling followed by intermittent cath (5x/d with goal <500cc) |
|
|
Term
| what is detrusor sphincter dysnergia |
|
Definition
| detrusor contracts against closed sphincter which leads to urge and overflow incontinence |
|
|
Term
| risk for detrusor sphincter dysnergia |
|
Definition
|
|
Term
| detrusor sphincter dysnergia treatment initial |
|
Definition
| intermittent cath, anticholinergics |
|
|
Term
| when should you skip detrusor sphincter dysnergia initial treatment and go right to surgery - 2 |
|
Definition
| detrusor does not respond to anticholinergics, poor compliance (leak point pressure is > 40mmHg) |
|
|
Term
| detrusor sphincter dysnergia surgery - 3 |
|
Definition
| ileocystoplasty, augmentation cystoplasty with catheterizable stoma, ileal conduit |
|
|
Term
| what is a ileocystoplasty |
|
Definition
| treatment for detrusor sphincter dysnergia, attach ileum 15cm from valve to bladder |
|
|
Term
| what is an augmentation cystoplasty with catheterizable stoma and its complications |
|
Definition
| detrusor sphincter dysnergia surgery, stomal stenosis, incontinence |
|
|
Term
| which surgery for detrusor sphincter dysnergia is best if the patient cant self cath |
|
Definition
| augmentation cystoplasty with catheterizable stoma |
|
|
Term
|
Definition
| treatment for detrusor sphincter dysnergia, connect ureter to ileum |
|
|
Term
| detrusor sphincter dysnergia surgery who cannot get an ileal conduit |
|
Definition
|
|
Term
| risk factors for pubic diastasis - 2 |
|
Definition
| connective tissue disorders, McRoberts |
|
|
Term
|
Definition
| 6mm at 30yo, 4.6mm in multip |
|
|
Term
| normal pubic relaxation during pregnancy (weeks, cause) |
|
Definition
| 29-32wk, relaxin, progesterone |
|
|
Term
| management of pubic diastasis |
|
Definition
| PT, rest, surgery if severe |
|
|
Term
| surgery for pubic diastasis - 3 |
|
Definition
| internal/external fixation, hip sica cast, pelvic sling |
|
|
