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
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|
Term
% of asymptomatic hematuria that is bladder cancer |
|
Definition
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|
Term
% of asymptomatic hematuria that has a cause |
|
Definition
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|
Term
% of asymptomatic hematuria without a cause that will be cancer |
|
Definition
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|
Term
if someone without risks has asymptomatic hematuria what is their risk of cancer |
|
Definition
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|
Term
if someone with risks has asymptomatic hematuria what is their risk of cancer |
|
Definition
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|
Term
risks specific to women for bladder cancer - 5 |
|
Definition
>60yo, smoker, gross hematuria, >25 RBC, painless |
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|
Term
toxins that can cause bladder cancer - 4 |
|
Definition
cyclophosphamide, benzenes, aromatic amines, food coloring |
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|
Term
genetic conditions that can cause bladder cancer - 3 |
|
Definition
retinoblastoma, cowden, lynch |
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|
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 |
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|
Term
#1 cause of asymptomatic hematuria - 3 things |
|
Definition
GYN contamination, UTI, stone |
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|
Term
dyes that can cause false positive asymptomatic hematuria - 4 |
|
Definition
beets, cyclophosphamide, chlorpromazine, hydrochloride |
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|
Term
medical conditions that can cause false positive asymptomatic hematuria - 3 |
|
Definition
myoglobinemia, porphyria, rhabdo |
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|
Term
every day things that can cause asymptomatic hematuria - 4 |
|
Definition
exercise, sex, trauma, viruses, menses |
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|
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 |
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|
Term
gyn conditions that can cause asymptomatic hematuria - 7 |
|
Definition
caruncle, fistula, atrophy (bladder, vaginal), PMP bleeding, menses, cervicitis |
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|
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 |
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|
Term
asymptomatic hematuria definition |
|
Definition
>/= 3+ RBC per HPF without other cause |
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|
Term
if someone has >/=3RBC/HPP but also has WBC, bacteria, nitrites, before you can diagnose asymptomatic hematuria you need |
|
Definition
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|
Term
signs of glomerular disease in urine testing - 3 |
|
Definition
casts, dysmorphic RBC, protein >1000 in 24h |
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|
Term
management of asymptomatic hematuria age of discrimination |
|
Definition
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|
Term
management of asymptomatic hematuria <50yo no risks |
|
Definition
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|
Term
asymptomatic hematuria management >50yo or with risks - 6 |
|
Definition
cystoscopy, BUN, Cr, CrCl, CT urogram if concern for stone |
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|
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 |
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|
Term
define fecal incontinence |
|
Definition
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|
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 |
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|
Term
physiology of fecal incontinence - 11 |
|
Definition
motility, consistency, compliance, sensation, sphincter, pelvic floor, neuropathy, CNS, overflow, psych, inflammation |
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|
Term
inicidence of fecal incontinence |
|
Definition
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|
Term
age with most fecal incontinece |
|
Definition
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|
Term
cause of most fecal incontinence |
|
Definition
atraumatic deinnervation 15-50% |
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|
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 |
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|
Term
studies for fecal incontinence - 6 |
|
Definition
EMG, manometry, pudendal nerve terminal motor latency test, fistula work up, colonoscopy, balloon explusion |
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|
Term
complications of fecal incontinence - 3 |
|
Definition
effect on daily living, institutionalization, perianal dermatitis |
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|
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 |
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|
Term
if the rectal sensation test is positive for defect what do you treat with |
|
Definition
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|
Term
effectiveness of biofeedback for fecal incontinence |
|
Definition
80% effective, increases strength |
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|
Term
what do you use to treat loose stool when treating fecal incontinence - 4 |
|
Definition
loperamide, immodium, fiber, fluid management |
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|
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 |
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|
Term
surgery for fecal incontinence - 4 |
|
Definition
sphincteroplasty, dextranometer, neosphincter / gracilis flap, colostomy |
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|
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 |
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|
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) |
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|
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 |
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|
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 |
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|
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 |
|
|