-Cystocele-
-Cystocele is a hernia of the anterior vaginal wall that is associated with decent of the bladder
-Risk factors for cystocele include parity, advancing age, and obesity
-Hysterectomy may be associated with an increase risk of cystocele
-Chronic constipation can increase the risk for cystocele
-Clinical symptoms may include: bulge, vaginal pressure, sexual dysfunction, and urinary and defecation problems
-Treatment is indicated for women with symptoms of prolapse. Asymptomatic cystocele is not an indication for treatment
-Surgical correction is definitive therapy
-Neoplasm-
-Vaginal neoplasms are the rarest of all gynecologic neoplasms
-Carcinoma in Situ (CIS) occur mostly in the third decade of life.
-Over one half of the patients with CIS will have an antecedent or coexistent neoplasm of the lower genital tract
-Treatment options include laser ablation, local excision, and chemical treatment with 5 FU. Total or partial vaginectomy with application of a split full thickness skin graft is usually reserved for treatment failures
-Invasive vaginal cancer is usually of the squamous cell carcinoma type (95%)
-Radiation therapy is the mainstay of treatment for patients with invasive vaginal cancer. Radical hysterectomy combined with upper vaginectomy and pelvic lymphadectomy being used for upper vaginal lesion
-Prolapse-
-Apical prolapse is descent to the cervix, uterus or vaginal vault
-Apical vaginal prolapse is descent of the vaginal cuff scar or cervix, below a point which is 2 cm less than the total vaginal length about the plane of the hymen.
-Risk factors for development include: parity, obesity, chronic constipation, hysterectomy, and advancing age
-Indications for surgical correction are those who are symptomatic and can tolerate surgical repair
-Rectocele-
-Rectocele is anterior protrusion of the rectum, usually into the vagina.
-The diagnosis of this is make of pelvic examination
-Risk factors for rectocele include: vaginal childbirth, advancing age, and increasing body mass index
-Treatment is surgical correction definitively
-Vaginitis-
-Vaginitis refers to disorders that cause infection, inflammation, or changes of the normal vaginal flora
-Ninety percent of cases of vaginitis are caused by bacterial vaginitis, trichomonas vaginitis, and candidia vaginitis
-Less common causes of vaginitis include atrophic vaginitis, cervicitis, foreign body, irritants, and allergens
-Symptoms of vaginitis include changes in color or volume or odor of vaginal discharge, pruritus, burning, irritation, erythema, dyspareunia, spotting, and dysuria
-Wet prep and KOH can help define clue cells which are indicative of bacterial vaginitis. Trichomonas does not have clue cells and is sexually transmitted. There is budding yeast with candidia
-Bacterial vaginitis is caused by Gardnarella
-Gardnarella is treated with metronidazole 500 mg BID for 7 days
-Candidia is treated with diflucan 150 mg PO times one dose, or terazole 7 vaginal suppositories for pregnant women.
-Trichomonas Vaginitis is treated with metronidazole 500 mg BID for 7 days. Trichomonas is an sexual transmitted disease and partners need to be treated
-Risk factors for cystocele include parity, advancing age, and obesity
-Hysterectomy may be associated with an increase risk of cystocele
-Chronic constipation can increase the risk for cystocele
-Clinical symptoms may include: bulge, vaginal pressure, sexual dysfunction, and urinary and defecation problems
-Treatment is indicated for women with symptoms of prolapse. Asymptomatic cystocele is not an indication for treatment
-Surgical correction is definitive therapy
-Neoplasm-
-Vaginal neoplasms are the rarest of all gynecologic neoplasms
-Carcinoma in Situ (CIS) occur mostly in the third decade of life.
-Over one half of the patients with CIS will have an antecedent or coexistent neoplasm of the lower genital tract
-Treatment options include laser ablation, local excision, and chemical treatment with 5 FU. Total or partial vaginectomy with application of a split full thickness skin graft is usually reserved for treatment failures
-Invasive vaginal cancer is usually of the squamous cell carcinoma type (95%)
-Radiation therapy is the mainstay of treatment for patients with invasive vaginal cancer. Radical hysterectomy combined with upper vaginectomy and pelvic lymphadectomy being used for upper vaginal lesion
-Prolapse-
-Apical prolapse is descent to the cervix, uterus or vaginal vault
-Apical vaginal prolapse is descent of the vaginal cuff scar or cervix, below a point which is 2 cm less than the total vaginal length about the plane of the hymen.
-Risk factors for development include: parity, obesity, chronic constipation, hysterectomy, and advancing age
-Indications for surgical correction are those who are symptomatic and can tolerate surgical repair
-Rectocele-
-Rectocele is anterior protrusion of the rectum, usually into the vagina.
-The diagnosis of this is make of pelvic examination
-Risk factors for rectocele include: vaginal childbirth, advancing age, and increasing body mass index
-Treatment is surgical correction definitively
-Vaginitis-
-Vaginitis refers to disorders that cause infection, inflammation, or changes of the normal vaginal flora
-Ninety percent of cases of vaginitis are caused by bacterial vaginitis, trichomonas vaginitis, and candidia vaginitis
-Less common causes of vaginitis include atrophic vaginitis, cervicitis, foreign body, irritants, and allergens
-Symptoms of vaginitis include changes in color or volume or odor of vaginal discharge, pruritus, burning, irritation, erythema, dyspareunia, spotting, and dysuria
-Wet prep and KOH can help define clue cells which are indicative of bacterial vaginitis. Trichomonas does not have clue cells and is sexually transmitted. There is budding yeast with candidia
-Bacterial vaginitis is caused by Gardnarella
-Gardnarella is treated with metronidazole 500 mg BID for 7 days
-Candidia is treated with diflucan 150 mg PO times one dose, or terazole 7 vaginal suppositories for pregnant women.
-Trichomonas Vaginitis is treated with metronidazole 500 mg BID for 7 days. Trichomonas is an sexual transmitted disease and partners need to be treated
No comments:
Post a Comment