Physical Exam and Gynecological Assessment

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Questions and Answers

What is a bulge caused by the bladder protruding into the submucosa of the anterior vaginal wall?

Rectocele

Uterine prolapse

Vaginal tissue protrusion

Cystocele (correct)

What is a bulge caused by the rectal cavity protrusion?

Uterine prolapse

Vaginal tissue protrusion

Rectocele (correct)

Cystocele

What can result in incompetency of the musculature?

Trauma to cervical wall

Trauma to posterior vaginal wall

Trauma to anterior vaginal wall (correct)

Trauma to uterine wall

What is a condition in which the cervix and uterus descend under pressure through the vaginal canal?

Uterine prolapse Signup and view all the answers

What may cause a laceration, usually transverse, giving the cervical os a “fishmouth” appearance?

Multiparity Signup and view all the answers

What is a sign of early pregnancy?

Bluish coloration of the cervix Signup and view all the answers

What is the result of a weakening of the vaginal walls in pelvic organ prolapse?

The pelvic organs descend and protrude into the vaginal canal Signup and view all the answers

What is the primary cause of a cystocele?

Injury or strain during childbirth Signup and view all the answers

What is the characteristic of a rectocele?

An upward pouching of the rectum Signup and view all the answers

What is the risk factor for developing a cystocele?

Multiparity Signup and view all the answers

What is the primary goal of medical management for fistulas of the vagina?

To eliminate fistula and treat infection Signup and view all the answers

What is the characteristic of a vesicovaginal fistula?

Urine escapes into the vagina Signup and view all the answers

What is the treatment for a rectovaginal fistula?

Low-residue diet and drainage Signup and view all the answers

What is the purpose of methylene blue dye instillation in the diagnosis of fistulas of the vagina?

To check for staining in the vagina Signup and view all the answers

What is the condition where the intestinal wall protrudes into the vagina?

Enterocele Signup and view all the answers

Which type of prolapse causes the anterior vaginal wall to bulge downward?

Cystocele Signup and view all the answers

What is the surgical procedure that repairs perineal lacerations?

Perineorrhaphy Signup and view all the answers

What is the condition where the uterus descends into the vaginal canal?

Uterine Prolapse Signup and view all the answers

Which symptom is commonly associated with Uterine Prolapse?

Urinary incontinence Signup and view all the answers

What is the purpose of a pessary device?

To support the uterus, bladder, or intestines Signup and view all the answers

What is the goal of postoperative nursing care for a rectocele repair?

To prevent infection and pressure on the suture line Signup and view all the answers

What is the condition where the rectal wall bulges into the vagina?

Rectocele Signup and view all the answers

What is the surgical procedure that repairs a cystocele?

Anterior colporrhaphy Signup and view all the answers

What is the consequence of delayed treatment for perineal lacerations?

All of the above Signup and view all the answers

Study Notes

Physical Exam

Supine lithotomy position is commonly used
Inspection:
- Nulliparous: labia minora come together at the opening of the vagina
- Multiparous: labia minora may gape and vaginal tissue may protrude
Cervix:
- Nulliparous: usually 2-3 cm wide and smooth
- Multiparous: may have a laceration, usually transverse, giving the cervical os a "fishmouth" appearance
Uterine prolapse: cervix and uterus descend under pressure through the vaginal canal
Cystocele: bladder protrudes into the submucosa of the anterior vaginal wall
Rectocele: rectal cavity protrudes into the posterior vaginal wall

Fistulas of the Vagina

A fistula is an abnormal opening between two internal hollow organs or between an internal hollow organ and the exterior of the body
Examples:
- Vesicovaginal fistula: opening between the bladder and vagina
- Rectovaginal fistula: opening between the rectum and vagina
Clinical manifestations:
- Vesicovaginal: urine escapes into vagina
- Rectovaginal: fecal incontinence; flatus discharged into vagina
Assessments and diagnostics:
- Methylene blue dye instilled into bladder, then vaginal packing is added to check for staining
- Cystourethroscopy; IV cystourethroscopy to determine exact location
Medical management:
- Goal: eliminate fistula/treat infection
- Proper nutrition; cleansing douches; enemas; rest; admin of intestinal antibiotics

Structural Disorders

Pelvic Organ Prolapse

Weakening of the vaginal walls allows the pelvic organs to descend and protrude into the vaginal canal
Risk factors: age; parity; menopause; hx pelvic surgery; genetic predisposition
Types:
- Cystocele: downward displacement of the bladder toward the vaginal orifice
- Rectocele: upward pouching of the rectum that pushes the posterior wall of the vagina forward
- Enterocele: protrusion of the intestinal wall into the vagina
Clinical manifestations:
- Cystocele: pelvic pressure and urinary problems
- Rectocele: rectal pressure instead of urinary symptoms
- Prolapse: feelings of pressure and ulcerations and bleeding; dyspareunia
Medical management:
- Kegel exercises; pessary device; surgical repairs (anterior colporrhaphy, posterior colporrhaphy, perineorrhaphy)

Uterine Prolapse

Structures that support the uterus weaken (typically from childbirth), the uterus may work its way down the vaginal canal and even appear outside the vaginal orifice (procidentia)
Symptoms:
- Pressure and urinary problems (incontinence or retention)
- Symptoms aggravated when a woman coughs, lifts a heavy object, or stands for a long time
Medical management:
- Surgery: uterus is sutured back into place
- Postmenopausal: hysterectomy or repair via colpopexy
- Conservative treatments and mechanical options, including lifestyle changes, pessaries, and pelvic floor muscle training

Benign Disorders

Vulvitis and Vulvodynia

Vulvitis: inflammation of the vulva, may occur with other disorders or poor hygiene
Vulvodynia: chronic vulvar pain syndrome

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Description

This quiz covers the physical exam and assessment techniques used in gynecology, including positioning, inspection, and trauma evaluation.