Case Study: Pelvis And Perineum Presentation History

Case Study Pelvis And Perineumpresentationhistorya Farmers Wife 4

Case Study - Pelvis and Perineum Presentation/History A farmer's wife, 42 years old, comes to the outpatient department with the following complaints. She has a bearing down sensation in her womb, "something seems to come down." This discomfort increases when she strains or lifts heavy loads. She often has backaches, particularly if she is on her feet all day. She also complains of urinary symptoms, such as frequency of and burning on urination. She fatigues easily.

The patient has had four children and two miscarriages. Her menstrual flow is increased and her periods are somewhat irregular. Examination On general examination the patient appears nervous and anxious. She is underweight and rather frail. Otherwise the general examination does not show any abnormalities.

Gynecological examination reveals a moderate downward bulging on the anterior vaginal wall that increases on straining. On examination in the erect position the cervix of the uterus is found in the vagina close to the vestibule. It recedes somewhat when the patient is supine, yet does not assume its normal position. The cervix is elongated. Discussion Thread Questions Uterine prolapse, often combined with a cystocele as we find it in this patient, is one of the most frequently encountered gynecological disorders. What is the cause of the uterine prolapse and the cystocele? With advancing age there is increased relaxation and loss of tonus of the muscular and fascial structures that constitute the support of the pelvic viscera. This fact is mainly responsible for the disorder. Do multiple childbirths contribute to the occurrence of uterine prolapse? Lacerations and overstretching of the supporting tissues during childbirth greatly enhance the chances for prolapse.

How do you explain the discomfort of the patient, consisting of a feeling of heaviness in the lower abdomen and backache? How do you explain the urinary symptoms such as frequency and burning in cystocele? What is the normal position of the uterus? How does its position change with an empty versus a full bladder? In what direction does the ostium of the uterus face if the uterus is in its typical anteverted position? Intra-abdominal pressure further accentuates the downward displacement of the cervix. Congestion and swelling gradually result in elongation of the cervix as in our patient. What are the main supporting structures of the uterus? What is the main muscular constituent of the pelvic diaphragm? It is variable in thickness and is often partly replaced by connective tissue after having been lacerated and stretched during childbirth. Its two halves are separated in front by a narrow gap. Give the name of the gap and state what partially closes it. The importance of this muscular component for the support of the uterus is exemplified by cases where, due to congenital paralysis of the muscle in malformations of the spinal cord, there is already a prolapse of the uterus in the early years of childhood. The support of the uterus by these structures is mainly indirect, however, in that the uterus rests on organs that on their part are sustained in their position by the intact pelvic and urogenital diaphragms. These organs are the bladder, on which the normally anteverted and anteflexed uterus rests, and the ampulla of the rectum, which supports the cervix uteri and the vagina caudally and posteriorly. Finally the fibrous connective tissue between the vagina and bladder and vagina and urethra should be mentioned as a supporting factor. The former is loosely areolar, the latter denser. Clinicians have given them the names of vesicovaginal and urethrovaginal septa or fasciae. They are a part of the pelvic visceral fascia and fuse with the outer layers of the organs previously mentioned. Submit your completed exercise as an attachment to the drop box for this module. Please be sure to include your last name and the course number in the title of the document, like so: "your name X 104 Assignment_Mod8. When you have submitted this drop box assignment, go to the Discussion Forum for this module in the course and develop a working diagnosis and associated treatment plan for this patient. This exam paper must not be removed from the venue School of Biological Sciences EXAMINATION Semester Two Final Examinations, 2012 BIOL2001 Australia's Terrestrial Environment This paper is for St Lucia Campus students. Examination Duration: 90 minutes Reading Time: 10 minutes Exam Conditions: This is a Central Examination This is a Closed Book Examination - specified materials permitted During perusal - write only on the rough paper provided This examination paper will be released to the Library Materials Permitted In The Exam Venue: (No electronic aids are permitted e.g. laptops, phones) An unmarked Bilingual dictionary is permitted Materials To Be Supplied To Students: 1 x 14 Page Answer Booklet 1 x Multiple Choice Answer Sheet Rough Paper Instructions To Students: Multiple-choice questions, mark the appropriate oval (either A, B, C, D or E) to indicate the correct answer. Short answer questions, write your answer in the writing booklet provided Venue ____________________ Seat Number ________ Student Number |__|__|__|__|__|__|__|__| Family Name _____________________ First Name _____________________ For Examiner Use Only Question Mark Total ________ Semester Two Final Examinations, 2012 BIOL2001 Australia's Terrestrial Environment PART A MULTIPLE CHOICE QUESTIONS Circle one (1) answer per question (either A, B, C, D or E) on the multiple choice answer sheet. Each question is worth 1 mark 1. Which of the following fish species is not native to Australia? A. Trout (Trutta salmo) B. Queensland lungfish (Neoceratodus forsteri) C. Spangled Perch (Leiopotherapon unicolour) D. Bullshark (Carcharhinus leucas) E. Desert Goby (Chlamydogobius eremius) 2. Which of the following statements is false? A. Australia has approximately 280 species of freshwater fishes B. Most of Australia’s freshwater fishes have a recent seawater ancestry C. Most native Australian freshwater fishes belong to the family Cyprinidae (Carp) D. All arid zone waterways contain up to 80% of the same species of fish E. Australia is home to many endemic species of fish 3. Which of the following is not believed to be responsible for dramatic reductions in some populations of Australian frogs: A. The introduction of cane toads B. Land clearing C. Chytrid fungus D. Increased exposure to UV radiation E. The use of chemical herbicides and insecticides in agriculture 4. The primary reason that female pythons brood their eggs is: A. Protection from predation B. Protection from fungus infection C. Protection from bacterial infection D. Maintenance of a warm incubation temperature E. To assist babies once they have hatched 5. The tooth arrangement in Australian colubrid snakes (tree snakes and mangrove snakes) is best described as: A. Proteroglyphous (front-fanged) B. Aglyphous (no-fangs) C. Polyglyphous (many-fanged) D. Poisglyphous (poison fanged) E. Opisthoglyphous (rear-fanged) Semester One Final Examinations, 2012 BIOL2001 Australia's Terrestrial Enviro a. Always being found in flocks b. Having two forward facing and two backward facing toes c. Having bright and contrasting coloured plumage d. Having a brush-like tongue e. Nesting in tree hollows 7. Which of the following statements about the breeding biology of megapodes (mound-building birds) is false? a. They have a monogamous mating system b. The eggshell is extremely thin compared to other birds c. The chicks are extremely precocious d. The eggshell is more permeable than other birds e. Females lay extremely large eggs for their body size Semester One Final Examinations, 2012 BIOL2001 Australia's Terrestrial Enviro birds because: A. They build mud nests B. They are obligate cooperative breeders C. Unrelated birds help to raise young D. Adults will feed young of rival flocks E. Only the dominate males and females get to breed 7. Nomadism in birds is best described as a strategy for: A. Avoiding territorial disputes with other birds B. Preventing the depletion of food in a particular area C. Exploiting abundant yet ephemeral and somewhat unpredictable food sources D. Forming large flocks to decrease the chance of individuals being predated E. Avoiding the attention of predators Semester One Final Examinations, 2012 BIOL2001 Australia's Terrestrial Environment PART B SHORT ANSWER QUESTIONS Write a short answer to each question in the answer booklet provided. 8. List four (4) methods for estimating how many species of insects there might be. Give approximate estimates for these numbers. (2 marks) 9. List a possible reason for: (a) an increase in the use of pesticides in Australia; (b) a decrease in the use of pesticide in Australia. (2 marks) 10. Describe two factors that permit aquatic organisms to persist over many generations in desert regions. These factors may relate to either the waterways or the organisms. (2 marks) 11. What words are missing from the following statement? (1 mark) Cane toads were introduced into Australia from _____________ to combat and predate upon the ______________. 12. Diapause during embryonic development is a feature of several species of Australian freshwater turtle. Briefly describe this phenomenon using one species as an example. (2 marks) 13. With what climates is the occurrence of viviparity in squamates (lizards and snakes) associated, and what is the reason for this association? (2 marks) 14. How do the nesting strategies of Australian freshwater crocodiles (Crocodylus johnstoni) differ from those of Indopacific crocodiles (Crocodylus porosus)? Which species is likely to suffer the highest mortality rate during nesting? (2 marks) 15. How is the evolution of the three main groups of passeriform birds (perching birds)—New Zealand wrens (Acanthisittidae), ‘suboscinces’ (Oligomyodi) and Passeres (song birds)—linked to the fragmentation of Gondwana? (2 marks) 16. Although they have only been here for a short time (

Paper For Above instruction

The case study presents a middle-aged woman suffering from uterine prolapse and associated pelvic support disorders. The primary focus is understanding the causes, anatomical support structures, and implications of pelvic organ prolapse in women.

Uterine prolapse occurs when the pelvic support structures weaken or become damaged, leading to descent of the uterus into or outside the vaginal canal. In this patient, the prolapse appears as a downward bulging on the anterior vaginal wall, which increases with strain, and a cervix that is elongated and displaced from its normal position. The key causes include aging-related relaxation of pelvic musculature and support tissues, along with the mechanical stresses of multiple childbirths, such as overstretching and tearing of tissues. These factors compromise the suspensory ligaments, fascia, and musculature responsible for maintaining pelvic organ position.

The discomfort experienced by the patient, including a feeling of heaviness and backache, can be attributed to the descent and congestion of pelvic organs, stretching and elongation of the cervix, and strain-induced intra-abdominal pressure. Urinary symptoms such as increased frequency and burning may result from cystocele, where the bladder protrudes into the vagina, causing irritation and altered bladder function.

Normal uterine positioning is anteverted and anteflexed — tilted forward over the bladder. When the bladder is full, the uterus is pushed upward and backward slightly; when empty, it assumes a more anterior position. The ostium of the uterus faces anteriorly in its typical position. The main supporting structures include the uterosacral ligaments, cardinal ligaments, levator ani muscles, and connective tissues like the vesicovaginal and urethrovaginal septa. The pelvic diaphragm's primary muscular component, the levator ani, is often variable in thickness, sometimes partially replaced by fibrous tissue after childbirth-related trauma.

The broad, anterior gap in the levator ani muscle group is the urogenital hiatus, which is partially closed by the puborectalis muscle. This musculature helps support the pelvic organs and maintain continence. Congenital or acquired paralysis or weakness of these muscles, such as through spinal cord malformations, can lead to early prolapse, demonstrating their support importance.

The indirect support to the uterus derives from the pelvic viscera—bladder and rectum—which are themselves maintained in position by the pelvic diaphragm and connective tissues. The fibrous connective tissue, including the vesicovaginal and urethrovaginal fasciae, provides additional support by anchoring the vagina to adjacent structures. These tissues fuse with organ layers, stabilizing pelvic organ placement.

Understanding these support mechanisms emphasizes the importance of muscular, ligamentous, and fascial integrity in preventing prolapse. Management strategies include pelvic floor muscle exercises, pessaries, and surgical repairs to restore support. These interventions aim to relieve symptoms and improve quality of life by reinforcing or reconstructing weakened supports.

In conclusion, pelvic organ prolapse like uterine prolapse involves complex interactions among anatomical support structures whose integrity diminishes with age, childbirth trauma, and tissue degeneration. Proper diagnosis and targeted therapeutic intervention can substantially improve patient outcomes, emphasizing the importance of understanding pelvic support anatomy.

References

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