VAGINAL FISTULA

VAGINAL FISTULA- an abnormal tortuous opening between internal hollow organs, or between the internal hollow organ and the exterior of the body


Uterovaginal fistulas- opening between the ureter and the vagina

Vessicovaginal fistula- opening between the bladder and the vagina

Retrovaginal fistula - opening between the rectum and the vagina


CAUSES:

• injury during the prolonged labor
• vaginal reconstruction or injury
• carcinoma

SIGNS AND SYMPTOMS:

• fecal in continence
• loss of urge to void
• bladder contineously emptying
• inflammation of the vulva
  

VULVITIS ( ABSCESS OF THE BARTHOLIN'S GLANDS)

VULVITIS - inflammation of the vulva

CAUSES:

• due to poor perineal hygiene
• discharge of infection

CAUSATIVE AGENT:

• gonococcos
• escherichia coli
• staphylococcus
• streptococcus
• trichonomas vaginitis

SIGNS AND SYMPTOMS

• burning pain during defecation and urination
• edematous genetalia
  
• profuse purulent exudate

BARTHOLIN'S GLANDS INFECTION- will leads to the formation of abscess characterized by pain and swelling of labia

TREATMENT:

• broads spectrum antibiotic
• or combination therapy like tetracycline, penicillin and streptomycin
• hot packs for comfort
• sitz bath -promotes healing
• analgesics for pain

Bartholin's cyst - normally surgically remove


Bartholinectomy- removal of bartholin's glands

Indication for Bartholinectomy

• due to chronic condition, provokes fear of carcinoma
• occur an obstruction when coitus

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HYDRAMNIOS

HYDRAMNIOS (POLYHYDRAMNIOS) -

• caused by excessive amount of amniotic fluid
• unknown cause but frequently seen in diabetic women
• elevated prolactin levels in amniotic fluid

SIGNS AND SYMPTOMS:

• increase uterine size for gestation
• big uterine size for gestational age
• difficulty in palpating fetal parts
• difficulty to auscultate fetal heart

DIAGNOSTIC PROCEDURE:

• ultrasound shows large pocket of fluid

NURSING CARE:

• provide emotional support to prevent anxiety
• record intake and output
• monitor fetal heart
• adequate rest and avoid stressful activity
• encourage nutritious foods that are rich in protein
  

OLIGOHYDRAMNIOS

OLIGOHYDRAMNIOS -

• there is a decreased amount of amniotic fluid and fluid becaome concentrated.
• this causes cord compression and fetal distress
  
• due to lack of fluid in the terminal air sacs, the infant may manifest to pulmonary hyperplasia
• cause is unknown
  

PREDISPOSING FACTORS:

• postdate pregnancy
• fetal renal disease
• fetal obstruction

SIGNS AND SYMPTOMS:

• prominent fetal parts are palpated in the abdomen
• small for date

NURSING CARE:

• psychological support to patient and family and allow to discuss about the diagnosis and the outcome
  

CERVICAL BIOPSY

CERVICAL BIOPSY -to get cervical tissue for further laboratory examination if there is lesion

Procedure:

• procedure should be done one week after end of menstruation
• explain to the patient about the procedure and its purpose
• let the patient to lie down in lithotomy position with foot on the stirrup
• Doctor nibbles tissue with the use of biopsy forceps( forceps instrument with teeth) There is no need of anesthesia because cervix has no pain receptor and patient does not experience pain when nibbling tissue. Some bleeding is expected from the site of nibbling tissue so, pressure dressing like packing is inserted.
• cervical tissue is preserved in 10%formalin and labeled properly before sending to laboratory for examination

CYTOLOGY TEST FOR CANCER (PAPANICOLAOU)

CYTOLOGY TEST- for Cancer (PAPANICOLAOU)- test for diagnosing cervical cancer by swabbing or or aspirating vaginal secretion from the posterior fonix and making a smear on a glass slide and examines and interpret by the pathologist.
This examination must not be performed to a patient who is presently on menstrual flow.

CLASSIFICATION for cytological findings suggested by Papanicolaou test

Class 1- absence of atypical or abnormal cells
Class 2- atypical cytology but no evidence of malignancy
Class 3- cytology suggestive of but not conclusive for malignancy
Class 4- cytology strongly suggestive of malignancy
Class 5- cytology conclusive to malignancy