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Differential Diagnosis Anterior wall prolapse; Congenital or inclusion dermoid vaginal cyst. Sacrohysteropexy; Abdominal procedure, Attachment of synthetic mesh from the utertocevical junction to the anterior longitudinal ligament of the sacrum. Fascial defect repairs; Fascial or muscle plication or attachment to ligaments to support the vagina in its presumed original position. 8th Edition APGO Objectives for Medical Students Pelvic Relaxation and Urinary Incontinence. Uterine prolapse ("dropped uterus") is a condition in which a woman's uterus (womb) sags or slips out of its normal position. It is the predominant etiologic agent among patients of middle and upper socioeconomic status with PID in the United States. Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY.
Original Editors - Cate Hurst and Katie Countryman from Bellarmine University's Pathophysiology of Complex Patient Problems project. Diverticula are small, bulging pouches that can form in the lining of your digestive system and are prevalent in adults after the age of 60.[1] They are found most often in the lower part of the large intestine (colon). The most common symptoms of diverticulitis include severe left lower quadrant abdominal pain, marked changes in bowel habits, fever, and nausea. Diverticula are common in more than half of adults over the age of 60, with 10%-25% developing diverticulitis.
In acute diverticulitis, patients can get an abscess or blockage in their colon or small intestine from the scarring that took place during the episode.
Physicians will suggest a variety of treatments based on the severity of patient’s diverticulitis.
Surgery may be required if patient has a complication (abscess, fistula formation, bowel obstruction), has had multiple episodes of uncomplicated diverticulitis, or may be immune compromised.
Follow up care may be suggested such as colonoscopy to rule out colon cancer or other digestive issues[4]. Diverticulitis is typically diagnosed during an acute attack due to complaints of severe abdominal pain. A thorough physical examination that includes palpation of the abdomen for tenderness is necessary to rule out other conditions and rule in diverticulitis. Diverticula typically develop in older adults (over the age of 40) when naturally weak places in the colon give way under pressure.
It was thought that foods such as nuts and corn could cause diverticulitis, however recent research does not support this theory. The main system that is involved is the Gastrointestinal system because the lining of the intestines and colon develop pouches that can progressively get larger, bulge out, and cause a possibility of a rupture[5].
Uncomplicated diverticulitis typically is treated with bowel rest (or clear liquids), antibiotics, and pain control.
Patients who have diverticulitis with complications (25% of patients), other health conditions, or have had multiple attacks (one-third of patients) may require surgery.
Emergency surgery is necessary within 48 hours for patients who have a ruptured intestine, peritonitis, or severe symptoms.[6] Hospitalization is suggested for patients with radiographic abnormalities, fever, and leukocytosis.

As a physical therapist, the optimal goal is to help a patient return moving in a functional way.
Exercise can be seen as a protective mechanism because it is promoting movement to the body, but also the different systems that could be affected from a sedentary lifestyle[2].
A common area of pain is the left lower quadrant, including referred pain to low back or thigh from an abscess[7]. Gastrointestinal disorders, such as inflammatory bowel disease, constipation, appendicitis or a hernia can cause the abdominal pain[2]. Genitourinary problems, such as inflamed prostate or urinary tract infection are possible[7]. Gynecological problems, including ectopic pregnancy, miscarriage, hemorrhage, ovarian cyst, or malignancy are other possible problems[7]. An abscess in the abdominal wall or psoas can all be a possible diagnosis when presenting with similar symptoms as diverticulitis[7]. Ehlers-Danlos, Marfan Syndrome, and Scleroderma are all connective tissue disorders that are shown to be similar to diverticulitis[2]. Diverticulitis can also be a genetic disorder where there can be a defect in the intestine wall[4].
Learn about the shoulder in this month's Physiopedia Plus learn topic with 5 chapters from textbooks such as Magee's Orthopedic Physical Assessment, 2014 & Donatelli's Physical therapy of the shoulder 2012.
Nusrat Nisar Department of Obstetrics & Gynaecology Liaquat University of Medical & Health Sciences, Jamshoro. Manchester repair; Involves partial amputation of cervix & approximation of cardinal ligaments. Genital(utero-vaginal )prolapse is extremely common, with an estimated 11% of women undergoing at least one operation for this condition. Background The pelvis encloses organs that primarily function in storage, distension and evacuation. Department of Obstetrics and Gynecology with course Perinatology Peoples’ Friendship University. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology ??????? ???? ????? – ???? ????? ??????? ?? ????? ??? ?? ?????. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!! Possible complications include perforation of bowels, abscess formation, fistula formation, obstruction, and bleeding.
Diverticulitis is more common in males, younger than 50 years old, but is seen more frequently in women in older age groups.[2] Diverticulitis is increasing in incidence in westernized countries.
Although many of the patients have the same side effects, they are usually experienced at different intensities and at various times.
Increasing the amount of exercise that is done each day has shown less of a risk for being diagnosed with diverticulitis. Fistula, an abnormal connection between two body parts, can also form between the colon and bladder or vagina, leading to a medical emergency[4]. Antibiotic treatment may be given on outpatient basis for 7-10 days for patients with stable vitals, absence of fever, and no significant results on CT or laboratory values.

Being active helps decrease the chances of developing diverticulitis because movement helps promote proper bowel movement. Depending on the symptoms that the patients present with, it is up to the therapist to do appropriate screening or testing to identify what is involved and what is causing the issues. For example, the obturator test, manual muscle testing and palpation of the illiopsoas,or McBurney’s point palpation can be done to look at positive or negative testing of referred pain to the thigh[2][7]. Left Lower-Quadrant Pain: Guidelines from the American College of Radiology Appropriateness Criteria. American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. 3 rd degree: Descent out side the introitus also known as procidentia & usually accompanied by cystourethrocele & Rectocele. Support to the Uterus- ? Pubo-cervical ligament: The pubocervical ligament is a ligament connecting the side of. Another medical emergency is if a person gets peritonitis, which occurs when contents of the intestine get into the abdomen from a ruptured inflamed pouch. Therapists can help patients with proper exercise, strengthening, and positioning to help them get the best and safest movement possible. Enterocele; Anterior & posterior repair & peritoneal sac containing the small bowel should be excised. It has been shown that diets high and fiber, however, do not protect people from the disease.
Certain medications, such as NSAIDS, steroids, and opiates put a person more at risk for developing this problem[4]. Patients with diverticulitis must be cautious about doing activities that increase the pressure on their abdomen so further herniation does not happen[2]. Patients have a higher risk of developing diverticulitis if they are on chronic steroids and immunosuppressants. When looking at diet, if people do not get enough fiber, this could lead to decreased bowel movements, causing constipation.[4].
The disorder is most common in people over the age of 60, although the average age of incidence has been decreasing. Younger individuals typically have more aggressive forms of diverticulitis and may require surgery after an initial episode.
Approximatley one-third of individuals will have another acute bout after an inital episode of diverticulits.

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