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Samenvatting Gynaecologie en urologie theorie SV
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Bekkenbodem re-educatie bij kind, vrouwen man
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1. Voorkomen van bekkenbodemdysfunctie: incontinentie ............................................................... 7
1.1 Incontinentie (ICS) ................................................................................................................... 7
1.1.1 Vrouw .............................................................................................................................. 7
1.1.2 Man.................................................................................................................................. 8
2. Anatomie van blaas en urethra ....................................................................................................... 8
2.1 Hogere urinewegen / nieren ................................................................................................... 9
2.2 Urethers................................................................................................................................. 10
2.3 Blaas ...................................................................................................................................... 12
2.3.1 Blaashals ........................................................................................................................ 13
2.3.2 Blaaswand...................................................................................................................... 13
2.4 Urethra .................................................................................................................................. 13
3. Anatomie en functie van bekkenbodemspieren ........................................................................... 15
3.1Inleiding ........................................................................................................................................ 15
3.2 Spieren oppervlakkig plan ..................................................................................................... 17
3.3 Spieren middenplan: diafragma urogenitale ........................................................................ 23
3.4 Spieren diepe plan: diafragma pelvis .................................................................................... 24
4. Fysiologie van de lagere urine wegen ........................................................................................... 28
4.1 Normale mictie ...................................................................................................................... 28
4.2 Pollakisurie ............................................................................................................................ 29
4.3 Zeldzame mictie .................................................................................................................... 29
4.4 Mictie ’s nachts...................................................................................................................... 29
4.5 Nycturie ................................................................................................................................. 29
5. Urine-incontinentie: vormen, oorzaken en gevolgen ................................................................... 31
5.1 Symptoomgerichte indeling .................................................................................................. 31
5.1.1 Stressincontinentie ........................................................................................................ 31
5.1.2 Urge incontinentie (OAB = overactieve blaas) .............................................................. 36
5.1.3 Overloop incontinentie ................................................................................................. 37
5.1.4 Incontinentie door extra-urethale oorzaken ................................................................. 37
5.1.5 Incontinentie door hyperreflexie .................................................................................. 37
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, 5.2 Gevolgen van incontinentie .................................................................................................. 38
5.3 Functionele indeling UI.......................................................................................................... 38
5.3.1 Reservoirstroornissen.................................................................................................... 38
5.3.2 Ledigingsstoornissen ..................................................................................................... 38
6. Diagnose arts ................................................................................................................................. 39
6.1 Anamnese .............................................................................................................................. 39
6.2 Klinisch onderzoek................................................................................................................. 39
6.2.1 Man................................................................................................................................ 39
6.2.2. Vrouwen ........................................................................................................................ 40
6.3 Onderzoeken ......................................................................................................................... 40
7. Specifieke onderzoeken ................................................................................................................ 41
7.1 Voorgeschiedenis, toestand .................................................................................................. 41
7.2 Cytoscopie ............................................................................................................................. 41
7.3 Uroflowmetrie ....................................................................................................................... 41
7.4 Urodynamisch onderzoek ..................................................................................................... 43
7.4.1 Parameters .................................................................................................................... 46
7.5 Echografie .............................................................................................................................. 46
8. Behandeling van incontinentie...................................................................................................... 47
8.1 Chirurgische behandeling ...................................................................................................... 47
8.1.1 Behandeling reservoirstoornissen ................................................................................. 47
8.1.2 Behandeling ledigingsstroonissen ................................................................................. 48
8.2 Neuromodulatie .................................................................................................................... 52
8.3 Medicamenteuze behandeling .............................................................................................. 52
8.3.1 Verbeteren reseroirfunctie............................................................................................ 52
8.3.2 Verbeteren ledigingsfunctie .......................................................................................... 52
8.4 Incontinentiematerialen........................................................................................................ 53
8.4.1 Opvangmaterialen ......................................................................................................... 53
8.5 Bekkenbodemreëducatie ...................................................................................................... 53
8.6 Levensstijl interventie ........................................................................................................... 53
8.6.1 Algemene maatregelen ................................................................................................. 53
9. Invloed blaas/darm........................................................................................................................ 56
9.1 Achtergrond........................................................................................................................... 56
9.1.1 Anatomie ....................................................................................................................... 56
9.1.2 Functioneel .................................................................................................................... 56
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, 9.2 Klinische impact..................................................................................................................... 57
9.2.1 Gecombineerde pathologie ........................................................................................... 57
9.2.2 Quality of life ................................................................................................................. 57
9.3 Medicatie ............................................................................................................................... 57
9.4 Oorzaken/risicofactoren van gemeenschappelijke problemen darm en blaas .................... 57
1. Inleiding ......................................................................................................................................... 58
1.1 Behandeling en preventie ..................................................................................................... 59
2. Informatief gesprek ....................................................................................................................... 59
2.1 Voorlichting patiënt............................................................................................................... 60
3. Klinisch functioneel onderzoek ..................................................................................................... 60
3.1 Anatomie evaluatie ............................................................................................................... 60
3.2 Evaluatie kracht, uithouding, uitputbaarheid ....................................................................... 61
3.2.1 Kracht ............................................................................................................................ 61
3.2.2 Uithouding ..................................................................................................................... 61
3.2.3 Uitputbaarheid .............................................................................................................. 61
3.3 Beoordeling van tonus van BB-spier ..................................................................................... 62
3.4 Vaginale prolaps .................................................................................................................... 62
4. Evaluatie urine verlies ................................................................................................................... 65
5. Functionele controle sfincter ........................................................................................................ 66
6. Dagboek of plaskalender ............................................................................................................... 66
6.1 Nuttige gegevens ................................................................................................................... 66
6.2 Verschillende items noteren ................................................................................................. 66
6.3 Voordelen .............................................................................................................................. 67
6.4 Nadelen ................................................................................................................................. 67
6.5 Opmerkingen ......................................................................................................................... 67
7. Blaastraining .................................................................................................................................. 68
7.1 Alleen dmv plaskalender ....................................................................................................... 68
7.2 Gevoel van aandrang te verminderen: BB-spieroefeningen ................................................. 68
7.3 Conclusie ............................................................................................................................... 69
8. Biofeedback: hulpmiddel voor bekkenbodemcontractie of – ontspanning.................................. 70
8.1 Auditieve feedback ................................................................................................................ 70
8.2 Visuele feedback.................................................................................................................... 70
8.3 Sensitieve feedback ............................................................................................................... 71
8.4 Besluit .................................................................................................................................... 72
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, 9. Elektrostimulatie ........................................................................................................................... 72
9.1 Effecten ................................................................................................................................. 72
10. Resultaten.................................................................................................................................. 73
1. Obstetrische anatomie .................................................................................................................. 75
1.1 Baringskanaal ........................................................................................................................ 75
1.1.1 Beendering baringskanaal ............................................................................................. 75
1.1.2 Weke baringskanaal ...................................................................................................... 76
1.1.3 Besluit ............................................................................................................................ 77
2. Zwangerschap: graviditeit (prenatale stadium) ............................................................................ 77
2.1 Zwangerschap testing............................................................................................................ 78
2.2 Duur van de zwangerschap ................................................................................................... 78
2.3 Miskraam ............................................................................................................................... 79
2.4 Ontwikkeling van foetus (niet kennen voor examen) ........................................................... 79
2.5 Fysiologische veranderingen bij de moeder.......................................................................... 81
2.5.1 Uterus ............................................................................................................................ 81
2.5.2 Gewichtstoename ......................................................................................................... 82
2.5.3 Houdingsveranderingen ................................................................................................ 83
2.5.4 Cardiovasculaire systeem .............................................................................................. 84
2.5.5 Nierfunctie ..................................................................................................................... 85
2.5.6 Spijsvertering ................................................................................................................. 85
2.5.7 De ademhaling............................................................................................................... 87
2.5.8 De huid .......................................................................................................................... 88
2.5.9 Venen............................................................................................................................. 89
2.5.10 Diastasis recti................................................................................................................. 89
2.5.11 Voorbereiding op lactatie ............................................................................................ 100
2.5.12 Psychische veranderingen ........................................................................................... 101
2.6 (Contra-) Indicaties tijdens de zwangerschap ..................................................................... 102
2.6.1 Voeding........................................................................................................................ 102
2.6.2 Sporten tijdens zwangerschap .................................................................................... 105
2.6.3 Contra-indicaties ......................................................................................................... 107
2.7 Pathologische situaties moeder .......................................................................................... 108
2.7.1 Hyperemesis gravidarum............................................................................................. 108
2.7.2 Zwangerschapshypertensie ......................................................................................... 109
2.7.3 Diabetes Gravidarum................................................................................................... 110
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