Myoma *

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Myoma *

  1. 1. Myoma ( Uterine fibroids) Done by :- Hamad Emad Thuhayr Supervisor by :- Dr. mamoon 2st BGM SOEPLE 2
  2. 2. Contents  SOEPEL  Anatomy  Introduction of Uterine fibroids  Signs and symptoms  Pathophysiology  Diagnosis and investigations  Treatment  References
  3. 3. SOEPEL  Subject : Ibtisam is 27 years old, from Unaizah , married for 4 months, not have children but she is pregnant for 11 weeks and Housewife. She has fever and 4 times vomiting in one day duration 3 days. low level of education. VITAL SIGNS: BP 92/5979 P 110 RR 14 normal T 38.1 C normal
  4. 4. SOEPEL Object: General examination & Abdominal examination Evaluation (DD): UTI, tonsillitis, sinusitis Plan: Hematology ;- Cbc,. Radiology ;- USG uterus. Elaboration: antibiotic. Learning goals: tonsillitis
  5. 5. Anatomy The uterus
  6. 6. INTRODUCTION  Definition.  A uterine myoma is a benign growth of smooth muscle in the wall of the uterus.  A uterine myoma is a solid tumor made of fibrous tissue, hence it is often called a 'fibroid' tumor.  most often slow-growing and usually cause no symptoms.  Myomas are the most frequently diagnosed tumor of the female pelvis and the most common reason for a woman to have a hysterectomy. Although they are often referred to as tumors, they are not cancerous.  They are the most common pelvic tumors.It is found in 25% of white women & 50% of black women.
  7. 7. Risk factor • Parity • More common in nulliparous and low parity women • Hereditary • More common in women with positive family history (mother and sister) • Obesity • • More common in obese women Conversion of circulating androgens to estrone (E1) by excess adipose tissue. • Early Menarche • Late menopause • Use of synthetic oestrogens such as Tamoxifen in treatment for CA breast
  8. 8. Classification • • • • • • • • Submucous leiomyoma Pedunculated submucous Intramural or interstitial Subserous or subperitoneal Pedunculated abdominal Parasitic Intraligmentary Cervical
  9. 9. Clinical features myoma may cause no signs or symptoms. Symptomatic in only 35-50% of Pt Symptoms depend on location, size, changes & pregnancy status • Heavy and prolonged bleeding. • Pelvic pain or pressure. • Weight gain or an abnormally enlarged abdomen. • Pressure on the bladder or bowel. • Pain in the back of the legs. • Pain during sexual intercourse.
  10. 10. Diagnosis and investigations  EXAMINTION • Most myoma are discovered on routine bimanual pelvic exam or abdominal examination • Retroflexed retroverted uterus  obscure the palpation of myomas .  LABORATORY FINDINGS • Anemia • Depletion of iron reserve • Rarely erythrocytosis pressure on the ureters back pressure on the kidneys  erythropoietin • Acute degeneration & infection  ESR, leucocytosis, & fever
  11. 11. Cont…..  IMAGING • Pelvic U/S is very helpful in confirming the Dx & excluding pregnancy / Particularly in • • • • obese Pt Saline hysterosonography can identify submucous myoma that may be missed on U/S HSG  will show intrauterine leiomyoma MRI  highly accurate in delineating the size, location & no. of myomas , but not always necessary IVP  will show ureteral dilatation or deviation & urinary anomalies HYSTROSCOPY  for identification & removal of submucous myomas
  12. 12. Treatment modalities • Nonsurgical treatment: • NSAIDs • Inhibit prostaglandin synthesis • Reduce menstrual flow (25-35%) • Relieve dysmenorrhea • Progestogens • Given for 21 days • Significant reduction in menstrual blood loss
  13. 13. • Danazol • Synthetic steroid  suppress estrogen and progesterone receptor in endometrium  thinning of lining of endometrium  reduction of blood loss • Disadvantage: masculinizing effect
  14. 14. • Tranexamic acid • • • • Antifibrinolytic agent Synthetic derivative of amino acid lysine Reversible blockage on plasminogen 50% reduction of menstrual blood loss • Levonorgestrel intrauterine system • Reduces blood loss by 80% • Not applicable to all type of fibroid
  15. 15. • GnRH agonist • Induce a reversible hypoestrogenic state • Reduce uterine volume • Pre-operative use • 3-4 months course prior surgery • Reduce fibroid size and uterine volume • Midline vertical laparotomy incision  lower transverse abdominal incision • Improve pre-operative haemoglobin level • Reduce perioperative blood loss and transfusion requirement
  16. 16. Cont…. • Surgery: 1. Myomectomy • • • • 2. 3. • Abdominal myomectomy Vaginal myomectomy Hysteroscopic myomectomy Laparoscopic myomectomy Hysterectomy Uterine artery embolization
  17. 17. Refferences • • • • Oxford Handbook of Clinical Medicine www.wikipedia.org www.emedicinehealth.com CECIL , GOLDMAN 26 EDETION.

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