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Uterine fibroids

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Uterine fibroids

  1. 1. UTERINE FIBROIDS
  2. 2. DEFINITION • Uterine fibroid is a leiomyoma (benign (non- cancerous) tumor from smooth muscle tissue) that originates from the smooth muscle layer (myometrium) of the uterus
  3. 3. CAUSES • unknown. • Family history • Genetic alterations. • Hormones. • Other chemicals.
  4. 4. RISK FACTORS • Heredity. • Race. • Pregnancy and childbirth. • Nulliparity Obesity • Oral contraceptives.
  5. 5. TYPES • BODY OR CORPOREAL FIBROIDS • Intramural or interstitial fibroids • Subserosal fibroids • Submucosal fibroids
  6. 6. • CERVICAL FIBROIDS 1-2 %
  7. 7. SECONDARY CHANGES IN FIBROID • Degenerative changes • Hyaline degeneration: • Cystic degeneration: • Calcification: • Fatty degeneration: • Red degeneration: • Septic degeneration:
  8. 8. • Infection • Atropy • Necrosis • Vascular changes • Sarcomatous changes
  9. 9. CLINICAL FEATURES • 75 % remains asymptomatic • Menustrual abnormalities – Menorrhagia (30%) – Metrorrhagia or irregular bleeding
  10. 10. • Dysmenorrhea • Infertility(30%): • Pain lower abdomen • Abdominal swelling (lump) • Pressure symptoms
  11. 11. • Abdominal examination • Feel is firm more towards hard may be cystic in cystic degeneration. • Margins are well defined except the lower pole. • nodular may be uniformly enlarged • Mobility is restricted from above downwards but can be moved from side to side. • Percussion : swelling is dull
  12. 12. • Pelvic examination • Bimanual examination reveals uterus irregularly enlarged • Uterus is not felt separated from the swelling and as such a groove is not felt between the uterus and the mass. • The cervix moves with the movement of the tumour felt per abdomen.
  13. 13. DIAGNOSIS • An abdominal, transvaginal or pelvic ultrasound • An endometrial biopsy • A hysteroscopy • Hysterosalpingography • Laparoscopy
  14. 14. TREATMENT • For symptomatic fibroids • Medication to control symptoms • Medication aimed at shrinking tumours • Ultrasound fibroid destruction • surgically aided methods to reduce blood supply of fibroids • Myomectomy or radio frequency ablation • Hysterectomy • Treatment for infection and anemia • Embolization
  15. 15. Medications • Oral contraceptive pills • GnRH agonists • The antihormonal drug RU-486 (mifepristone) • Danazol (Danocrine) • Antifibrinolytics (tranexamic acid) • Nonsteroidal anti-inflammatory agents • Progesterone receptor modulator named Ellaone
  16. 16. SURGERY • Myomectomy • Hysterectomy
  17. 17. • Uterine artery embolization, • Uterine artery ligation • Radio frequency ablation • Endometrial ablation
  18. 18. COMPLICATIONS • Menorrhagia. • Abdominal pains • Premature birth, labor problems, miscarriages • Infertility
  19. 19. • Leiomyosarcoma • Twisting of the fibroid • Anemia • Urinary tract infections • A c-section may be needed • Some pregnant women with fibroids have heavy bleeding immediately after giving birth.
  20. 20. NURSING DIAGNOSIS • Acute pain related to post operative wound as manifested by facial expression and pain scale score • Imbalanced nutrition less than body requirements related to pain as manifested by decreased food intake.
  21. 21. • Impaired bowel elimination , constipation related to decreased activity, pain on straining • Disturbed sleep pattern related to pain and hospitalization • Risk for infection related to the surgery • Low Self-Esteem related to changes in femininity as evidenced by Withdrawal, depression

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