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Myoma uteri presentation

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Myoma uteri presentation

  1. 1. CASE PRESENTATION 6
  2. 2. CASECase 48 10 2555 30 90%
  3. 3. CHIEF COMPLAINT 5 PTA
  4. 4. PRESSENT ILLNESS5 PTA 3 5 8 6-72 PTA DMPA
  5. 5. PRESSENT ILLNESS
  6. 6. PAST HISTORYU/D Thyroid 6 PTAP3003 last 20LMP 4-8 55 (5 days/28-30 days/ 3pads per day)PMP
  7. 7. FAMILY HISTORY
  8. 8. PERSONAL HISTORY
  9. 9. PHYSICAL EXAMINATIONVital signs  BP 110/50 mmHg PR 72 /min  RR 18 /min BT 37 cGA  Good consciousness, mild pale, no jaundice, no cyanosis, no edemaHEENT  Mile pale conjunctivae, no icteric scleraeCardiovascular  Pulse full and regular, normal S1S2, no murmur
  10. 10. PHYSICAL EXAMINATIONLung  Equal chest expansion, clear, no adventitous soundAbdomen  No distention, Normoactive bowel sound, soft,, palpable midline pelvic mass size 2/3> PS, globular shape, irregular surface, rubbery, not tender, movable no rebound tendernessNeurological  Grossly intactExtremities  No edema, no fracture
  11. 11. PHYSICAL EXAMINATIONPer vagina examination :  MIUB - Normal  Vg - No discharge, no lesion  Cx - No mass and polyps, closed  Ut - 16 wk. size with globular mass at fundus  Adn - No palpable mass, no tenderness  CDS - No bulging
  12. 12. PERTINENT FINDINGAn middle aged Thai woman 48 yearsPerimenopausal periodAbnormal uterine bleedingAbdominal massAnemic symptomsUnderlying Thyroid disease (Clinical Euthyroid) s/p Surgery 6 years PTA
  13. 13. PROBLEM LIST Abdominal mass with Abnormal uterine bleeding and anemic symptoms Underlying Thyroid disease Clinical euthyroid s/p Surgery 6 years PTA
  14. 14. APPROACH AUB
  15. 15. APPROACH AUB
  16. 16. Causes of menorrhagia
  17. 17. DIFFERENTIAL DIAGNOSISUterus mass (leiomyoma vs leiomyosarcoma)AdenomyosisOvarian tumorEndometrium diseaseCervical cancerSystemic conditions  Hypothyroid  Coagulopathies
  18. 18. INVESTIGATIONCBC  Hb 10.0 g/dl WBC 6,500 /ul  HCT 29.0 % PMN 58.0 %  MCV 55.0 fl Lymp 39.0 %  MCH 19. pg Mono 1.0 %  MCHC 35.1 g/dl Eo 2.0 %  Plt 208,000 /ul Baso 0 %
  19. 19. INVESTIGATIONPBS  RBC Morphology Abnormal RBC  Microcytic 1+  Hypochromic 1+  Target cell, schitocyte FewThyroid function test  FT3 2.245 (1.21-4.18) mmol/l  FT4 14.25 (7.2-17.2) mmol/l
  20. 20. INVESTIGATION UA  Color/Appearance Y/C  pH 7  Ketone Neg  Protein Neg  Nitrite Neg  Glucose Norm  WBC 0-1  RBC 0-1  Sq.epithelium 10-20  Bacteria -
  21. 21. INVESTIGATION Coagulogram normal BS 86 mg/dl BUN 10 mg/dl Creatinine 0.7 mg/dl Anti-HIV negative CXR normal EKG normal sinus rhythm, rate 70/min
  22. 22. INVESTIGATIONPAP smear Negative for intraepithelial lesion or malignancy but reactive cellular change associate with inflammationEndometrium Biopsy Inactive endometrium
  23. 23. INVESTIGATIONUltrasound-
  24. 24. TREATMENT (11/12/2555) Total abdominal hysterectomy with bilateral salpingooophorectomy  Uterus 16 wk size with large intramural myoma at fundus 8x8 cm. and intramural myoma 4x4 cm. at anterior of body of uterus  Both normal  Normal liver and spleen  Normal omentum  No immediate comlication  Estimate blood loss 800 ml.
  25. 25. TREATMENT (11/12/2555)
  26. 26. PROGRESS NOTE (12/12/2555) S: Hct 35 vol% O: V/S BP 100/40 mmHg RR 18 /min PR 90/min BT 36.5 c Abd soft, normoactive bowel sound, no tenderness, no active bleeding A+P :  Multiple myoma with hypermenorrhea S/P TAH c BSO day 1 : clinical stable  Step diet  Off IV+Foley  Pain control
  27. 27. PROGRESS NOTE (13/12/2555) S: O: v/s BP 100/50 mmHg RR 18 /min PR 72/min BT 36.8 c Abd soft, normoactive bowel sound, no tenderness, no active bleeding A+P :  Multiple myoma with hypermenorrhea S/P TAH c BSO day 2 : clinical stable  Observe bleeding  Pain control  Plan discharge

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