Benign growths in the uterus that can develop during a woman's childbearing years.Highest incidence was seen in Pakistani women 78%, then rural Indian women 37.65%, urban India 24% and Nigerian women 30%. Arobosoba from Nigeria has reported prevalence of uterine fibroids in black women was more (26%), in comparison to Caucasian women (17.9%).
Retroversion is the term used when the long axis of the Corpus or body and cervix are inline and the whole organs backwards in relation to the long axis of birth canal.
Retroflexion signifies bending backwards of the Corpus on the cervix at the level of internal OS.
These two conditions are usually present together and are loosely called retroversion or retro displacement.
It is discussed in briefly.
Retroversion is the term used when the long axis of the Corpus or body and cervix are inline and the whole organs backwards in relation to the long axis of birth canal.
Retroflexion signifies bending backwards of the Corpus on the cervix at the level of internal OS.
These two conditions are usually present together and are loosely called retroversion or retro displacement.
It is discussed in briefly.
Endometritis is caused by an infection in the uterus. It can be due to chlamydia, gonorrhea, tuberculosis, or a mix of normal vaginal bacteria. It is more likely to occur after miscarriage or childbirth. It is also more common after a long labor or C-section.
Endometritis is caused by an infection in the uterus. It can be due to chlamydia, gonorrhea, tuberculosis, or a mix of normal vaginal bacteria. It is more likely to occur after miscarriage or childbirth. It is also more common after a long labor or C-section.
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
Peri operative nursing is a nursing specialty that works with patients who are having injuries, invasive procedures. Peri-operative nurses work closely with surgeons, anesthesiologists, nurse anesthetist, surgical technologists, and nurse practitioners. They perform preoperative, intraoperative, post operative care primarily in the operating theater. The nurse assesses the patient data; establishing nursing diagnosis; identifies desired patient outcome; develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient
All aspects of peri operative care is described.
-preoperative care
-postoperative care
Role of nurse in pre operative nursing:
1.Pre operative assessment.
2.Obtaining informed consent.
3.Pre operative teaching.
4.Physical preparation of patients.
5.Psychological preparation
6.Informed Consent
POST OPERATIVE CARE: Post operative phase begins when the client is admitted to the post operative unit and ends with the client’s post operative evaluation in the physician’s office.
GOAL:
Restore homeostasis and prevent complication.
Maintain adequate cardio vascular and tissue perfusion
Maintain adequate respiratory function
Maintain adequate nutrition and elimination
Maintain adequate fluid electrolyte balance
Maintain adequate renal function
Promote adequate rest, comfort, and safety
Promote adequate wound healing
Promote and maintain activity and mobility
Provide adequate psychological support.
TRANSFER FROM OPERATION ROOM:
After sending the patient to operating room, prepare a bed to receive the patient undergone surgery.
Receive the patient without disturbing the devices attached to the patient.
Assessment A- Airway, B- Breathing, C- Circulation, C- Consciousness, S- Safety, D- Dressing, D- Drainage, D- Drugs , E- Elimination F- Foods, F- Fluids P- Pain.
Ask the theater staff about any complications during surgery.
Check vital signs.
Check the operation site for bleeding, discharge, etc. if drainage tube are filled.
Keep the patient well covered to prevent draught
Never leave the patient alone to prevent injury from fall
Observe the patient for swallowing reflexes
Quickly observe the functioning of all devices and make sure that they are in its functioning order.
Check the doctor’s order for other instruction and treatment.
POST OPERATIVE COMPLICATIONS:
Haematological: Hemorrhage
Respiratory: Atelectesis, Pneumonia, Pulmonary Embolism
Cardiovascular: Hypertension, cardiac dysrhythmias, venous thrombosis
Urinary: Urinary retention
Gastrointestinal: Constipation
Neurological: CVA/Stroke
Immunological: Infection
Wound healing: infection
Psychological: Body image problrms
POST OPERATIVE NURSING CARE:
Maintaining Respiratory function:
i.Encourage diaphragmatic breathing exercise at least every two hours while clients are awake
ii.Instruct to use incentive spirometers for maximum inspiration
iii.Encourage early ambulation
iv.Change position every one two hours.
Introduction
The sleep – wakefulness cycle is genetically determined rather than learned and is established sometime after birth.Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity and [inhibition of nearly all voluntary muscle during REM sleep] reduced interactions with surroundings.
Sleep can be regarded as a physiological reversible reduction of conscious awareness. Nearly one third of human life is spent in sleep. Disorders of sleep can affect activities of daily living (ADL) of an individual.
Definition
It is an easily reversible state of relative unresponsiveness and serenity which occurs more or less regularly and repetitively each day.
The EEG recordings show typical features of sleep which is broadly divided into two broadly different phases:
1. D-sleep (desynchronised or dreaming sleep), also called as REM- sleep (rapid eye movement sleep),active sleep, or paradoxical sleep.
2. S-sleep (synchronised sleep), also called as NREM-sleep (non-REM sleep), quiet sleep, or orthodox sleep. S-sleep or NREM-sleep is further divided into four stages, ranging from stages 1 to 4. As the person falls asleep, the person fifi rst passes through these stages of NREM-sleep.
Stages of sleep
The EEG recording during the waking state shows alpha waves of 8-12 cycles/sec. frequency. The onset of sleep is characterised by a disappearance of the alpha-activity.
Stage 1, NREM-sleep is the first and the ligh test stage of sleep characterised by an absence of alphawaves, and low voltage, predominantly theta activity.
Stage 2, NREM-sleep follows the stage 1 within a few minutes and is characterised by two typical EEG changes:
i. Sleep spindles: Regular spindle shaped waves of 13-15 cycles/sec. frequency, lasting 0.5-2.0
seconds, with a charac teristic waxing and waning amplitude.
ii. K-complexes: High voltage spikes present intermittently.
Stage 3, NREM-sleep shows appearance of high voltage, 75 μV, δ-waves of 0.5-3.0 cycles/sec.
Stage 4, NREM-sleep shows predominant δ-activity in EEG. NREM-sleep is followed by REM-sleep, which is a light phase of sleep. The EEG is characterised by a return of α-waves (α-wave sleep); other changes are similar to stage 1 NREM-sleep. One of the most characteristic features of the REM-sleep is presence of REM or rapid (conjugate) eye move ments. The other features include generalised mus cular atony, penile erection, autonomic hyperactivity (increase in pulse rate, respiratory rate and blood pressure), and movements of small muscle groups, occurring intermittently. Although it is a light stage of sleep, arousal is diffificult. These stages occur regularly throughout the whole duration of sleep. The first REM period occurs typically after 90 minutes of the onset of sleep, although it can start as early as 7 minutes after going off to sleep, e.g. in narcolepsy, in major depression, and after sleep deprivation.
Legal issues related to nursing is of significant importance in regulation of profession as well as promotion of nursing practice.
All related aspects are briefly discussed in a nutshell according to INC syllabus of M.Sc. Nursing
An overhead projector (OHP), like a film or slide projector, uses light to project an enlarged image on a screen, allowing the view of a small document or picture to be shared with a large audience.
In the overhead projector, the source of the image is a page-sized sheet of transparent plastic film (also known as "foils" or "transparencies") with the image to be projected either printed or hand-written/drawn. These are placed on the glass platen of the projector, which has a light source below it and a projecting mirror and lens assembly above it (hence, "overhead"). They were widely used in education and business before the advent of video projectors.
Problem based learning, A teaching strategySusmita Halder
Problem Based Learning or PBL is a self directed process of learning which enables students to learn from real life experiences and enhances their problem solving skills under guidance of teacher as the facilitator.
Bibliography-
• Kaur Sodhi Jaspreet, Comprehensive Textbook of Nursing Education, 1st ed. New Delhi, India :Jaypee Brothers Medical Publishers (P) Ltd.; 2017, Page No.- 70
• R Promila, Nursing Communication and Educational Technology, 1st ed. New Delhi, India :Jaypee Brothers Medical Publishers (P) Ltd.; 2010, Page No.- 270
• Suresh S. Communication and educational technology in nursing. 2nd ed. New Delhi, India: Elsevier; 2016., Page No.- 272-276
Breast self examination is discussed with brief outline-
Definition
Advantages
Barriers
Recommendations
Identification of clients at risk
Physical assessment
Steps
Points to be remembered
Brief description of urine Testing procedure includes
Definition
Purpose
Articles required
Steps of testing of urine test for sugar and albumin
Findings
Termination
Group Therapy is a form of psychotherapy given to group of carefully selected people under supervision of professional therapist to fulfill a common therapeutic objective. It is briefly discussed in this session
Play therapy is a form of psychotherapy used in children in order to explore their mind as well as to diagnose and treat issues related to developmental crisis and any disorders.
Several types of play therapies are available which are administered under guidance of a professional play therapist according to individualized need of children .
A brief outline is discussed over here.
Temperature is the balance between the heat production and heat loss.
A brief outline of diffrent aspects regarding body temperature is discussed here under following headings
*Normal body temperature regulation
*Fever of unknown origin
*Hyperthermia
*Hypothermia
*Frost bite
Introduction
Recreation is a form of activity therapy used in most psychiatric settings
Definition
Recreation is a form of psychotherapy which is a planned therapeutic activity that enables people with limitations to engage in recreational experiences
Aim
• To encourage social tendencies
• To decrease withdrawal tendencies
• To promote Socially acceptable behavior
• To encourage a feeling of confidence and feeling of self worth
• To develop skill feelings and abilities
Points to be kept in mind
• Provide a non threatening and non demanding environment
• Provide activities better relaxing and without rigid guidelines and timeframes
• Provide activities that are enjoyable and sell satisfying
Types of recreational activities
Motor:
Fundamentals: Hocky, Football
Accessory: play and dancing
Sensory
Visual- motion picture
Auditory- song
Intellectual
Reading debate quiz etc
Recreational activities for psychiatric disorders
Anxiety- aerobic activity like walking jogging etc
Depressive- non competitive sports which provides outlet for anger searches walking jogging
Manic- one to one basis individual games such as Badminton, balls etc
Paranoid schizophrenia- puzzle concentrate activities, cheese etc
Catatonic schizophrenia- dancing social activities to keep contact with reality athletics
Dementia- concentration replication craft and concrete craft that breed Familiarization and comfort
Childhood and adolescence disorder- one to one basis and giving a feeling of importance playing story telling painting etc
Adolescence play in groups therefore team play like sports games outdoor games which provides gross motor activities are indicated for them
Mental retardation- activities should be according to clients level of functioning such as walking dancing swimming ball playing etc
Role of nurse in recreational therapy
• Encourage the patient to communicate and express his feelings
• Nurse must provide a non-threatening and non-demanding environment where client can express inner feelings in a non-judgmental manner
• Nurse must provide activities which are relaxing and without any reason guidelines also she should keep in mind whether this therapy is appropriate for the client or not
• She must frequently observed client’s behaviour throughout the session
• Provide incentives for work
• allowed them to express their feelings so that development of skills and talents and abilities can be understood
• She must provide guidelines which are enjoying as well as self-satisfying
Definition:
individual psychotherapy is a method of bringing about change in a person by
exploring his or her feelings attitude thinking and behaviour.
Therapy is conducted on a one-to-one basis such as the therapies treats one patient at a time. Patients generally seek this kind of therapy based on their desire.
Such therapy helps to-
• Understand themselves and their behaviour
• Make personal changes
• Improve interpersonal relationships
• Get relief from emotional pain or unhappiness.
Indications:
• Stress related disorders
• Alcohol and drug dependence
• Sexual disorders
• Marital disharmony
Approaches
There are four main approaches to individual therapy which include
1. Psychodynamic therapy is primary key based on psychoanalytic theory, shamshan that when a patient has insight into early relationships and experiences as the source of his or her problems they can be resolved.
2. Humanistic therapy is on the patient’s view of the world and he is your heart problems. The goal is to help patients realise their full potential through the therapies genuineness unconditional positive regard which fosters the patient’s sense of self-worth and sympathetic understanding of patients point of view. Clarify his or her own feelings and choices.
3. Behaviour therapy does not foster awareness but emphasizes the principles of learning with positive or negative reinforcement and observational modelling
4. Cognitive therapy focuses on identifying and correcting distorted thinking patterns that can be to emotional distress and problem behaviours. Cognitive therapies believe that patients change their behaviour by changing their maladaptive thinking about themselves and their experiences. Patients are taught problem solving skills and stress reducing methods. The learning that their psychological difficulties or problems can be solved through cognitive processing.
Theory of Object Relations was given by, M. Mahler.
Margaret Schönberger Mahler (May 10, 1897 – October 2, 1985) was a Hungarian physician, who later became interested in psychiatry. She was a central figure on the world stage of psychoanalysis. Her main interest was in normal childhood development, but she spent much of her time with psychiatric children and how they arrive at the "self". Mahler developed the separation–individuation theory of child development.
She formulated the theory with Pine & Bergman on 1975.
➡️ Normal autistic phase – First few weeks of life. The infant is detached and self-absorbed. Spends most of his/her time sleeping.
➡️Normal symbiotic phase – Lasts until about 5 months of age. The child is now aware of his/her mother but there is not a sense of individuality. The infant and the mother are one, and there is a barrier between them and the rest of the world.
➡️Separation–individuation phase –
Separation refers to the development of limits, the differentiation between the infant and the mother, whereas individuation refers to the development of the infant's ego, sense of identity, and cognitive abilities.
Mahler explains how a child with the age of a few months breaks out of an "autistic shell" into the world with human connections. This process, labeled separation–individuation, is divided into subphases, each with its own onset, outcomes and risks. The following subphases proceed in this order but overlap considerably
Separation refers to the development of limits, the differentiation between the infant and the mother, whereas individuation refers to the development of the infant's ego, sense of identity, and cognitive abilities.
Mahler explains how a child with the age of a few months breaks out of an "autistic shell" into the world with human connections. This process, labeled separation–individuation, is divided into subphases
▶️Hatching / differentiation
▶️Practicing –
▶️Rapprochement-Rapprochement is divided into a few sub phases:
Beginning – Motivated by a desire to share discoveries with the mother.
Crisis – Between staying with the mother, being emotionally close and being more independent and exploring.
Solution – Individual solutions are enabled by the development of language and the superego.
Disruptions in the fundamental process of separation–individuation can result in a disturbance in the ability to maintain a reliable sense of individual identity in adulthood.
▶️Object constancy or Consolidation phase-
The Power Point Presentation was prepared for micro-teaching session. It gives a basic outline regarding preparation and use of posters.
The PPT is based on following points-
1. Definition
2. Parts
3. Rules to prepare posters
4. Uses
5. Advantages
6. Disadvantages
Bibliography:
Basavanthappa BT. Nursing Education. New Delhi, India: Jaypee Brothers Medical; 2009.
Neeraja KP. Textbook of nursing education. Jaypee Brothers Medical Publishers (P) Ltd.; 2003.
Suresh S. Communication and educational technology in nursing. 2nd ed. New Delhi, India: Elsevier; 2016.
Nervous system consists of highly complex structure co-ordinates and controls the body along with the endocrine system.
Here we discussed about some important outlines concerned of psychobiology which is coming under unit 2 of syllabus of clinical speciality - mental health nursing.
The key points are,
- The anatomic review
- Brain & limbic system
- Nerve tissue-> Neurons & Neuroglia, Synapses, Synaptic cleft
- Neurotransmitters
- Autonomic nervous system, - sympathetic and parasympathetic nervous system.
Apart from these, its relation with different psychiatric disorders are also explained in brief.
Health Care delivery system is the skeleton of meeting healthcare needs of enormous population of every country.
In order to have a clear view of community medicine, it is essential to know about different health care systems in order to fulfill learning objectives of students.
ECG or electrocardiography is the graphical representation of electrical impulses produced by the heart.
The electrical impulses form due to movement of ions in the myocardial cells representing depolarization and repolarization, denotes the conduction pathway of heart, which coincides with cardiac cycle. Apart from normal electrocardiography common arrhythmias are also discussed during this session.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. INTRODUCTION
Uterine fibroids are benign smooth muscle tumors
that occur within the uterus.
These are most common benign tumors of female
genital tract.
It is also known as uterine leiomyoma ,myoma or
fibromyoma.
3. INCIDENCE
• It has been estimated that at least 20% of women at the age of 30
have got fibroid in their wombs.
• Fortunately 50% of them remain asymptomatic.
• The incidence of symptomatic fibroid in the hospital outpatient is
about 3%
• A high incidence of 10% prevails in England. The incidence is even
higher in black women
4. TYPES OF OF UTERINE FIBROID
Uterine fibroids can be classified according to
anatomical location.
1. Corporal /body ( the fibroids are mostly located
in the body of the uterus and are usually
multiple)
2. Cervical ( The fibroids are mostly located in the
cervix of uterus. This can be supravaginal or
vaginal)
5. CORPOREAL FIBROIDS OF
UTERUS
1. Interstitial or intramural: (75%) : fibroidss are initially in intramural
position but subsequently some are pushed outwards or inwards.
2. Subperitoneal or subserous(15%) : In this condition the intramural
fibroid is pushed outwards towards the peritoneal cavity. The
fibroids are either personally or completely covered by
peritoneum.
6. • When it is completely covered by peritoneum it attains a pedicle – penductulated subserous fibroid.
• in some cases the pedicle may be turn through and the fibroid gets its nourishment from the
omental for mesenteric additions and is called – wandering or parasitic fibroid.
• Sometimes the intramural fibroid may be pushed out in between the layers of broad ligament and is
called- broad ligament fibroid.
3. Submucous (5%) : the intramuralfibroid when pushed towards the uterine cavity and is lying
underneath the endometrium it is called submucous fibroid. Submucous fibroid can make the uterine
cavity irregular and distorted. Penductulated mucous fibroid may come out through cervix it may be
infected or ulcerated to cause metrorrhagia. The type is very least common but it produces maximum
symptoms
7. CERVICAL FIBROIDS
• Cervical fibroids are rare.
• In the supravaginal part of cervix it may be interstitial or subperitoneal variety
and rarely polypoidal. Depending upon the position it may be anterior-posterior
lateral or central. Interstitial growths mein displays the cervix or expanded so
much that the external cost is difficult to recognise it also affects ureter
• In the vaginal cervix the fibroid is usually penductulated.
• A fibroid polyp arising from the uterine body when occupies and distance from
the cervical canal is called pseudo cervical fibroid
8. ETIOLOGY
Histogenesis
• Origin
• The etiology still remains unclear.
• the prevailing hypothesis is that it arises from new plastics in the
smooth muscle cell of myometrium
• The stimulus for initial neoplastic transformation is not known.
9. 1. Chromosomal abnormality: in about 40% of cases there is a
wearing type of chromosomal abnormality particularly in
chromosome 6 or 7 rearrangements and deletion takes place.
Somatic mutations in mitral cells may also be the cause for
uncontrolled cell proliferation.
2. Role of peptide growth factors: epidermal growth factor EGF,
insulin like growth factor 1 IGF1 , transforming growth factor
TGF, simulate the growth of leiomyoma either directly or via
oestrogen.
3. A positive family history is often present.
10. • Growth
it is predominantly and oestrogen dependent tumor. Oestrogen and
progesterone is incriminated as the cause. Oestrogen dependency is
evidence by
• Growth potential ATI is limited during childbearing period
• Increase growth during pregnancy
• They do not occur before menarche
• Following menopause there is cessationof growth and they undergo
atrophy after menopause
11. • It seems to contain more oestrogen receptors than adjacent
myometrium.
• Association of anovulation
• The growth potentiality varies. As a whole the rate of growth is
slow and takes about three to five years for the five to grow
sufficiently to be felt per abdomen (Evidence shows Ovarian
tumors grow in months.
• However fibroid grows rapidly during pregnancy or OCP users.
Rapid growth also may be due to degeneration or due to
malignant change
12. RISK FACTORS
INCREASED RISK
• Nulliparity
• Obesity
• Hyper oestrogenic
state
• Black women
REDUCE RISK
• Multiparity
13. CLINICAL FEATURES OF CORPOREAL FIBROID
PATIENT PROFILE
• Patients are usually nari Paris or having a long period of
secondary infertility
• Early marriage and frequent childbirth makes it even
higher amongst the multiparous women
• The incidence is at its peak in 35 to 45 years
• There is a tendency of delayed menopause.
14. SYMPTOMS
• 75% of fibroids remain asymptomatic. They are accidentally
discovered by physician during routine examination or at leopard to
me or laparoscopy.
• The symptoms are related to an atomic type and size of tumor.
• The site is more important than the size. A small submucous fibroid
may produce more symptoms than a big subserous fibroid.
15. MENSTRUAL ABNORMALITIES
A . In 30% of cases mineral is the classic symptom of symptomatic fibroid.
Menstrual loss is progressively increased with successive cycles due to
• Increase surface area of endometrium
• Interference with normal uterine contractility due to interposition of fibroid
• Condition and dilation of adjacent endometerial venous plexus is caused by
obstruction of tumor.
• Endometrial hyperplasia due to hyper oestrogenic state.
• Pelvic congestion
• Imbalance of thromboxane A2 and prostacyclin with deficiency of thromboxane A2.
16. B. Metrorrhagia or irregular bleeding may be due to
• Ulceration of submucous fibroid polyp
• Torn vessels from slugging base of a polyp
• Associated endometrial carcinoma.
C. dysmenorrhea. : the congestive variety may be due to associated
pelvic congestion or endometriosis.
• Spasmodic type is associated with extrusion of polyp and its
aspiration from uterine cavity
• Subserous or broad ligament fibroids are usually on associated with
menstrual abnormalities.
17. D.Infertility – infertility may be a major complaint the probable known attributing factors are
UTERINE
• Distortion and or elongation of uterine cavity which leads to difficult sperm ascent
• Preventing kramak contraction due to fibroids during intercourse leads to impaired sparm
transport
• Congestion and dilatation of endometrial venous plexus
• Atrophy an ulceration of endometrium
• Menorrhagia and dyspareunia
TUBAL – cornua block duty position of fibroid.
OVARIAN – anovulation
PERITONEUM- endometriosis
18. OTHER SYMPTOMS ARE
• Pregnancy related problems like abortion preterm labour and intrauterine growth restriction. The
reasons are defective implantation of class inter poly developed endometrium reduce space of for
growing foetus and placenta. Shoulder dystocia postpartum hemorrhage are also common.
• Pain per abdomen: usually painless ,pain may be due to associated pelvic pathology such as tumor,
endometriosis , pelvic inflammatory disease etc
• Patient may have a sense of heaviness in lower abdomen she may feel a lump in the lower abdomen
even without any other symptoms
19. CLINICAL FEATURES OF CERVICAL FIBROID
• In non pregnant state the symptoms are predominantly due to pressure effects on
the surrounding structures
• Anterior cervical: bladder symptoms like frequency or even retention of urine are
species the retention is more due to pressure then elongation of urethra.
• Posterior cervical: rectal symptom is the form of constipation
• Lateral cervical: vascular obstruction may lead to hemorrhoids and edema of legs
the ureter is post laterally and below the tumor
• Central cervical: Is producers predominant bladder symptoms.
It is mainly asymptomatic during pregnancy but produces obstruction during labour.
20. SIGNS
1. General examination reveals varying degrees of pallor depending upon the
magnitude and duration of menstrual loss
2. Abdominal examination reveals tumor may not be sufficiently enlarge to be felt per
abdomen. Bath is enlarged to 14 weeks or more of the following features are noted.
3. Upon palpation
• It fields farm more hard may be due to cystic degeneration
• Margins are well defined accept the pole which cannot be reached suggestive of
pelvic in origin
• Surface is nodular and mobility is restricted
21. 4. This swelling is dull on percussion.
5. Pelvic examination reveals the uterus is regularly enlarged by
the swelling per abdomen.
• Uterus isnot well separated from swelling such as groove is not
filled between the uterus and the mass
• Movement of cervix along with the tumor is felt per abdomen
22. FATE OF A FIBROID!
( COMPLICATIONS)
• Surface necrosis
• Polypoid change following pedicle formation
• Infection
• Degeneration including sarcomatous change
• Sarcomatous change are rare
• Hemorrhage due to rupture of surface vein of subserous fibroid
• Polycythemia due to erythropoietic function by the tumor
• Torsion of subserous penductulated fibroid.
24. QUESTIONS ✍️
1. What is uterine fibroid? 1
2. What are the signs and symptoms of uterine fibroid?
5
3. Explain treatment modalities of fibroid uterus.
9
1+5+9=15