UTERINE FIBROIDS - OBGYN - EASYMEDNOTES 2021

 FIBROID


Fibroid is the commonest benign tumor of the 
uterus and is common benign tumor 
in female.

Risk factors

The major risk factors are :

• Nulliparity

• Obesity

• Hyperestrogenic state

• Multiparity

• Smoking



Complications

The major complications of fibroids are:

  • Degenerations
  • Necrosis
  • Infection
  • Sarcomatous change is very RARE
  • Torsion of subserous pedunculated fibroid
  • Hemorrhage
Polycythemia due to:

  • Erythropoietic function by the tumor
  • Altered or changed erythropoietic function of the kidney through ureteric pressure.


INVESTIGATIONS


 The uterine fibroids can be diagnosed from the history and pelvic examination.

Ultrasound and Color Doppler (TVS) findings are:

(i) Uterine contour is distorted. 

(ii) Depending on the amount of connective tissue or smooth muscle proliferation, fibroids are of different echogenecity they may be hypoechoic or hyperechoic. 

(iii) Vascularization is at the periphery of the fibroid. 

(iv) Central vascularization indicates degenerative changes.

  • Ultrasound is used confirm the diagnosis of fibroid.
  • Transvaginal ultrasound can accurately assess the myoma location, dimensions volume and also any adnexal pathology. 
  • Hydroureter or hydronephrotic changes can be diagnosed. 
  • Three-dimensional ultrasonography can locate fibroids accurately. 
  • Serial ultrasound examination is needed during medical or conservative management
  • Saline Infusion Sonography (SIS) is helpful to detect any submucous fibroid or polyp 
  • Magnetic resonance imaging (MRI)—is more accurate compared to ultrasound. It helps to differentiate adenomyosis from fibroids. As MRI is expensive and not widely available it is not frequently used.
  • Laparoscopy is done and it is helpful if the uterine size is less than 12 weeks and having pelvic pain and infertility. Associated pelvic endometriosis and tubal pathology can be shown. It can also differentiate a pedunculated fibroid from ovarian tumor.
  • Hysteroscopy is used to detect submucous fibroid in the infertility and in repeated miscarriages. The presence and site of submucous fibroid can be diagnosed by direct visualization during hysteroscopy.
  • Submucosal fibroid can be resected at the same time using a resecting hysteroscope.
  • Uterine curettage—In the presence of irregular bleeding, to detect any co-existing pathology and to study the endometrial pattern, curettage is helpful. It also helps to diagnose a submucous fibroid by feeling a bump. But, hysteroscopy and biopsy is a better alternative.


Differential diagnosis

The fibroid of varying sizes may be confused with: 

(1) Pregnancy 

(2) Full bladder 

(3) Adenomyosis

(4) Myohyperplasia 

(5) Ovarian tumor


MANAGEMENT OF FIBROID UTERUS

MEDICAL MANAGEMENT

  1. Drug therapy is used in the management of symptomatic fibroids. 
  2. The drugs are used either to palliation or alternative to surgery. 
  3. Prior to drug therapy, one must know about the diagnosis. 

The objectives of medical treatment are:

  • To improve menorrhagia and to correct anemia before surgery.
  • To minimize the size and vascularity of the tumor in order to facilitate surgery. In some cases of infertility to facilitate hysteroscopic or laparoscopic surgery. As an alternative to surgery in perimenopausal women or women with high-risk factors for surgery. Where postponement of surgery is planned temporarily.

  • Antiprogesterones: Mifepristone is very effective to reduce fibroid size and also menorrhagia. It may produce amenorrhea.

  • Danazol can reduce the volume of a fibroid in some extent. 
Because of androgenic side effects, danazol is used only for a period of 3–6 months



SURGICAL MANAGEMENT OF FIBROID UTERUS

Myomectomy may be done by:

  • Laparotomy 
  • Laparoscopy  
  • Hysteroscopy
 Embolotherapy

  • Myolysis
  • Hysterectomy


Comments

Post a Comment

Popular posts from this blog

NEOPLASIA - PATHOLOGY - 2021 - EASYMEDNOTES

  Neoplasia Neoplasia is a new growth It is an excessive an unregulated proliferation that eventually independent of physiologic growth stimuli. cancer Cancer is the common term for malignant tumours. It is derived from the Latin word - crab . clonality A tumour is known to be clonal when the entire cells within a tumour arises from a single cell that has incurred genetic change.  A clonal neoplasm is therefore constituted by cells which carry the same genetic anomaly. Two main components of all neoplasms 1) Tumour cells that have the parenchyma 2) Tumour stroma which is a supporting framework consisting of connective tissue and newly formed blood vessels. Basic principles of carcinogenesis 1) Non-lethal Genetic damage or mutation may be acquired by the action of environmental agents such as chemicals, radiation or viruses. 2) The classes of normal regulatory genes are: I) The growth promoting proto-oncogenes Activation of proto-oncogenes activation gives rise to oncogenes. Proto- onco
Read more

TRIANGLES OF NECK - ANATOMY - EASYMEDNOTES 2021

Image
TRIANGLES OF NECK There are 2 triangles of neck 1. Anterior triangle 2. Posterior triangle ANTERIOR TRIANGLE OF THE NECK The anterior triangle is present at the front of the neck. On either side of the neck. BOUNDARIES Superior border: It is bounded by inferior border of mandible. Medial border: It is bounded by the imaginary midline of neck . Lateral border: It is bounded by anterior border of the sternocleidomastoid muscle. CONTENTS The contents of anterior triangle are muscles, nerves, arteries, veins and lymph nodes. Muscles : suprahyoid muscle- Superior,  Infrahyoid muscle - Inferior Arteries : Common carotid artery Vein : Internal jugular vein Nerves:  Facial nerve, Glossopharyngeal nerve, Vagus nerve, Accessory nerve, Hypoglossal nerve. SUBDIVISIONS The triangle is subdivide by hyoid bone, suprahyoid and infrahyoid muscles into four triangle. CAROTID TRIANGLE BORDER:  The borders of the carotid triangle are: Superior border :  The superior border is bounded b
Read more

OSTEOPOROSIS - ORTHOPAEDICS - EASYMEDNOTES 2021

Image
OSTEOPOROSIS   Osteoporosis is commonest metabolic bone disease.   osteoporosis is characterised by a reduction in the bone density due to a decrease in the bone mass. This occurs when the rate of bone resorption exceeds the rate of bone formation.  CAUSES Several aetiological factors are present. Commonest factor in males is senility and in females is menopause . Causes of generalized osteoporosis : Senility Post-immobilization  example : a bed-ridden patient  Post-menopausal Protein deficiency,  Inadequate intake – old age, illness Malnutrition Malabsorption Excess protein loss (3rd degree burns, CRF etc.)  Endocrine Cushing's disease,  Cushing's syndrome,  Hyperthyroid stat e  Drug induced Long term steroid therapy ,  Phenobarbitone therapy . CLINICAL FEATURES  Osteoporosis is an asymptomatic disorder unless complications predominantly fractures occur.  Loss of bone mass leads to loss of strength so that a trauma is sufficient to cause a fracture. 
Read more