Bening pelvi abdminal mass in obstd.pptx

Tachycardia is a heart rate that exceeds 100 beats per minute in an adult, though is of greater concern when it exceeds 150. Symptoms may vary from none to severe. These may include palpitations, light headedness, shortness of breath, chest pain, or syncope.

Types include sinus tachycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, extra beats such as atrial premature beats and ventricular premature beats, ventricular tachycardia, and ventricular fibrillation. Underlying risk factors include low oxygen, fever, heart disease, stimulants, and electrolyte abnormalities. Diagnosis is by electrocardiogram (ECG). They can be divided into narrow complex and wide complex and than further divided into regular and irregular.

Treatment depends on the type of tachycardia. An underlying cause may need to be addressed, if present. If a person is unstable due to the tachycardia, synchronized cardioversion is generally recommended, though in certain cases adenosine may be used. If the QRS complex is narrow and the person is stable vagal maneuvers, adenosine, beta blockers, or calcium channel blockers may be used. Tachycardia is common.

Signs and symptoms
Tachycardia can lead to fainting.

When the rate of blood flow becomes too rapid, or fast blood flow passes on damaged endothelium, it increases the friction within vessels resulting in turbulence and other disturbances. According to the Virchow's triad, this is one of the three conditions that can lead to thrombosis (i.e., blood clots within vessels).

Causes
Some causes of tachycardia include:

Sinus tachycardia
Atrial fibrillation
Atrial flutter
Atrial tachycardia
AV nodal reentrant tachycardia
Brugada syndrome
Junctional tachycardia
Multifocal atrial tachycardia
Pacemaker mediated
Supraventricular tachycardia
Ventricular tachycardia
Wolff–Parkinson–White syndrome
Postural orthostatic tachycardia syndrome
Drug related:

Alcohol
Stimulants
Cannabis (drug)
Drug withdrawal
Tricyclic antidepressants
Sinus tachycardia
Sinus tachycardia can occur due to a large number of reasons include

Adrenergic storm
Anaemia
Anxiety
Early manifestation of circulatory shock
Dysautonomia
Exercise
Fear
Hypoglycemia
Hypovolemia
Hyperthyroidism
HyperventilationAny narrow complex tachycardia combined with a problem with the conduction system of the heart, often termed "supraventricular tachycardia with aberrancy"
A narrow complex tachycardia with an accessory conduction pathway, often termed "supraventricular tachycardia with pre-excitation" (e.g. Wolff–Parkinson–White syndrome)
Pacemaker-tracked or pacemaker-mediated tachycardia
Tachycardias may be classified as either narrow complex tachycardias (supraventricular tachycardias) or wide complex tachycardias. Narrow and wide refer to the width of the QRS complex on the ECG. Narrow complex tachycardias tend to originate in the atria, while wide complex tachycardias tend to originate in the ventricles. Tachycardias can be further classified as eith

1. Risk factors Positive family history Age 35-45 Parity: nulliparous and low parity Obesity Hyper estrogenic state African racial origin

2. Site : The body of uterus in about 97% The cervix in about 3% Rare sites include round ligament , utero-sacral ligament . Size : It varies from very small fibroid to huge tumor filling the whole abdomen . Consistency Firm unless affected by degeneration . The tumor becomes soft during pregnancy or due to hyaline or cystic degeneration. It is hard when calcified.

3. Fibroid Types Sub serous Project from the uterus into the peritoneal cavity Sometimes pedunculated Least likely to cause symptoms Sub mucous Project into the uterine cavity Sometimes pedunculated Most likely to cause symptoms Intramural Most common Usually multiple

4. Secondary changes in the fibroid Atrophy Necrosis Malignancy Degeneration Infection Vascular changes

5. Atrophy It normally occurs after menopause due to lack of estrogen and reduced blood supply to the uterus.

6. Necrosis Due to complete cutting of the blood supply of the tumor leading to death of tissue . Necrosis may occur after torsion of a sub serous fibroid.

7. Malignancy : Occurs rarely with the incidence 1:350 cases or less as it change into sarcoma . the suspicion is greatest in postmenopausal period when there is rapidly increasing size of fibroid. The affected area loses the world appearance it becomes soft and yellow in color with areas of hemorrhage and necrosis .

8. Malignancy is suspected in the following conditions: Rapid growth of the tumors Growth of the tumors after menopause . Postmenopausal bleeding The tumor becomes painful and tender Loss of weight and cachexia Evidence of distant metastases

9. Degeneration Hyaline degeneration: asymptomatic softening and liquefaction of the fibroid It is the commonest degeneration . It usually occur when the fibroid gradually outgrows its blood supply. It usually starts at the centre of of large tumor because it the least vascular area. The affected area is replaced by hyaline material and appears structure less Clinically the patient may complain of dull aching pain and the tumor becomes soft in consistency.

10. Cystic degeneration: asymptomatic central necrosis leaving cystic spaces at the center. It is the result of liquefaction of hyaline material leading to the formation of cystic spaces and the tumor becomes soft in consistency. The condition may also follow red degeneration. It may be mistaken for pregnant uterus.

11. Cystic degeneration

12. Calcification degeneration calcium deposition leading to calcification so calcification is found at the periphery of the tumors and along the blood vessels passing radially towards its center. It is usually preceded by fatty degeneration and occurs in tumor with poor blood supply and so it usually occurs after menopause . Clinically the tumor becomes stony hard in consistency and may be detected incidentally on abdominal X ray.

13. Red degeneration hemorrhage and necrosis occurs within the fibroid typically presenting in the mid-second trimester pregnancy with acute pain. It is incomplete necrosis due to acute disruption of the blood supply to the fibroid during active growth. It affects interstitial fibroids . Clinically there is sudden onset of sever abdominal pain localized over the affected tumor may be accompanied with vomiting and mild fever. Treatment is usually medical by rest and analgesic for pain.

14. Red degeneration

15. Fatty degeneration Fat globules are deposited inside the muscle fiber and the tumor becomes soft in consistency and yellow in color Infection It may occurs after abortion or labor or from adjacent organs as bowel or appendix or follow red degeneration . vascular changes Edema : this is common during pregnancy . Congestion : due to torsion of a subserous fibroid

16. DIAGNOSIS Fibroids can cause several gynecological complaints and are one of the commonest indications for hysterectomy . The diagnosis of the fibroid is made by the following : History : In about more than 50% the condition is asymptomatic and discovered accidently , however the patient may complain of one or more of the following :  

17. Menstrual disturbance and abnormal vaginal bleeding Menorrhagia ( the commonest ) Pressure effects Urine frequency , dysuria , urine retention . Constipation and piles Dyspnea and palpitation Pain This may be due to acute red degeneration , torsion of a pedunculated fibroid Abdominal mass This may be the only presentation particularly with sub serous fibroid

18. Infertility sub mucous fibroid may prevent implantation of the ovum or causes early abortion blocked tubes by corneal fibroids mechanical obstruction by cervical fibroid Removal of sub mucosal fibroids can enhance fertility and also outcomes with assisted reproductive techniques such as in-vitro fertilization (IVF) General symptoms symptoms of anemia as headache and palpitation if there is excessive blood loss

19. Rare symptoms polycythemia : usually caused by a large myoma in the broad ligament . The explanation is unknown but the tumor may compress the ureter and affects erythropoietic function of the kidney or the tumor itself produces erythropoietin Hypoglycemia : if the tumor is retroperitoneal causing pancreatic stimulation

20. Examination : Abdominal examination : visible and/or palpable abdominal mass arising from the pelvis Bimanual examination : enlarged, firm , smooth or irregular, non-tender uterus palpable .

21. Investigations : to confirm the diagnosis CBC Ultrasound HSG hysteroscopy [for the sub mucosal type] Laparoscopy [for the sub serosa type] MRI and CT Imaging- D&C biopsy to prepare the pt. for surgery CBC , RBS, ECG, CX-RAY, LFT, RFT, IVP and urine

22. Hysteroscopy

23. Complication of fibroid Anemia due to menorrhagia Acute abdominal pain due to torsion of a pedunculeated sub serous fibroid . Degenerative changes as hyaline and red degeneration . Malignant changes. Inversion of uterus caused by fundal submucous fibroid . Infertility. Uterine prolapse : small fibroids increase the wt of uterus.

24. Fibroid and pregnancy Effects of pregnancy on fibroid Red degeneration Effects of fibroid on pregnancy During pregnancy : abortion ectopic pregnancy pressure symptoms preterm labor malpresentation nonengaement placenta previa

25. During labor : obstructed labor prolonged labor retained placenta PPH During puerperium : sub involution of uterus secondary PPH puerperal sepsis

26. Treatment The line of treatment depends on many factors as: Age parity desire to have children general condition size site number m …

27. conservative treatment. medical treatment. surgical treatment. Radiological treatment

28. Conservative treatment In Small symptomless fibroid, but the patient should kept under observation and examined clinically and by U/S every 6 months The exceptions to this rule are : apedunculeated sub serous fibroid which is labile to torsion. if the fibroid is growing rapidly . growth post menopause

29. medical treatment It is indicated for : Small single symptomatic fibroid In preparation for operation ( to reduce tumor size ) when the patient is unfit for operation

30. The most common drugs that are used for treatment of menorrhagia include : Ant prostaglandins (NSIAD).e.g. mefenamic acid . Antifibrinolytic drugs ( Tranexemic acid ). Combined oral contraceptive pills. levonorgestrel intrauterine system (LNG-IUS ).

31. The only effective medical treatment is to use: injectable gonadotrophin-releasing hormone ( GnRH) agonists , which induce a menopausal state by shutting down ovarian estradiol production. However, GnRH treatment is not tolerated by all women because of severe menopausal symptoms. More recently, the selective progesterone receptor modulator

32. (SPRM) ulipristal acetate has been shown to be as effective as GnRH agonists in reducing fibroid volume. and alleviating HMB symptoms, although it is not yet widely accepted into clinical practice. In addition to being an oral tablet, this SPRM does not induce a menopausal state and associated symptoms. However, neither GnRH nor SPRM represent a viable long-term treatment option. Moreover, when ovarian function returns, the fibroids regrow to their previous dimensions.

33. Surgical treatment   The choice of surgical treatment is determined by : the presenting complaint the patient's wishes for menstrual function fertility

34. Minimally invasive hysteroscopic surgery can be used to cut away a sub mucous fibroid or fibroid polyp, helping to resolve HMB symptoms even in the presence of other types of fibroid Where a bulky fibroid uterus causes pressure symptoms or where HMB is refractory to medical interventions, the options are myomectomy

35. Myomectomy Best for single fibroid in a young woman where preservation of fertility is required . It is done either Transvaginal or using the hystroscope Also the procedure can be performed through a laparotomy incision or, increasingly , laparoscopically .  

36. An important point for the preoperative discussion during the consent process for myomectomy is that there is a small but significant risk of uncontrolled lifet hreatening bleeding during myomectomy, which could lead to hysterectomy.

37. indication of Hysterectomy: Age more than 45 years old Complete family Uncontrolled bleeding -Multiple myoma Malignant changes Unfunctioning uterus Recurrency The presence of other lesions in uterus as adenomyosis Cervical fibroid

38. Radiological Uterine artery embolization (UAE) is a technique performed by interventional radiologists. It involves embolization of both uterine arteries under radiological guidance. A small incision is made in the groin under local anaesthesia and a cannula placed into the femoral artery and guided into the uterine arteries.

39. Embolization particles are then injected, reducing the blood supply to the uterus, which induces infarction and degeneration of fibroids such that the overall reduction in fibroid volume is around 50%. Complications include fever, infection, fibroid expulsion and potential ovarian failure

40. Uterine artery embolization

41. special types of fibroid cervical leiomyoma The paucity of smooth muscle elements in the cervical stroma makes leiomyoma that arise in the cervix uncommon cervical leiomyoma is most often solitary and may be large enough to fill the entire pelvic cavity ,compressing the bladder , rectum ,and ureters

42. clinical finding : cervical leiomyomas are often silent producing no symptoms unless become very large . symptoms result from pressure on surrounding organs such as the bladder ,rectum, or soft tissues of parametrium or obstruction of the cervical canal. Frequency and urgency of urination are the result of bladder compression.

43. Urinary retention occasionally occurs as a result of pressure against the urethra . Heavy vaginal bleeding may occur . If the direction of growth is lateral there may be ureteral obstruction with hydronephrosis rectal encroachment causes constipation . Dyspareunia may occur if the tumor occupies the vagina . Large cervical leiomyomas in pregnancy because of their location may cause soft-tissue dystocia , preventing descent of the presenting part in the pelvis .

44. Imaging A plain film may demonstrate the typical mottled calcific pattern associated with cervical leiomyomas . Hysterography may define distortion of the endocervical canal . Intravenous urography may demonstrate ureteral displacement or obstruction . Transvaginal ultrasound or MRI can be helpful in determining the size and location .

45. Treatment Small , asymptomatic cervical leiomyoma don’t require treatment . If the leiomyomas become symptomatic , removal may be possible via hysteroscopic resection .

46. If additional multiple leiomyomas are present that cannot be resected with : hysteroscopic uterine artery embolization abdominal myomectomy hysterectomy may be indicated , depending on the patient's desire for preservation of fertility

47. Parasitic fibroid The condition occur when apedunculeated subserous fibroid undergoes torsion and forms adhesion with the omentum and other structures. The tumor acquires a new blood supply from these structure and become completely detached from the uterus and forms a free intra abdominal mass

48. Benign tumors of the ovaries

49. Ovarian tumors may be physiological or pathological and may arise from any tissue in the ovary most BOT are cystic frequently asymptomatic and resolve spontaneously Physiological cysts(functional cysts ) are cysts which form in the ovary during the normal ovarian cycle

50. F ollicular cysts T he most common functional cyst they result from failure of ovulation with continued growth of the follicle Follicular cysts vary in diameter from 3-8cm . Typically follicular cysts asymptomatic Bleeding and torsion can occur . Large follicular cysts may cause aching pelvic pain , dyspareunia ,and occasionally abnormal uterine bleeding associated with a disturbance of ovulatory pattern . Most follicular cysts disappear spontaneously within 60 days without treatment.

51. Large follicular cysts may cause aching pelvic pain , dyspareunia ,and occasionally abnormal uterine bleeding associated with a disturbance of ovulatory pattern . Most follicular cysts disappear spontaneously within 60 days without treatment.

52. Corpus luteal cyst these are thin-walled unilocular cysts ranging from 3-11cm in size . After normal ovulation the granulosa lining the follicle become luteinized . A persistent corpus luteum cyst may cause local pain or tenderness . It can be also associated with either amenorrhea or delayed menstrusion ,thus simulating the clinical of an ectopic pregnancy . A corpus luteum cyst may be associated with torsion of the ovary causing sever pain ,or may rupture and bleed .

53. Theca lutein cyst elevated levels of chorionic gonadotropin can produce theca lutein cysts and thus are seen in patients with: hydatidiform mole choriocarcinoma patients under - going chorionic gonadotropin or clomiphene therapy. Rarely they are seen in normal pregnancy . The cyst disappears spontaneously after termination of molar pregnancy .

54. True benign ovarian neoplasms Benign epithelial tumors: Serous cystadenoma mucinous cystadenoma brenner tumour clear cell tumor

55. Benign sex cord stromal tumors Granulosa cell tumor theca cell tumor fibroma sertoli-leydig cell tumor s