Uterine fibroid

nitish singh
asst. professor

1. NITISH SINGH ASST. PROF.

2. INTRODUCTION UTERINE FIBROID IS A LEIOMYOMA (BENIGN (NON- CANCEROUS) TUMOR FORM FROM SMOOTH MUSCLE TISSUE) THAT ORIGINATES FROM THE SMOOTH MUSCLE LAYER (MYOMETRIUM) OF THE UTERUS. SYNONYMS: MYOMA, FIBROMYOMA. MOST COMMON BENIGN NEOPLASM IN THE FEMALE. INCIDENCE: 20 TO 40% OF REPRODUCTIVE AGE WOMEN.

3. D E F I NIT I ON “UTERINE FIBROIDS ARE NONCANCEROUS GROWTHS OF THE UTERUS THAT OFTEN APPEAR DURING CHILDBEARING YEARS.” UTERINE FIBROIDS AREN'T ASSOCIATED WITH AN INCREASED RISK OF UTERINE CANCER AND ALMOST NEVER DEVELOP INTO CANCER.

4. RISK F AC T ORS Heredity Race Pregnancy and childbirth Oral contraceptives

5. E TI O L OGY

6. Hormones- estrogen, progesterone Idiopathic Family history Growth Factor

7. OTHER FACTORS- ONSET OF MENSTRUATION AT AN EARLY AGE DIET LOW LEVELS OF VITAMIN D DRINKING ALCOHOL OBESITY NULLIPARITY

8. TYPES/ C L ASS I FIC A TI O N

9. Body or corporeal fibroids Intramural or interstitial fibroids Pedunculated fibroids- Sub serosal fibroids, Submucosal fibroids Cervical Fibroids

10. CLINICAL FEATURES ASYMPTOMATIC  FIBROID SIZE<4CM ABNORMAL UTERINE BLEEDING  MENORRHAGIA > 64% WOMAN PRESENT WITH HEAVY BLOOD LOSS. METRO MENORRHAGIA PRESENT IN CASES OF INFECTED / ULCERATED FIBROID POLYP. INFERTILITY PAIN LOWER ABDOMEN ABDOMINAL SWELLING (LUMP) PRESSURE SYMPTOMS

11. DI A GNOS I S HISTORY COLLECTION PHYSICAL EXAMINATION

12. FIBROID SIGNS G/E - PALLOR P/A - IF >12 WEEKS SIZE, FIRM, NODULAR, ARISING FROM PELVIS, LOWER LIMIT CAN’T BE REACHED, RELATIVELY WELL DEFINED, MOBILE FROM SIDE TO SIDE, NONTENDER, DULL ON PERCUSSION, NO FREE FLUID IN ABDOMEN. P/S - CERVIX PULLED HIGHER UP. P/V - UTERUS ENLARGED, NODULAR, UTERUS NOT SEPARATELY FELT, TRANSMITTED MOVEMENT PRESENT, NOTCH NOT FELT.

13. FIBROID USG : WELL DEFINED HYPOECHOIC LESIONS. PERIPHERAL CALCIFICATION WITH DISTAL SHADOWING IN OLD FIBROIDS

14. TAS & TVS - SIZE, SITE AND NUMBER OF FIBROIDS DIFFERENTIATES THE TUMOR FROM OTHER SWELLING AS OVARIAN TUMOR.

15. HYSTEROSCOPY - TO VISUALIZE A SUB MUCOUS FIBROID OR A SMALL FIBROID POLYP.

16. MRI - MOST ACCURATE IMAGING MODALITY FOR DIAGNOSIS OF FIBROID. IT DOES PRECISE FIBROID MAPPING & CHARACTERIZATION. DETECTS ALL FIBROIDS ACCURATELY. OVARIES ARE EASILY SEEN DETECTS SMALL MYOMAS (0.5 CM)

17. LAPAROSCOPY - IT IS HELPFUL, IF THE UTERINE SIZE IS LESS THAN 12 CMS AND ASSOCIATED WITH PELVIC PAIN AND INFERTILITY.

18. ENDOMETRIAL BIOPSY - TISSUE SAMPLE IS TAKEN TO SEND IT FOR BIOPSY PROCEDURE TO FIND OUT THE TYPE OF FIBROID MALIGNANCY.

19. COMPLICATIONS MENORRHAGIA ABDOMINAL PAIN PREMATURE BIRTH, LABOR PROBLEMS, MISCARRIAGE INFERTILITY TWISTING OF THE FIBROID ANEMIA URINARY TRACT INFECTIONS SOME PREGNANT WOMEN WITH FIBROIDS HAVE HEAVY BLEEDING IMMEDIATELY AFTER GIVING BIRTH.

20. MANAGEMENT MEDICAL/ PHARMACOLOGICAL

21. Oral cont r a c ep tive pills- reduce the heavy flow GnRH agonists (e.g., leuprolide)- used pre- postoperat iv ely to shrink the size of the tumor. Antihor monal drug RU- 486 (mifep ri stone) Danazol (D a nocrin e )- decreasing the number of hormones made by the ovaries Ant i fibr inoly tics (tranexamic acid)- inhibitors of fibrinolysis N o nsteroidal anti- in f lammator y agents- to treat symptomati c symptoms

22. SURGICAL

23. UTERINE ARTERY EMBOLIZATION/ EMBOLOTHERAPY

24. UTERINE ARTERY LIGATION

25. LAPAROSCOPIC OR ROBOTIC MYOMECTOMY

26. HYSTEROSCOPIC MYOMECTOMY

27. ENDOMETRIAL ABLATION AND RESECTION OF SUBMUCOSAL FIBROIDS

28. ABDOMINAL MYOMECTOMY

29. HYSTERECTOMY A SURGICAL OPERATION TO REMOVE ALL OR PART OF THE UTERUS IN CASE OF LIFE THREATENING CONDITION OF THE WOMEN I.E., MENORRHAGIA, POST-MENOPAUSAL PERIOD. MOST COMMON SURGICAL TREATMENT DONE IN INDIA.

30. TECHNIQUES OF HYSTERECTOMY ABDOMINAL HYSTERECTOMY VAGINAL HYSTERECTOMY LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY LAPAROSCOPIC-ASSISTED SUPRACERVICAL HYSTERECTOMY TOTAL LAPAROSCOPIC HYSTERECTOMY

31. NURSING INTERVENTIONS THE NURSE DETERMINES WHAT THE EXPERIENCE MEANS TO THE PATIENT AND ENCOURAGES HER TO VERBALIZE HER CONCERNS. EXPLANATIONS ARE GIVEN ABOUT PHYSICAL PREPARATIONS AND PROCEDURES THAT ARE PERFORMED. THE PATIENT NEEDS REASSURANCE THAT SHE WILL STILL HAVE A VAGINA AND THAT SHE CAN EXPERIENCE SEXUAL INTERCOURSE AFTER TEMPORARY POSTOPERATIVE ABSTINENCE WHILE TISSUES HEAL. THE NURSE NEEDS TO APPROACH AND EVALUATE EACH PATIENT INDIVIDUALLY IN LIGHT OF THESE FACTORS. A NURSE WHO EXHIBITS INTEREST, CONCERN, AND WILLINGNESS TO LISTEN TO THE PATIENT’S FEARS WILL HELP THE PATIENT PROGRESS THROUGH THE SURGICAL EXPERIENCE.

32. THE CONT… NURSE ASSESSES THE INTENSITY OF THE PATIENT’S PAIN AND ASSISTS THE PATIENT WITH ANALGESIA AS PRESCRIBED. THE NURSE COUNTS THE PERINEAL PADS USED, ASSESSES THE EXTENT OF SATURATION WITH BLOOD, AND MONITORS VITAL SIGNS. ABDOMINAL DRESSING IS MONITORED FOR DRAINAGE IF AN ABDOMINAL SURGICAL TECHNIQUE WAS USED. NURSE SHOULD INSTRUCT TO CONTACT THE NURSE OR SURGEON IF BLEEDING IS EXCESSIVE. THE PATIENT IS ENCOURAGED AND ASSISTED TO CHANGE POSITIONS FREQUENTLY. NURSE HELPS THE PATIENT TO AMBULATE EARLY IN THE POSTOPERATIVE PERIOD.

33. CON T … INTAKE AND OUTPUT CHART IS MONITORED. EXPLAIN THE PATIENT ABOUT FOLLOW UP VISITS. ADMINISTER IRON AND BT AS PRESCRIBED. ENCOURAGE VERBALIZATION OF FEELINGS MONITOR ACTIVE FLUID LOSS FROM WOUND DRAINAGE, BLEEDING. ENCOURAGE PATIENT TO DRINK PRESCRIBED FLUID AMOUNTS

34. CON T … MONITOR SERUM ELECTROLYTES. ENCOURAGE CLIENTS TO INCREASE FLUID INTAKE OBSERVATIONS OF CHANGES IN MENTAL STATUS, BEHAVIOR OR LEVEL OF CONSCIOUSNESS. NOTE THE CATHETER PATENCY WAS SETTLED (WHEN USING CATHETER) ASSESS NUTRITIONAL STATUS, INCLUDING WEIGHT, HISTORY OF WEIGHT LOSS AND SERUM ALBUMIN. ENCOURAGE INTAKE OF PROTEIN AND CALORIE-RICH FOODS. HELP IN DEVELOPING EFFECTIVE COPING STRATEGIES.

35. S U MMA R Y …

36. THANK YOU!