Case Presentation Uterine Myoma

8/16/2019 Case Presentation Uterine Myoma

1/22

Case Presentation:

Uterine Myoma

Marijesmar Gonzalez Valle

OB GYN Clerkship

Dr. Rojas

July 19 !""#


2/22

CC:

$a%ien% re&ers' “Me crecio la barriga”.

(%a%es ha)in* pel)i+ pain.


3/22

HPI:

Case o& a ,- year ol pa%ien% G/$/0" %ha%

as ami%%e %o %he hospi%al ue %o pel)i+

pain. $a%ien% re&ers lo a2ominal

enlar*emen%. 3l%rasoun re)eale u%erinemyomas. $a%ien% as ami%%e an s+heule

&or sur*ery. Durin* sur*ery u%erine myomas

ere remo)e as ell as ahesions &rom

2oels %o %u2e.


4/22

Past Medical History:

(ys%emi+ 4llness

56N

DM 44

0s%hma

Cons%ipa%ion

7amily 5is%ory

56N' ! sons

DM' (is%er3n+les

CVD' Gran&a%her

0n8ie%y' Mo%her

5. pylori' Mo%her


5/22

OB Gyn Medical History:

G3P3A0: Ges%a%ionalia2e%es on /r. pre*nan+y:

Marital Status: Marrie

Religion: Ca%holi+

Sexual Partners: 1

First Coitus: !" years ol

Menarche:1" years

Menses: irre*ularsome%imes %i+e per mon%h

Dysmenorrhea: No

LMP: (%a%es %ha% oesno% remem2er

Dyspareunemia: No

SD!s: No

Contracepti"es: $ills Conoms Nu)aRin*

Dx: Pelvic pain ue %o3%erine Myoma


6/22

Labs:

CBC

C5;M #

5*B' 1/.9

*


7/22

Dx:

$el)i+ $ain

3%erine Myoma

0hesion &rom 2oels %o %u2e

Mil Cys%o+ele


8/22

Procedures:

6o%al 02ominal 5ys%ere+%omy

Ri*h% (alpin*oophere+%omy

=ysis o& 0hesion

Va*inal 0n%erior all (uspension


9/22

Uterine Myoma

0re lo+alize smoo%h mus+le +ell

proli&era%ion surroune 2y a

pseuo+apsule o& +ompresse mus+le&i2ers.

3p %o /"A o& 0meri+an omen ha)e

u%erine myomas.


10/22

Uterine Myoma

DN0 s%uies re)eale'

6ha% ea+h myoma arises &rom a sin*le

smoo%h mus+le +ell

6he smoo%h mus+le +ell is )as+ular inori*in.

Consiere %o 2e 2eni*n %umors %ha% are

hormonally responsi)e %his is 2e+ausees%ro*en usually inu+es %heir rapi *ro%h in

hi*h es%ro*en s%a%es.


11/22

Uterine Myoma

;s%ro*en

$rou+%ion o& pro*es%erone re+ep%ors in %hemyome%rium

$rou+%ion o& se)eral *ro%h &a+%ors

Gro%h o& myomas


12/22

Uterine Myoma


13/22

Types o Uterine Myomas

Intramural:

3%erine enlar*emen%

Subserous:

Pedunculated Submucous: ,A

Intracavitary:

02normal 2leein*an +rampin*


14/22

!i"ns and !ymptoms:

Bleein* is %he mos% +ommon presen%in*

symp%om.

$ro*ressi)e in+rease in pel)i+ pressureH

$el)i+ $ain

5ypermenorrhea

Dysmenorrhea

Dyspareunia

Me%rorrha*ia


15/22

Dia"nosis

02ominopel)i+ e8amina%ion

$el)i+ 3l%rasoun

;nome%rial Biopsy5ys%eros+opy

=aparos+opy

Compu%erize 08ial 6omo*raphyMR4


16/22

#is$ %actors:

5i*h es%ro*en s%a%es'

$re*nan+y

3se o& oral es%ro*en;s%ro*en prou+in* %umors

=a%er reprou+%i)e an perimenopausal

a*e *roups./F9 %imes hi*her in 0&ri+anF 0meri+ans


17/22


18/22

Clinical Presentation:

0no%her presen%a%ion is a sense o&

pro*ressi)e pel)i+ &ullness +ause 2y a

sloly enlar*in* in%ramural or

su2serous myomas hi+h on o++asionmay a%%ain a massi)e size.

$el)i+ pain mani&es% 2y %he onse% o&

se+onary ismenorrhea.


19/22

Complications

Chroni+ 4ron De&i+ien+y 0nemia

3rina%ion pro2lems

5yroure%er 5yronephrosis

4n&er%ili%y

Mis+arria*e$rema%ure Deli)ery


20/22

Mana"ement o Condition

Minimi#e $terine %lee&ing:

4n%ermi%%en% $ro*es%in

supplemen%a%ion

$ros%a*lanin syn%he%ase inhi2i%ors

GrR5 a*onis%' %emporally +hemi+ally

inu+e menopauseDanazol

Mi&epris%one R3F-@>:


21/22

Treatment

Myome+%omy

=aparo%omy

5ys%ere+%omy3%erine 0r%ery ;m2oliza%ion 30;:


22/22

Biblio"rap&y:

Be+kman Charles R.B. =in* 7rank . (mi%h Ro*er $. Barzansky

Bar2ara M. 5er2er% illiam N.$. I Dou*las . =au2e. Obstetrics

and Gynecology. $terine Leyomioma an& 'eoplasia. ,%h ei%ion.

=ippin+o%% illiams I ilkin*s. !"">. pp --@F-,-.

;ars RD. Moss JG. =umsen M0. u O. Murray =(. 6ale (.

Murray GD. Commi%%ee o& %he Ranomize 6rial o& ;m2oliza%ion)ersus (ur*i+al 6rea%men% &or 7i2rois. Uterine-artery embolization

versus surgery for symptomatic uterine fibroids Journal 0r%i+le.

Mul%i+en%er (%uy. New England Journal of Medicine. !"#$%:"&'(&)

*&&( Jan *!.

5o)sepian DM. Ra%%s V(. Rori*uez M. 5uan* J(. 0u2u+hon MG.$il*ram 6E. A prospective comparison of the impact of uterine

artery embolization, myomectomy, and hysterectomy on ovarian

function. Journal of +ascular , Interventional -adiology. (#(%:'

!) *&&" Jul.

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Case Presentation Uterine Myoma