LEIOMYOMATA OF THE UTERUS

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fibroma full description, diagnosis and managment by Dr Mbuilu jody

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LEIOMYOMATA OF THE UTERUS : 

LEIOMYOMATA OF THE UTERUS Drs J. Mbuilu & P. Nyindi O&G / MPH South Africa 10/16/2011 1

CONTENTS: 

CONTENTS Background DEFINITION INCIDENCE PATHOPHYSIOLOGY Diagnosis CLASSIFICATION PRESENTATION DIFFERENTIAL DIAGNOSIS MANAGEMENT COMPLICATIONS & PROGNOSIS REFERENCES

DEFINITION: 

DEFINITION Tumours of Mullerian duct origion,composed of Smooth muscle & fibrous strands. Fibroids>misnomer

INCIDENCE : 

INCIDENCE 5 – 25% of woman aged 35yrs( estimated at 1 in every 5) Rarely pre-puberty and in post-menopause

PATHOPHYSIOLOGY: 

PATHOPHYSIOLOGY High levels of unopposed oestrogen >endometrial hyerplasia Relation with endometrial Ca High risk:Nulliparae Low parity Baby v/s Fibroids!!!!!!!

CLASSIFICATION: 

CLASSIFICATION

PRESENTATION: 

PRESENTATION M/C- -Abdominal mass; 50% - Abdominal uterine bleeding ( menorrhagia) - Infertility - Vaginal discharge( infection of submucosal myoma - Uterine inversion, rarely in myomatous polyps - Usually painless -Pressure effects *Urinary retension Constipation Overflow incontinence

CONT…: 

CONT… Examination – General: Pallor Abdonimal mass +/- tenderness PV:+/-

DIFFERENTIAL DIAGNOSIS: 

DIFFERENTIAL DIAGNOSIS

D/D CONT…: 

D/D CONT… 1. Pregnancy:B – HCG 2. Ovarian tumours:Sonar ,C T ,Tumour makers 3. Ca endometruim : Age,endometrial sampling 4. Endometrosis 5.Obstructive : bladder masses Kidney masses

MANAGEMENT: 

MANAGEMENT SURGICAL vs NON-SURGICAL

CONT…: 

CONT… NON SURGICAL - Drugs: * Gonadotropin Releasing hormone analogue *Mifeprestone *Danazol *Traneximic Acid(cyclocapron)

`SURGICal Indications: : 

`SURGICal Indications: *Larger than 14 weeks *Distorts uterine cavity for pregnancy Situated in low part of uterus during pregnancy Complicated Sudden enlargement

SURGERY: 

SURGERY OPTIONS: *MYOMECTOMY vs HYSTERECTOMY -NB:Age,size of myoma & desire to fall pregnant, * Laparoscopic vs Laparotomy -NB:Multiple,size(>8 cm),deep submucosal>>>>>Lapapromy * Selective Uterine artery occlusion( Risk vs Benefit??)

Abdominal myomectomy: 

Abdominal myomectomy

Laparoscopic myomectomy: 

Laparoscopic myomectomy

COMPLICATIONS: 

COMPLICATIONS PREGNANT * 1 ST & 2 nd Trimester : > recurrent m/c >necrobiosis *3 rd Trimester >PROM >Preten labour >Abrution placentae >IUGR Pregnant vs Non-pregnant

CONT…: 

CONT… Non-Pregnant >Anaemia >Infection >Torsion >Ascitis

REFERENCE: 

REFERENCE T.F KRUGER,MH BOTHA.Clinical Gynaecology.3 rd edition.2007.pg207-210. Dr Ashraf Fouda.Manangement of Uterine Leiomyomas.May 2003. *http://www.firoidsecondopinion.com/fibroids.photos/

THANKS: 

THANKS