Fibroid uterus

Fibroid uterus : 

Fibroid uterus By Dr Ravikanth Dept of obgy

Fibroid uterus (syn.leiomyoma,fibroma , myoma,) : 

Fibroid uterus (syn.leiomyoma,fibroma , myoma,) Commonest pelvic tumour-20% Arise from progenitor myosite Composed of muscle tissue with variable amount of connective tissue Frequently multiple may be 200 in one uterus Slow to grow

Etiology : 

Etiology Exact etiology is not known Rare before 20 yrs 20% in over 20 yr age 40%in over 40 yrs age Common in nulliparus and infertile woman ‘Fibroids are the reward of virtue,babies the fruit of sin’ Familial incidence Functional cysts of ovary Ass,-endometrial ca,endometriosis,

Sites of fibroid : 

Sites of fibroid

Rare variety : 

Rare variety

Rare variety : 

Rare variety Parasitic fibroid wombstone

symptom : 

symptom Asymptomatic Menorrhage Metrorhagia Pain abdomen Mass per abdomen

General effects on the body : 

General effects on the body Effects of anaemia Polycythemia –large broad ligament type Hypoglycaemia –in retroperitoneal Dyspepsia Urinary symptoms –frequency,retention Infertility ‘Woman postpones her pregnacy later fibroid postpones it ’ site of fibroid & ass,condition Pregnancy complications

Secondary changes : 

Secondary changes Degenaration atrophy fatty change calcification cystic degenaration red degenaration Torsion Infection Sarcomatous change – 0.2% Plain x-ray

Diagnosis : 

Diagnosis degen haemor fib tvs Contrast enhanced CT

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Thick endo Endo polyp sonosalphingography tvs

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egg shell calcification tvs

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T2 sagital T1 axial T1 sagital MRI

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Hysteroscoppic view normal Submucosal polyp

Differential diagnosis : 

Differential diagnosis Adenomyosis Pregnancy Ovarian tumour Abdominal tumour –eg.enterogenous cyst Abdominal tuberculosis

Management : 

Management No treatment <12 wk asymptomatic perimenopausal General treatment correction of anaemia Palliative treatment Waiting for surgery - danazol,progestogens,GNRHagonests.

Management : 

Management D&C,or endometrial aspiration Polypectomy Hysteroscopic Myomectomy Only as a Rx of infertility Hysterectomy vagainal , abdominal,laproscopic,LAVH Embolisation

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Wt 600g

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2nd postoperative day

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After one month

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After three month

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Another case 26 wk fibroid Wt -1kg