Uterine fibroids

UTERINE FIBROIDS

DEFINITION

• Uterine fibroid is a leiomyoma (benign (non-

cancerous) tumor from smooth muscle tissue)

that originates from the smooth muscle layer

(myometrium) of the uterus

CAUSES

• unknown.

• Family history

• Genetic alterations.

• Hormones.

• Other chemicals.

RISK FACTORS

• Heredity.

• Race.

• Pregnancy and childbirth.

• Nulliparity Obesity

• Oral contraceptives.

TYPES

• BODY OR

CORPOREAL

FIBROIDS

• Intramural or

interstitial fibroids

• Subserosal fibroids

• Submucosal fibroids

• CERVICAL FIBROIDS 1-2 %

SECONDARY CHANGES IN

FIBROID

• Degenerative changes

• Hyaline degeneration:

• Cystic degeneration:

• Calcification:

• Fatty degeneration:

• Red degeneration:

• Septic degeneration:

• Infection

• Atropy

• Necrosis

• Vascular changes

• Sarcomatous changes

CLINICAL FEATURES

• 75 % remains asymptomatic

• Menustrual abnormalities

– Menorrhagia (30%)

– Metrorrhagia or irregular bleeding

• Dysmenorrhea

• Infertility(30%):

• Pain lower abdomen

• Abdominal swelling (lump)

• Pressure symptoms

• Abdominal examination

• Feel is firm more towards hard may be cystic

in cystic degeneration.

• Margins are well defined except the lower

pole.

• nodular may be uniformly enlarged

• Mobility is restricted from above downwards

but can be moved from side to side.

• Percussion : swelling is dull

• Pelvic examination

• Bimanual examination reveals uterus

irregularly enlarged

• Uterus is not felt separated from the swelling

and as such a groove is not felt between the

uterus and the mass.

• The cervix moves with the movement of the

tumour felt per abdomen.

DIAGNOSIS

• An abdominal, transvaginal or pelvic

ultrasound

• An endometrial biopsy

• A hysteroscopy

• Hysterosalpingography

• Laparoscopy

TREATMENT

• For symptomatic fibroids

• Medication to control symptoms

• Medication aimed at shrinking tumours

• Ultrasound fibroid destruction

• surgically aided methods to reduce blood

supply of fibroids

• Myomectomy or radio frequency ablation

• Hysterectomy

• Treatment for infection and anemia

• Embolization

Medications• Oral contraceptive pills

• GnRH agonists

• The antihormonal drug RU-486

(mifepristone)

• Danazol (Danocrine)

• Antifibrinolytics (tranexamic acid)

• Nonsteroidal anti-inflammatory agents

• Progesterone receptor modulator named

Ellaone

SURGERY

• Myomectomy

• Hysterectomy

• Uterine artery embolization,

• Uterine artery ligation

• Radio frequency ablation

• Endometrial ablation

COMPLICATIONS

• Menorrhagia.

• Abdominal pains

• Premature birth, labor problems,

miscarriages

• Infertility

• Leiomyosarcoma

• Twisting of the fibroid

• Anemia

• Urinary tract infections

• A c-section may be needed

• Some pregnant women with fibroids

have heavy bleeding immediately after

giving birth.

NURSING DIAGNOSIS

• Acute pain related to post operative wound as

manifested by facial expression and pain scale

score

• Imbalanced nutrition less than body

requirements related to pain as manifested by

decreased food intake.

• Impaired bowel elimination , constipation

related to decreased activity, pain on straining

• Disturbed sleep pattern related to pain and

hospitalization

• Risk for infection related to the surgery

• Low Self-Esteem related to changes in

femininity as evidenced by Withdrawal,

depression