Fibroids 2022 PDF

FIBROID  44-year-old woman presented with history of heaviness in the lower part of abdomen for 6 months , associated with menorrhagia and increased urinary frequency. 1- what are your differential diagnosis/ mention types ? 2- which source of investigation need to confirm the diagnosis ?...

FIBROID  44-year-old woman presented with history of heaviness in the lower part of abdomen for 6 months , associated with menorrhagia and increased urinary frequency. 1- what are your differential diagnosis/ mention types ? 2- which source of investigation need to confirm the diagnosis ? 3- how we can treat her condition?  A 28 years old women G3P2 at 28 weeks of gestation presented with sever abdominal pain , O\E, her BP 110\70mmhg,PR-88b\m, temp.36.8c, abdominal examination fundal high at 35week of gestation longitudinal lie, cephalic presentation, FH 140b\m. no hx of vaginal bleeding. 1- what could be the cause behind her condition? 2- how will you confirm your diagnosis 3-mention 4 step in the management of this condition.  What is fibroid? Fibroidftp.hethtfn common in ent muscle gap reproductive It is a benign Tumor of uterine smooth muscles Also known as myomas or leiomyomas ,common in reproductive age groups, are made up of round whorls of smooth muscles and connective tissue, it can be as small as a pea and can grow as large as a melon. estrafox It is estimated that 20-50% of women have, or will have fibroids at some time in their life. They are rare in women under the age of 20. Most common { women in their 30s and 40s, Timonin 30s and 40s black , nallipara, in blacks Nullipova +ve family hx , obesity , smoking}. vetalyhistoryobesitsmoking long term use of OCPs& Depoprovera are ass. with reduced risk,and tend to shrink after the menopause reduce huh of fibroids Pathophysiology fibroids are hormone dependent and contain receptors for both oestrogen&progesteron ,their action mediated by a number of growth factors {epidermal G.F., apoptosis –inhibiting protein reduced of growth inhibitory ( monocyte chemotachtic protein-1} Cytogenic aberration on Chr.(3,6,7,12). malignant transformation (0.1%) to sarcoma.  Types of fibroids within myonetrium Intramural — these grow in the wall of the uterus and are the most common type of fibroid. beneath Sub serous—- these fibroids grow sevorn from the outer layer of the uterus wall and sometimes grow on stalks (called pedunculated fibroids). Sub serous fibroids can grow to be very large.  beneathendometrium Sub mucous — submucous fibroids develop in the muscle underneath the inner lining of the uterus. They grow into the uterine cavity and can also grow on stalks which, if long enough, can hang through the cervix. Cervical — cervical fibroids grow in the wall of the cervix (neck of the uterus) and are difficult to remove without damaging the surrounding area. differ  broad ligament vascan Interligamentous Fibroid dangerous A fibroid which grows sideways between the ligaments which support the uterus in the abdominal region. This type of fibroid is especially difficult to remove without the possibility of interfering with the blood supply or other organs. Parasitic Fibroid The rarest form of fibroid occurs when a fibroid attaches itself to another organ. fileroid on  Fibroids — Symptoms 50 conthovesymptoms It is estimated that 50% of women with fibroids do not have symptoms. symptoms depends on the size of the fibroids a large fibroid might press against bladder, causing bladder problems. Fii FFesizes 50 ASYMPTOMI found incidentally on 4150  am menomyc heavy Heavy menstrual bleeding (menorrhagia) Heavy bleeding may involve flooding (a sudden gush of blood), long periods or passing large clots of blood. Anemia (iron deficiency) toferter Averi or Pain and pressure Some women with fibroids experience painful periods, dull aches in their thighs, back pain or constant pressure in the abdominal area that feels like bloating or fullness. Occasionally, fibroids can cause sudden severe pain in the pelvic area or lower back. This may be due to a fibroid on a stalk (pedunculated) that has become twisted. This kinks the blood vessels in the stalk and cuts off the blood supply to the fibroid. 86  if fibroid Pain during sex(Dysparonia)is on the cervix Dysparain Fibroids that press on the cervix or hang through the cervix into the vagina can make penetrative sex painful and can also cause bleeding during sex. can also bleeding during sex Bladder frequency frequent need to urinate urgency leaking or dribbling urine dribbling wine urinaryretention urgent need to urinate, often passing only a small amount Urinary retention ,difficulty or inability to pass urine – this is very serious may need urgent care. A foleys catheter will be use to empty bladder. Bowel constipation hemorrhoids (piles) Bowel constipation hemorrhoids  Fibroids and pregnancy They could Most fibroids do not get in the way of a pregnancy. Eine Some fibroids in certain areas, however, can make conception difficult or lead to miscarriage. Fibroids may press against, or block the entrance to, the fallopian tubes, thus preventing the egg from reaching the uterus. E Sub mucous fibroids that grow inwards into the uterine ItimT cavity are thought to cause recurrent miscarriage. 1st mist During pregnancy fibroids grow during pregnancy because of higher levels of oestrogen. Another effect of pregnancy on fibroids called 'red degeneration.' This is when a center of fibroid cut off from blood supply so it under go o f necrosis. during pregnancy.fi edevotion Eg Red degeneration can cause intense abdominal pains and uterine contractions, which could lead to early labour (PPROM). early labor PPROM Treatment is only conservative by analgesia, IVF and tocolytic. L WE A fibroid can also interfere with delivery if it blocks the passage of fetus to the birth canal, which may recommend a Caesarean section. post labor may increase the risk of postpartum hemorrhage. Complication or changes in the fibroid management until Enfervative she delivers Red degenration. Most common in pregnancy Calcification. In menopause common Twisted (tortion) Necrosis Sarcomatous Hyaline degenration Infection.  Diagnosis 1- history & physical examination. 2-Ultrasound scan It can provide more detailed information about the size and location of fibroids. u/s also used to exclude HYDRONEPHROSIS o and to distinguish ovarian Mass from fibroids. If the ultrasound results are unclear, may need a hysteroscopy or laparoscopy. 3-Hysteroscopy Submulowal A hysteroscopy can be used for visualization of the uterine cavity by using a small telescope (hysteroscopy) which is inserted into uterus through vagina, and can also be used to take a biopsy (tissue sample) under a local or general anesthesia. grammar 4- Laparoscopy A laparoscopy looks to the size and shape of the uterus from outer surface. It can also be used to take tissue samples.  D.DX. 1-From any abdominal& pelvic masses in reproductive years. 2- pregnant uterus. fetus 3-overian tumor tumo 4- sarcoma of uterus savium  Living with fibroids& prevention As the cause of fibroids is still unknown, there are no clear guidelines for preventing them. However, there are some things that may help reduce risk: Reduction body weight, this will minimize estrogen levels in your body. An Italian study found that women who eat little meat but a lot of green vegetables and fruit seem to be less likely to develop fibroids than women who eat a lot of red meat and few vegetables.  Treatments If fibroids are a symptomatic, need conservative management and regular follow up ultrasounds to check if they are growing and increasing in size. Treatment will depend on several factors, including the severity of symptoms, the size and position of fibroid(s), age and whether or not want to have children in the future. If women nearing the menopause, for example, when fibroids tend to shrink on their own, wait and symptoms will improve without treatment. conservative & medical treatment Correction of anemia by oral iron Transexamic acid: used in preference to NSAIDs for the menorrhgea. COCs: long term use 50% decrease menorrhgea. progesterone: long term medroxy pro. will protect from fibroids levonorgesterel-releasing IUDs will protect better than copper both danazol &androgenic anti progesterone as gesteronon reduce size &blood loss from fibroids mefeprostol wich is antiprogesteron decrease size of fibroids &less effect on bone density  A group of drugs, called GnRH analogues, reduce oestrogen levels as a result, cause fibroids to shrink. Studies have shown that when taken for six months, GnRH analogues can reduce the size of fibroids by up to 50%. They also stop menstrual bleeding and pelvic pain. GnRH analogues use in patient who are unfit for surgery or failure of medical therapy, also Prior to hysterectomy & I myomectomy to decrease blood loss , size & more chance of transverse abd. Incision, iron therapy used with to treat anemia. GnRH analogues side effect These include menopause-like symptoms such as hot flushes, vaginal dryness and bone loss (osteoporosis) Once drug stop fibroids begin to grow againe, periods should also return within a few weeks, although some women may no longer ovulate after treatment. In some cases, may recommend them as a temporary treatment for women who are nearing menapouse. Add-back therapy ome I o 1- (Tibolol)Is treatment of choice for add- back therapy with GnRH for long term to decreass size ,bone loss, vasomter symptoms L 2- Low dose estrogen(0.75mg or 0.3mg) conjugated estrogen with cyclical norethesteron0.7mg or continuous norethesteron 10mgfor aperiod of 2years.  Surgical procedures The main treatments for fibroids are: 1- Myomectomy (removing fibroids individually, leaving the uterus intact) ( laparotomy,laparoscopy,Hyteroscopy). laparotomy for the (intramural) and in the outer layer of the uterus (subserous). Laparoscopic Myomectomy Hysteroscopic myomectomy For submecosa