L1: Fibroid Flashcards
1
Q
Another Name of Fibroid
A
Uterine Leiomyoma
2
Q
Def of Fibroid
A
- It is a benign tumor arising from smooth muscles of the uterus and associated fibrous tissues.
3
Q
Incidence of Fibroid
A
4
Q
Etiology & PPT Factors for Fibroid
A
5
Q
Hyper-Estrogenic States
A
6
Q
NE of Fibroid
A
7
Q
Sites of Fibroid
A
8
Q
Sites of Fibroid
- Corporeal
A
9
Q
Sites of Fibroid
- Cervical
A
10
Q
Sites of Fibroid
- Ligaments
A
11
Q
Size of Fibroid
A
The size varies from a small seedling up to a large tumor filling the abdominal cavity.
12
Q
Shape of Fibroid
A
- Tumor may be spherical OR polypoidal
- The uterus may be symmetrically OR asymmetrically enlarged.
13
Q
Surface of Fibroid
A
14
Q
Surrounding of Fibroid
A
- The surrounding muscle fibers are compressed to form a false capsule.
15
Q
Consistency of Fibroid
A
16
Q
CS of Fibroid
A
- It shows a whorl appearance & is paler than the surrounding.
- It has a false capsule formed of the compressed surrounding myometrial muscles.
17
Q
Capsule of Fibroid
A
The capsule is formed of compressed surrounding muscle fibers.
18
Q
ME of Fibroid
A
19
Q
Blood Supply of Fibroid
A
20
Q
Complications & Pathological Changes in Fibroid
A
21
Q
Complications & Pathological Changes in Fibroid
- Degenerative Changes
A
22
Q
Degenerative Changes in Fibroid
- Hyaline Deg.
A
23
Q
Degenerative Changes in Fibroid
- Necrosis
A
Occurs at the tip of a fibroid polyp.
23
Q
Degenerative Changes in Fibroid
- Atrophy
A
Physiological atrophy after menopause or pregnancy.
24
Degenerative Changes in **Fibroid**
- Cystic Deg.
It is either due to:
- Liquefaction of the hyaline material (false cyst)
- Telangiectasia (true cyst)
25
Degenerative Changes in **Fibroid**
- Fatty Deg.
- Precedes calcification
- The tumor becomes yellow & rubbery in consistency
26
Degenerative Changes in **Fibroid**
- Calcification
* The tumor becomes stony hard
* White patches are seen at the periphery.
* X-ray: reveals an eggshell appearance [womb stone].
27
Degenerative Changes in **Fibroid**
- Red Deg.
28
Incidence of **Red Degeneration**
Common in pregnancy due to:
- Rapid growth of tumor
- Increased vascularity
- Increased fibrinogen
29
CP of **Red Degeneration**
- Acute abdominal pain & tenderness
- Vomiting, low-grade fever & tachycardia.
30
TTT of **Red Degeneration**
- Treatment is mainly conservative as bed rest and analgesics,
- Myomectomy for affected tumors only if conservative treatment failed
- Surgery should be avoided to avoid bleeding.
31
Complications & Pathological Changes in **Fibroid**
- Malignant Changes
32
Malignant Changes in **Fibroid**
- Incidence
leiomyosarcoma is very rare (< 0.1% of myomas).
33
Malignant Changes in **Fibroid**
- Criteria susspecting Malignant Changes
34
Complications & Pathological Changes in **Fibroid**
- Vascular
35
Complications & Pathological Changes in **Fibroid**
- Infection
36
Infection in **Fibroid**
- Causes
37
Infection in **Fibroid**
- CP
- Lower abdominal pain, tenderness
- FAHM
- Tachycardia.
38
Infection in **Fibroid**
- TTT
- Antibiotics
- Myomectomy or hysterectomy after control of fever.
39
Complications & Pathological Changes in **Fibroid**
- Pelvic Organs Changes
40
Pelvic Organs Changes in **Fibroid**
- Uterus
41
Pelvic Organs Changes in **Fibroid**
- Ovaries
Functional follicular cysts are commonly associated with fibroid.
42
Pelvic Organs Changes in **Fibroid**
- Tube
- Chronic Salpingitis.
- Tubal block by cornual fibroid.
- Stretch of the tube due to large broad ligament fibroid.
43
Pelvic Organs Changes in **Fibroid**
- Urinary organs
44
Complications & Pathological Changes in **Fibroid**
- Torsion of pedunculated sub-serous fibroid
45
Torsion of pedunculated sub-serous fibroid
- PPT Factors
- Moderate sized tumor with long pedicle
- Pregnancy or puerperium.
46
Torsion of pedunculated sub-serous fibroid
- CP
Acute abdominal pain, shock in some cases.
47
Torsion of pedunculated sub-serous fibroid
- TTT
- Anti-shock measures if the patient is shocked then
* Myomectomy or hysterectomy
48
Complications & Pathological Changes in **Fibroid**
- Rupture of a surface vein on a sub-serous fibroid
49
Rupture of a surface vein on a sub-serous fibroid
- CP
Picture of internal hemorrhage.
50
Rupture of a surface vein on a sub-serous fibroid
- TTT
- Anti-shock measures followed by myomectomy or hysterectomy.
51
Complications & Pathological Changes in **Fibroid**
- Impaction (incarceration)
- Occurs in cervical or posterior wall sub-serous myomas.
- It is liable to occur in the premenstrual period.
52
Complications & Pathological Changes in **Fibroid**
- Complications during pregnancy
53
Complications & Pathological Changes in **Fibroid**
- Complications during labor & PP
54
Dx of **Fibroid**
55
Symptoms in **Fibroid**
56
Symptoms in **Fibroid**
- Asymp
accidentally discovered in many cases.
57
Symptoms in **Fibroid**
- AUB
58
Symptoms in **Fibroid**
- Pain
59
Symptoms in **Fibroid**
- Infertility
60
Symptoms in **Fibroid**
- Dys Group
dysuria, dyschazia, dysparuenia, dysmenorhea, and discharge.
61
Symptoms in **Fibroid**
- Mass
may be abdominal or pelvi-abdominal
62
Signs of **Fibroid**
63
Signs of **Fibroid**
- General
64
Signs of **Fibroid**
- Abdominal
65
Signs of **Fibroid**
- Local & Pelvic
66
INVx for **Fibroid**
67
INVx for **Fibroid**
- Lab
Blood picture, kidney function tests, liver function tests, estrogen level...
68
INVx for **Fibroid**
- Rad
69
INVx for **Fibroid**
- Endoscope
70
INVx for **Fibroid**
- Histopathology
Endometrial curettage to confirm diagnosis and to exclude malignancy
71
Leiomyoma subclassification system (FIGO classification)
- SM
72
Leiomyoma subclassification system (FIGO classification)
- O
73
Leiomyoma subclassification system (FIGO classification)
- Hybrid
74
TTT of **Fibroid**
75
TTT of **Fibroid**
- Prohylactic
- By avoidance of hyper-estrogenic state & proper ttt
76
TTT of **Fibroid**
- Actual TTT
77
Actual TTT of **Fibroid**
78
Actual TTT of **Fibroid**
- Indications of **No TTT But Follow up**
79
Actual TTT of **Fibroid**
- Examples of **Conservative Meds**
- GRH analogues
- Progestogens
(For 6-9 Months)
80
Actual TTT of **Fibroid**
- Indications of **Conservative Meds**
81
Actual TTT of **Fibroid**
- Examples of **Surgical TTT**
82
Mymectomy in **Fibroid**
- Indications
- Young patient < 40 years desiring pregnancy
- Small sized uncomplicated fibroid.
83
Mymectomy in **Fibroid**
- Adv
The uterus is preserved for future pregnancies.
84
Mymectomy in **Fibroid**
- Timing
Postmenstrual to decrease bleeding.
85
Mymectomy in **Fibroid**
- Types
- Abdominal [laparotomy or laparoscopy]
- Vaginal [polypectomy or hysteroscopy].
86
Mymectomy in **Fibroid**
- Disadv
87
Hysterectomy in **Fibroid**
- Indications
88
Hysterectomy in **Fibroid**
- Types
89
Salpingo-oophorectomy may be added in certain cases
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