Please enable JavaScript.
Coggle requires JavaScript to display documents.
Uterine fibroids (Clinical
presentation (Gynae symptoms
Heavy periods
…
Uterine fibroids
-
Complications
Compression symptoms
Bladder, bowel
-
-
Pregnancy problems
Acute pain
Pre-term, miscarriage, malpresentation, CS
-
-
Epidemiology
-
Reproductive age women, peak in 40s
-
Diagnosis
Investigations
-
Bloods
FBC, haematinics (anaemia)
U+Es, LFTs, clotting
Investigations
TV USS: fibroids (type, dimensions)
Hysteroscopy: biopsy if needed
-
History
POH
Gravidy/parity, conception, birth methods,
complications, complete family?
PMH/PSH
Medical conditions,
abdo/pelvic surgery
PGH
Menses, known conditions,
contraception, STIs, smears
DH
Regular meds, allergies
PC/HPC
Dysmenorrhoea, menorrhagia,
may have urinary symptoms, bloating
-
SH
Occupation, smoking/alcohol, ADLs
Examination
Abdo
Masses, firm, non-tender uterus
-
Management
Medical
Analgesia
Indication: dysmenorrhoea
E.g. NSAIDs, paracetamol
Hormonal
-
-
Hormonal contraception
Indication: heavy bleeding, not needing fertility
E.g. levornogestrel IUS, COCP, POP etc.
Non-hormonal
Antifibrinolytics
Indication: menorrhagia, need fertility
E.g. tranaxemic acid
MOA: reduces fibrinolysis, reducing bleeds
Mefamanic acid
Indication: menorrhagia/dysmenorrhoea, need fertility
MOA: inhibit PGs, reducing menorrhagia and dysmenorrhoea
-
Surgical
-
Myomectomy
Indication: intramural fibroid
MOA: open, laparoscopic or hyteroscopic
USS therapy
Indication: failed medical treatment
MOA: MR-guided, USS waves destroy fibroids
Hysterectomy
Indication: medical failure, family complete
Differentials
Neoplastic
Polyps
Cancer (cervical, endometrial)
Other pelvic tumour
-
-
Pathophysiology
Pathology
Tumour of smooth muscle +/- fibrous tissue (leiomyomas)
Often multiple, hand, round tumours of varied sizes
Oestrogen dependent, so enlarge in pregnancy and COCP
Atrophy at the menopause or after pregnancy (red degeneration)
Can cause pressure symptoms on other structures
Types
Submucosal: inner mucosal surface, extend into cavity, often symptomatic
Subserosal: under visceral peritoneum (outer serosal surface of uterus),
extend into uterine cavity, often asymptomatic; can cause pressure symptoms on bladder/bowel
Intramural: within myometrium, limited extension into the cavity, may be symptomatic
Pedunculated: into uterus or outside; mobile, prone to torsion
-