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8/16/2019 Case Presentation Uterine Myoma
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Case Presentation:
Uterine Myoma
Marijesmar Gonzalez Valle
OB GYN Clerkship
Dr. Rojas
July 19 !""#
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CC:
$a%ien% re&ers' “Me crecio la barriga”.
(%a%es ha)in* pel)i+ pain.
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HPI:
Case o& a ,- year ol pa%ien% G/$/0" %ha%
as ami%%e %o %he hospi%al ue %o pel)i+
pain. $a%ien% re&ers lo a2ominal
enlar*emen%. 3l%rasoun re)eale u%erinemyomas. $a%ien% as ami%%e an s+heule
&or sur*ery. Durin* sur*ery u%erine myomas
ere remo)e as ell as ahesions &rom
2oels %o %u2e.
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Past Medical History:
(ys%emi+ 4llness
56N
DM 44
0s%hma
Cons%ipa%ion
7amily 5is%ory
56N' ! sons
DM' (is%er3n+les
CVD' Gran&a%her
0n8ie%y' Mo%her
5. pylori' Mo%her
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OB Gyn Medical History:
G3P3A0: Ges%a%ionalia2e%es on /r. pre*nan+y:
Marital Status: Marrie
Religion: Ca%holi+
Sexual Partners: 1
First Coitus: !" years ol
Menarche:1" years
Menses: irre*ularsome%imes %i+e per mon%h
Dysmenorrhea: No
LMP: (%a%es %ha% oesno% remem2er
Dyspareunemia: No
SD!s: No
Contracepti"es: $ills Conoms Nu)aRin*
Dx: Pelvic pain ue %o3%erine Myoma
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Labs:
CBC
C5;M #
5*B' 1/.9
*
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Dx:
$el)i+ $ain
3%erine Myoma
0hesion &rom 2oels %o %u2e
Mil Cys%o+ele
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Procedures:
6o%al 02ominal 5ys%ere+%omy
Ri*h% (alpin*oophere+%omy
=ysis o& 0hesion
Va*inal 0n%erior all (uspension
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Uterine Myoma
0re lo+alize smoo%h mus+le +ell
proli&era%ion surroune 2y a
pseuo+apsule o& +ompresse mus+le&i2ers.
3p %o /"A o& 0meri+an omen ha)e
u%erine myomas.
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Uterine Myoma
DN0 s%uies re)eale'
6ha% ea+h myoma arises &rom a sin*le
smoo%h mus+le +ell
6he smoo%h mus+le +ell is )as+ular inori*in.
Consiere %o 2e 2eni*n %umors %ha% are
hormonally responsi)e %his is 2e+ausees%ro*en usually inu+es %heir rapi *ro%h in
hi*h es%ro*en s%a%es.
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Uterine Myoma
;s%ro*en
$rou+%ion o& pro*es%erone re+ep%ors in %hemyome%rium
$rou+%ion o& se)eral *ro%h &a+%ors
Gro%h o& myomas
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Uterine Myoma
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Types o Uterine Myomas
Intramural:
3%erine enlar*emen%
Subserous:
Pedunculated Submucous: ,A
Intracavitary:
02normal 2leein*an +rampin*
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!i"ns and !ymptoms:
Bleein* is %he mos% +ommon presen%in*
symp%om.
$ro*ressi)e in+rease in pel)i+ pressureH
$el)i+ $ain
5ypermenorrhea
Dysmenorrhea
Dyspareunia
Me%rorrha*ia
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Dia"nosis
02ominopel)i+ e8amina%ion
$el)i+ 3l%rasoun
;nome%rial Biopsy5ys%eros+opy
=aparos+opy
Compu%erize 08ial 6omo*raphyMR4
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#is$ %actors:
5i*h es%ro*en s%a%es'
$re*nan+y
3se o& oral es%ro*en;s%ro*en prou+in* %umors
=a%er reprou+%i)e an perimenopausal
a*e *roups./F9 %imes hi*her in 0&ri+anF 0meri+ans
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Clinical Presentation:
0no%her presen%a%ion is a sense o&
pro*ressi)e pel)i+ &ullness +ause 2y a
sloly enlar*in* in%ramural or
su2serous myomas hi+h on o++asionmay a%%ain a massi)e size.
$el)i+ pain mani&es% 2y %he onse% o&
se+onary ismenorrhea.
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Complications
Chroni+ 4ron De&i+ien+y 0nemia
3rina%ion pro2lems
5yroure%er 5yronephrosis
4n&er%ili%y
Mis+arria*e$rema%ure Deli)ery
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Mana"ement o Condition
Minimi#e $terine %lee&ing:
4n%ermi%%en% $ro*es%in
supplemen%a%ion
$ros%a*lanin syn%he%ase inhi2i%ors
GrR5 a*onis%' %emporally +hemi+ally
inu+e menopauseDanazol
Mi&epris%one R3F-@>:
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Treatment
Myome+%omy
=aparo%omy
5ys%ere+%omy3%erine 0r%ery ;m2oliza%ion 30;:
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Biblio"rap&y:
Be+kman Charles R.B. =in* 7rank . (mi%h Ro*er $. Barzansky
Bar2ara M. 5er2er% illiam N.$. I Dou*las . =au2e. Obstetrics
and Gynecology. $terine Leyomioma an& 'eoplasia. ,%h ei%ion.
=ippin+o%% illiams I ilkin*s. !"">. pp --@F-,-.
;ars RD. Moss JG. =umsen M0. u O. Murray =(. 6ale (.
Murray GD. Commi%%ee o& %he Ranomize 6rial o& ;m2oliza%ion)ersus (ur*i+al 6rea%men% &or 7i2rois. Uterine-artery embolization
versus surgery for symptomatic uterine fibroids Journal 0r%i+le.
Mul%i+en%er (%uy. New England Journal of Medicine. !"#$%:"&'(&)
*&&( Jan *!.
5o)sepian DM. Ra%%s V(. Rori*uez M. 5uan* J(. 0u2u+hon MG.$il*ram 6E. A prospective comparison of the impact of uterine
artery embolization, myomectomy, and hysterectomy on ovarian
function. Journal of +ascular , Interventional -adiology. (#(%:'
!) *&&" Jul.
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