Case Presentation

Uterine Myoma

Presented by: Abu, Camile Granada, Glyde Pebbles Landicho, Katrina Linatoc, Jeanne Lyn Luza, Ailen Maralit, Ma. Krishna Sim, Khay Ulan, Darlene Umali, Marianne Lyn Avena, Gaudencio Dimaculangan, Argenald Joseph Hernandez, Michael Franklin

INTRODUCTION Uterine myoma is the most common tumors of the female genitalia tract. Myoma commonly called fibroid. It is the benign tumor of the smooth muscle in the wall of the uterus. Hysterectomy has been a common therapy in patients who have completed reproduction. Total hysterectomy plus unilateral salphingo oophorectomy TAHBSO- this procedure removes the utereus, cervix, one ovary and one fallopian tube, while one ovary and one fallopian tube are left in places.

Fibroids can be present and be apparent. However they are clinically apparent in up to 25 % of the women. Although, myoma is generally considered to be slowly growing tumor in 20-40% of women at the age of 35 and more have uterine fibroids of significant sizes with severe clinical symptoms. Moreover, myoma can be relapse in 7-28% of patient after surgical treatment and in certain case it may even turn to malignant tumor, this could causes significant morbidity including prolonged or heavy menstrual bleeding, pelvic pleasure and pain and in rare cases reproductive dysfunction. Myoma affects one of every four women ¾ of woman with this condition,however, experience no symptoms.

Uterine myoma is developing on the background of hyper estrogen, progesterone, deficits in hyper gonodotrophine. The majority of the researches say that the growth of myoma depends on concentration of cystosolic receptors to the sex hormones and their interactions, with the endrogen or extrogen hormones. In accordance to clinical observations, it can be admitted that both growth and regressions of myoma are estrogen-dependent, is the tumor size gets increased during pregnancy and is regressed after menopause. The only that needs to clear is to find out whether it is decreased in receptors numbers of estrogen, progesterone and androgen- hormones quantities which lead to regression in myoma size ( regarding androgen there is an hypothesis that myoma is sensitive to androgen ) for growth that formed tumors, the need to be further supported by negative factors.

Abortions, long term used of inadequate contraceptive pills, chronic sub-acute and acute inflammation of uterus or its appendices, stress, ultraviolet radiation, cystic formation of ovary etc. for example, the woman who had ten abortions by the age of thirty have double to developed uterine myoma at fourty years old. In fact, uterine myoma = account for 20% of 650,000 hysterectomies performed annually in the U.S interest in the uterine preservation and organ preserving surgery through techniques minimally invasive surgery has increased the first reports of laparoscopic myomectomy.

PATIENT’S PROFILE PATIENT’S NAME: Lady L. AGE: 48 years old GENDER: Female PERMANENT ADDRESS: Inosluban, Lipa City BIRTHDATE: August 26, 1960 BIRTHPLACE: Lipa City, Batangas CIVIL STATUS: Married CITIZENSHIP: Filipino RELIGION: Roman Catholic ADMISSION DATE: August 22, 2008 ADMISSION DIAGNOSIS: Uterine Myoma ATTENDING PHYSICIAN: Dra. Lovely Cacho Dra. Alice Lojo

HISTORY OF PRESENT ILLNESSS Present condition started about 6 years prior to admission. When patient noted heavy vaginal bleeding and body weakness every menstrual period that last almost a week. Due to that instance, she went to the hospital for check-up and she found out that she has a myoma. Her attending physician said that she need to undergo surgery but they didn’t have enough money that time, they would need to save for the hospitalization and operation that will undergo. Until August 22, 2008, when her relative noted her to be pale, having dizziness and body weakness bought her to the hospital. After a series of examination, she was scheduled and prepared her to surgery.

PAST MEDICAL HISTORY She has never been hospitalized except when she had two breech presentations with her two sons. Other than that, she usually experiences cough, cold, fever and buys over the counter drugs to treat the said illnesses. Prior to that, sometimes she consults the said quack doctors or faith healers if she thinks that it’s just that a simple illness.

SOCIO – CULTURAL She is a friendly person. She is closed with her four sons and loves them so much. She admitted that few years ago, she used to smoke when she is defecating and after eating. She said that she loves to eat vegetables and she exercises regularly. She cooks in a canteen in Lipa bus stop which sustains their basic needs.

PHYSICAL ASSESSMENT ACTUAL NORMAL VITAL SIGNS VALUES

INTERPRETA TION

RR- 24

12-20 beats/min.

Normal

PR- 80

60-100 beats/min.

Normal

BP- 120/70

90/60- 130/90 mmHg

Normal

Height = 5’1 cm

Weight = 57 Kg.

Body Parts Technique Normal used findings

Actual findings

Significance

Head

Inspection Palpation

NormocephaNormocephaNormal lic lic Normal No No abdominal abdominal mass mass

Hair and scalp

Inspection

Evenly distributed, Thick hair, no infection and infestation

Even Normal distribution of hair , no infection and infestation

Eyes

Inspection

Symmetric Sunken to the face, eyeball both eyes coordinated with parallel alignment.

Not Normal. Due to dehydration

External eye Structure Eyebrows

Inspection

Hair evenly Evenly distributed, distributed Skin intact with skin intact

Normal

Eyelashes

Inspection

Equally distributed, Curled slightly outward

Equally Normal distributed, Curled slightly outward

Eyelids

Inspection

Skin intact, Skin intact, Normal No no discharge, discharge, No no discolorationdiscoloration , , lids are Lids close symmetrical. symmetricall y

Lacrimal gland

Inspection No edema No edema Normal or tearing. and tearing

Pupils Inspection Black in (color , color, equal shape and in size symmetry normally 3of size) 7 mm in diameter, round smooth border , iris flat and round.

Black in Normal color, equal in size 4mm in diameter

Ears

Inspection Symmetrica Positioned Normal lly aligned symmetrically to the face, to the face, firm and No notable ear not tender discharge, with no clean and dry,. discharged noted.

Nose

Inspection Symmetric and straight, no discharges or flaring

Symmetric Normal and straight , no nasal discharges noted, no flaring noted

Mouth Lips

Inspection Uniform Uniform dark pink in color dry color, soft and moist and smooth

Tongue

Inspection Tongue at midline without lesion

Not Normal due to chemical content of cigarette such as nicotine.

Dry and free ofNormal lesion

Teeth

Inspection

Complete, Incomplete, Not normal. white, shiny missing teeth, ill Aging is a tooth enamel, fitting dentures factor free of debris affecting loss of teeth and also insufficient calcium and fluoride.

Neck

Inspection Palpation

Coordinated , Coordinated Normal smooth movement with Normal movement no discomfort with no No masses, discomfort tenderness No masses, tenderness

Upper Inspection Extremities Skin

Palpation

Pinkish in color

Pallor

Not normal. It is a manifestatio n of in adequate circulating blood or hemoglobin.

Slightly moist

Poor skin turgor Not normal due to dehydration

Palpation

Arms

Normother Not warm, not Normal mia cold to touch, T=36

Inspection Normally Normally firm, Normal Palpation firm, no no contracture, Normal contracture, no swelling, no swelling, equal size on equal size both sides of on both body sides of Pulse rate: 80 body Pulse Rate: 60-100

Nails

Inspection Palpation

Smooth, highly Pink, smooth Normal vascular and texture, convex Normal intact curvature epidermis Capillary refill: 2 Capillary Refill seconds of 1-2 seconds

Chest and Lungs

Inspection

Symmetric Symmetric chest Normal chest expansion, quiet, expansion, rhythmic and quiet, rhythmic effortless and effortless respiration respiration

Palpation

No No retraction, Normal retraction, no tenderness, no no masses tenderness, no masses

Auscultatio Quiet, n rhythmic

Heart

BronchovesiculNormal ar and vesicular breath sounds

Auscultatio Normal Cardiac rate of Normal n heart rate 80 60-100bpm

Abdominal

Inspection

Unblemishe Lesions noted Not normal d skin, on the surgical because of uniform in site post color procedure done

Auscultation Average Audible bowel Normal normal sound of 8 per bowel minute sounds 5-25 per minute

Lower Inspection No lesion, extremities Palpation can move Skin freely Capillary refill: 1-2 seconds

No edema, no Normal deformities Normal and can move freely Capillary refill: 2 seconds