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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 INTERPRETA
VITAL SIGNS VALUES TION

RR- 24 12-20 beats/min. Normal

PR- 80 60-100 Normal


beats/min.
BP- 120/70 90/60- 130/90 Normal
mmHg
Height = 5’1 cm Weight = 57 Kg.

Body Parts Technique Normal Actual Significance


used findings findings
Head Inspection NormocephaNormocephaNormal
Palpation lic lic Normal
No No
abdominal abdominal
mass mass
Hair and Inspection Evenly Even Normal
scalp distributed, distribution
Thick hair, of hair , no
no infection infection
and and
infestation infestation
Eyes Inspection Symmetric Sunken Not Normal.
to the face, eyeball Due to
both eyes dehydration
coordinated
with parallel
alignment.

External Inspection Hair evenly Evenly Normal


eye distributed, distributed
Structure Skin intact with skin
Eyebrows intact
Eyelashes Inspection Equally Equally Normal
distributed, distributed,
Curled Curled
slightly slightly
outward outward
Eyelids Inspection Skin intact, Skin intact, Normal
No no
discharge, discharge,
No no
discolorationdiscoloration
, , lids are
Lids close symmetrical.
symmetricall
y
Lacrimal Inspection No edema No edema Normal
gland or tearing. and tearing
Pupils Inspection Black in Black in Normal
(color , color, equal color, equal
shape and in size in size 4mm
symmetry normally 3- in diameter
of size) 7 mm in
diameter,
round
smooth
border , iris
flat and
round.
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 Symmetric Normal


and and straight ,
straight, no no nasal
discharges discharges
or flaring noted, no
flaring noted
Mouth Inspection Uniform Uniform dark Not Normal
Lips pink in color dry due to
color, soft chemical
and moist content of
and smooth cigarette
such as
nicotine.

Tongue Inspection Tongue at Dry and free ofNormal


midline lesion
without
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 Coordinated , Coordinated Normal


Palpation smooth movement with Normal
movement no discomfort
with no No masses,
discomfort tenderness
No masses,
tenderness
Upper Inspection Pinkish in Pallor Not normal.
Extremities color It is a
Skin manifestatio
n of in
adequate
circulating
blood or
hemoglobin.

Palpation Slightly Poor skin turgor Not normal


moist due to
dehydration
Palpation Normother Not warm, not Normal
mia cold to touch,
T=36
Arms 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 Smooth, highly Pink, smooth Normal
Palpation vascular and texture, convex Normal
intact curvature
epidermis Capillary refill: 2
Capillary Refill seconds
of 1-2 seconds

Chest and Inspection Symmetric Symmetric chest Normal


Lungs 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, BronchovesiculNormal
n rhythmic ar and
vesicular
breath sounds
Heart 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, No edema, no Normal
extremities Palpation can move deformities Normal
Skin freely and can move
Capillary freely
refill: 1-2 Capillary
seconds refill: 2
seconds