Beruflich Dokumente
Kultur Dokumente
STEP 1
Adneksa
: alat alat organ panggul sekitar dari uterus atau rahim,
misalnya: ovarium, tuba fallopi dan ligementumnya
Vaginal discharge : cairan yg keluar dari vagina.
STEP 2
1. Why does she complaints over 15 days of menstruation?
2. Why does she has foul-smelling, discharge between irregular merstrual
cycle?
3. Is there any relation between her and her mother who died cause of
cervical cancer?
4. Why the patient needed to test by USG and histopathology examination?
5. What is the relation between anemic and obesity?
6. Whats the interpretation of gynecologival examination?
7. Whats the relation between the size of uterus and the abdominal pain?
8. What.s the correlation of patient irregular menstruation cycle, sometimes
ywice in a month?
9. What is the sign of she had been married and never conceived?
10.Whats the correlation between age and the problem of the patient?
11.Why did the patient had this condition since she was young?
12.Differential Diagnosis?
13.Treatment of the scenario?
14.Risk factor of this scenario?
15.Clinical examination of this scenario?
STEP 3
1. Why does she complaints over 15 days of menstruation?
Aktivitas/fisik pekerjaan berat. May cause imbalance of estrogen and
progesteron.
Psikis stress, axiety.
Normal duration of mestruation is between 3-8 hari
Menoragia, because of abnormal heavy and prolonged menstrual period
Because of the immaturity of hypothalamus, hypofisis axis, ovarium,
endometrium. Hypophisis is not in normal condition and the ovarium is not
matture
The probability of the case is leiomyoma, adenomiosis, polip
endometrium, hyperplasia endometrium, cervical cancer, malformation
artery or vein in uteri, haemostasis disturbance as like von wilebrand
disease, disturbance factor 2,5,7,9, 13. Trombositopenia and platelet
disturbance, thyroid disease, renal failure, systemic lupus eritematosous,
adenoma, prolactinomia, stress and over exercise.
Diabetic, obesity and intake of medication (antiepilectic, antipsicotic)
8. Whats the correlation between age and the problem of the patient?
Kemungkinan dari muda pasien ini sudah ditemukan adanya massa yg
menghambat pasien untuk hamil dan terjadinya menstruasi yg lama.
9. Whats the correlation between her mother condition and the patient
condition thats not pregnant yet?
10.Why did the patient had this condition since she was young?
Aktivitas/fisik pekerjaan berat. May cause imbalance of estrogen and
progesteron.
Psikis stress, axiety.
Normal duration of mestruation is between 3-8 hari
Menoragia, because of abnormal heavy and prolonged menstrual period
Because of the immaturity of hypothalamus, hypofisis axis, ovarium,
endometrium. Hypophisis is not in normal condition and the ovarium is not
matture
The probability of the case is leiomyoma, adenomiosis, polip
endometrium, hyperplasia endometrium, cervical cancer, malformation
artery or vein in uteri, haemostasis disturbance as like von wilebrand
disease, disturbance factor 2,5,7,9, 13. Trombositopenia and platelet
disturbance, thyroid disease, renal failure, systemic lupus eritematosous,
adenoma, prolactinomia, stress and over exercise.
Diabetic, obesity and intake of medication (antiepilectic, antipsicotic)
11.Whats the interpretation of gynecologival examination?
Abnormal uterus: the size was about swans egg.
Bagaimana cara melakukan pf pembesaran uterus?
12.Why the patient needed to test by USG and histopathology examination?
To see if theres a mass or enlargement in the uterus, dan apakah ada
keganasan pd massanya
TSH
HSG : Hidrosalfingography (?)
Toxoplasma : IgM and IgG
Pap smear
13.Differential Diagnosis?
Leiomyoma
Endometriosis
Ca cervix
14.Treatment of the scenario?
High Dose Estrogen
15.Risk factor of this scenario?
Obesity
Genetic
Life style (Bad)
Hormone
STEP 7
1. Why does she complaints over 15 days of menstruation?
Uterine fibroids arise from the myometrial layer of the uterine corpus or, less
commonly, the uterine cervix, and may occur singly or multiply. Fibroids may remain
within the muscular layer (intramural) or protrude outwardly to become subserosal in
location or inwardly towards the endometrial cavity, where they become known as
submucous
fibroids.
Subserosal
and
submucosal
fibroids
may
become
Progesteron memungkinkan pembesaran tumor dengan cara downregulation apoptosis dari tumor. Estrogen berperan dalam pembesaran
tumor dengan meningkatkan produksi matriks ekstraseluler (Hadibroto,
2005).
a. Perdarahan abnormal
Gangguan perdarahan yang terjadi umumnya hiperminore, menoragia dan
dapat juga terjadi metroragia, Perdarahan abnormal ini yang dapat
menyebabkan anemia defesiensi besi.
Patofisiologi perdarahan uterus abnormal yang berhubungan dengan
mioma uteri masih belum diketahui dengan pasti. Beberapa penelitian
menerangkan bahwa adanya disregulasi dari beberapa faktor
pertumbuhan dan reseptor-reseptor yang mempunyai efek langsung pada
fungsi vaskuler dan angiogenesis. Perubahan-perubahan ini menyebabkan
kelainan vaskularisasi akibat disregulasi struktur vaskuler didalam uterus
yang menyebabkan terjadinya venule ectasia.
gambar
uterus
normal
dan
struktur
The vaginal discharge can become chronic and foul-smelling, due to fibroid
expulsion, and surgical evacuation of the uterus may be required.
http://www.gponline.com/clinical-review-uterine-fibroids/article/1115934
3. Is there any relation between her and her mother who died cause of
cervical cancer?
4. What is the correlation between obesity and sign, symptom of patient?
Astudyfoundthattheriskofmyomasincreased21%witheach10 kgincrease
in body weight and with increasing body mass index [21]. Shikora et al.
reportedsimilarresultsinwomenwithgreaterthan30%bodyfat[22].The
adipose tissue converts adrenal and ovarian androgens into estrogens,
whereas several mechanisms associated with obesity lead to decreased
synthesis of sex hormone binding globulin. Consequently, the increase of
biologicallyavailableestrogenscouldberesponsibleforincreasingmyoma
prevalenceand/orgrowthinoverweightandobesewomen.Furthermore,
NairandAlHendyevaluatedtheassociationbetweenobesityrelatedchronic
inflammationandinitiation,aswellastheprogressionofuterineleiomyomaby
usinganin vitromodelwithrepresentativecelllinesofadipocytesandhuman
uterineleiomyomacells.Theydemonstratedthatcocultureofadipocytesand
uterine leiomyoma cells results in an increased proliferation of leiomyoma
cells,andtheyhavealsodemonstratedthatTNFtreatmentincreaseshuman
Rasa Nyeri
Rasa nyeri bukanlah gejala yang khas tetapi dapat timbul karena
gangguan sirkulasi darah pada sarang mioma, yang disertai
nekrosis setempat dan peradangan. Pada pengeluaran mioma
submukosa yang akan dilahirkan, pada pertumbuhannya yang
menyempitkan kanalis servikalis dapat menyebabkan dismenore.
The pathogenesis of pain associated with these lesions is also a mystery. Some
authors have suggested that pain could result from local pressure by the tumor on
cutaneous nerves. However, the histologic findings do not show that prominent nerve
fibers are associated with these tumors. Others have theorized that specific
infiltrating cells may play a role; one study of 24 angioleiomyomas revealed that
painful tumors had fewer mast cells than asymptomatic ones. Yet others have
suggested that muscle contraction may be pivotal in the induction of pain.
The excitation of the arrector pili muscle occurs via the sympathetic nervous system.
Norepinephrine, secreted by postganglionic nerve fibers, activates the alphareceptors of the muscle. Muscle contraction ensues; this is triggered by the influx of
ions, most specifically calcium. Understanding this basic physiologic process may be
relevant to the medical treatment of symptomatic leiomyomas.
http://emedicine.medscape.com/article/1057733-overview#aw2aab6b2b2
6. Whats the correlation of patient irregular menstruation cycle, sometimes
twice in a month, and anemic?
7. What is the sign of she had been married and never conceived?
8. Whats the correlation between age and the problem of the patient?
9. Whats the correlation between her mother condition and the patient
condition thats not pregnant yet?
http://emedicine.medscape.com/article/1057733-workup#a0723
13.Differential Diagnosis?
14.Treatment of the scenario?
15.Risk factor of this scenario?
16.Other clinical examination of this scenario?
HSG : Hidrosalfingography (?)