Beruflich Dokumente
Kultur Dokumente
UTERINE LEIOMYOMA
Supervised by:
dr. Hj. Hesty Duhita Permata, Sp.OG
Created by:
Yosefine Ivanda T (2016-061-031)
INTRODUCTION
Name : Mrs. I
Age : 47 years old
Nationality : Indonesian
Marital Status : Married
Occupation : Shop owner
Religion : Moslem
Address : Kp.Cikedok, RT 03/RW
04
Date of Admission : July 12th, 2017
Date of Examination : July 12th, 2017
CHIEF
COMPLAINT :
Heavy and painful bleeding from the genital that worsened
since 10 days before admission to the hospital.
HISTORY OF PRESENT
ILLNESS
Heavy and painful menstrual bleeding
5 years Bled 2x/month, duration 10-15 days, used 4-5 pads a
day
before admission Palpable solid mass in lower abdomen, slowly getting
bigger
Bleeding worsened
10 days Bright red, with a few dark red lumps, 24 pads/day, full
Abdominal mass (+)
before admission No abdominal/pelvic pain
HISTORY OF PAST ILLNESS
Gestational
No. Year Labor History
Age
1. 2000 3 months Abortus
PHYSICAL EXAMINATION
General condition : appeared moderately ill
Conciusness : compos mentis
Abdomen
Inspection : convex, mass in lower abdomen
Auscultation : bowel sound (+) 4 times/minute
Palpation : palpable solid mass on the center of
abdomen, from symphisis pubis to two fingers above umbilicus,
with smooth surface and strictly defined borders, no tenderness,
no fluctuation
Percussion : dull on mass area, but tympani on other
areas
Gynecological Examination
Vulva: normal, no edema, no lesion
Vagina : normal, no lesion
Bimanual Pelvic Examination:
palpable firm, irregularly enlarged uterus
can be moved from side to side
the cervix moves with the movement of the mass felt per
abdomen
Cavum Douglasi: empty.
LABORATORY EXAMINATION
(June 12th, 2017 09.53)
Normal
Types Result Unit
Value
Hematology
Hemoglobin 4,0 g/dL 12-14
Hematocrit 16 % 37-47
Leukocyte 5.700 /mL 4.000-10.000
150.000-
Platelets 299.000 /mL
450.000
Erythrocyte 2,8 millions/mL 3,8-5,2
MCV 57 fL 80-100
MCH 15 pg 26-34
MCHC 25 g/dL 32-36
TRANSABDOMINAL
ULTRASOUND
USG image shows an enlarged uterus with
hyperechoic lesion.
WORKING
DIAGNOSIS :
Mrs. I, 47 years old, with uterine leiomyoma and anemia.
MANAGEMENT
THEORY CASE
OBSERVATION Observe general condition, vital signs, and
bleeding
MEDICAL THERAPY Transfuse with PRC until Hb > 10 g/dL, check
Sex Steroid Hormones (anti-progesterone post transfusion Hb
e.g. Mifepristone, SPRM e.g. ulipristal Give tranexamic acid 3x500 mg IV
acetate, androgens e.g. danazol and Give mefenamic acid 3x500 mg IV
gestrinone)
GnRH Agonists (Leuprolide acetate,
goserelin, luporelin, buserelin or nafarelin)
Non-Hormonal Options (Tranexamic acid,
NSAIDs, WB or PRC transfusion)
SURGICAL THERAPY
LITERA
TURE
REVIE
W
DEFINITION
UTERINE LEIOMYOMA
ABDOMINAL EXAMINATION:
Inspection: abdominal lump or swelling.
Palpation:
Firm mass, maybe cystic in cystic degeneration.
Margins are well-defined.
Surface is nodular; may be uniformly enlarged in a single fibroid.
Mobility is restricted from above downwards but can be moved
from side to side.
Percussion: swelling is dull.
PHYSICAL EXAMINATION
Hysterectomy
Myomectomy
Uterus-preserving surgery that excises myomas and is
considered or women who desire fertility preservation or who
decline hysterectomy.
CONCLUSION
The diagnosis was made correctly by
the attending physician.
The management was only
symptomatic.
It is recommended to use COC and/or
leuprolide acetate if possible because
it would help shrink the leiomyoma
volume and improve bleeding
symptoms, while waiting for
menopause.
REFERENCES
1.Chapter 9: Pelvic mass. In: Hoffman BL, Schorge JO, Bradshaw KD,
Halvorson LM, Schaffer JI, Corton MM, ed. Williams Gynecology 3rd
edition. McGraw-Hill. 2016;3:202-12.
2.Chapter 19: Benign lesions of the uterus. In: Dutta DC, Konar H, ed. DC
Duttas Textbook of Gynecology 6th edition. Jaypee Medical Publisher.
2013;6:272-83.