tailieunhanh - Case lâm sàng sản khoa - Case 6

Tham khảo tài liệu 'case lâm sàng sản khoa - case 6', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 24 A 40-ycar-old G5 P5 woman complains of menorrhagia of 2-yr duration. She states that several years ago a doctor had told her that her uterus was enlarged. Her records indicate that 1 yr ago she underwent a uterine dilation and curettage with the tissue showing benign pathology. She takes ibuprofen without relief of her vaginal bleeding. On examination her BP is 135 80 HR 80 bpm and temp is 98 F. The heart and lung examinations arc normal. The abdomen reveals a lower abdominal midiinc irregular mass. On pelvic examination the cervix is anteriorly displaced. An irregular midline mass approximately 18 weeks size seems to move in conjunction with the cervix. No adnexal masses are palpated. Her pregnancy test is negative. Her hemoglobin level is g dL leukocyte count is 10 000 mm3 and platelet count is 160 000 mm3. What is the most likely diagnosis What is your next step 202 CASE FI LIAS OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 24 uterine Leiomyomata Summary A 40-year-old G5 P5 woman with a history of an enlarged uterus complains of menorrhagia and anemia despite ibuprofen. A prior uterine dilation and curettage showed benign pathology. Examination reveals an irregular midline mass approximately 18 weeks size that is seemingly contiguous with the cervix and there is an anteriorly displaced cervix. Most likely diagnosis Symptomatic uterine leiomyomata. Next step Hysterectomy. Analysis Objectives 1. Understand that the most common reason for hysterectomy in the United States is symptomatic uterine fibroids. 2. Know that hysterectomy is reserved for symptomatic uterine fibroids that arc refractory to an adequate trial of medical therapy. 3. Know that menorrhagia is the most common symptom of uterine leiomyomata. Considerations This 40-year-old woman complains of menorrhagia. The physical examination is consistent with uterine fibroids because of the enlarged midiinc mass that is irregular and contiguous with the cervix. If the mass were lateral or moved apart .