IV.

NARRATIVE PATHOPHYSIOLOGY

Leimyomas are the most common benign tumors of the female genital tract. The mass is mostly composed of muscles and fibrous connective tissue. It is hypothesized that its growth is related to estrogen stimulation. The incidence is higher on women during the reproductive years where estrogens and other hormones are actively produced by the body. Many women opt to use oral contraceptives as a birth control method. Oral contraceptives promote estrogen dominance and eventually influence the growth of the cells in the uterus. High-fat diet is also considered a source of estrogen where as diets rich in fiber and low in fat decreases estrogen reabsorption. Leimyoma formation is also possible because of hyperestrogenism due to progesterone deficiency that is caused by luteal insufficiency. Apart from estrogen stimulation, heredity is a factor in the occurrence of leimyomas. Fibroids formation is 4.2 times more common in first-degree relatives than with fibroids without genetic influence. Estrogen is vital in the regulation the menstrual cycle. Presence of this hormone during the first phase influences the proliferation of smooth muscle cells in the uterine walls. Overstimulation increases the size of the uterine lining and further develops into a fibroid. During menstruation, the excessively thickened endometrium does not desquamate (shed its lining) easily (or even completely) at the end of the cycle, resulting in prolonged and/or excessive menstrual bleedings. Following the degeneration of the interior part of the fibroid, are the degenerative changes that eventually replace smooth muscle cells by fibrous connective tissue. The fibroid continually grows and its size puts pressure on the adjacent organs, the bladder and rectosigmoid. Urinary frequency and constipation, respectively, are the results of the compression of these organs.

V. SCHEMATIC PATHOPHYSIOLOGY Uterine myomas also called fibroids are tumors that grow from the wall of the uterus. Predisposing Factors Age- 42 y.o. Gender Family History- sister Use of OCP- 13 years Increased hormonal production of estrogen Precipitating Factor Luteal Insufficiency High fat diet

Proliferation of smooth muscle

Overgrowth of uterine lining Development of uterine Increased blood flow volume (before: does not use sanitary pads; upon palpation of mass: 4-5 sanitary pads/day during menstruation)

Degeneration of interior part of the

Hyaline Degeneration

Red or carneous

Smooth muscle cells are replaced by fibrous connective tissue

Continued growth of fibroid

Increased abdominal girth (40 inches preop)

Palpable mass at right hypogastric region. (UTZ showed enlarged uterus and isoehoic mass at anterior uterus)

Endometrial distention

Pressure on bladder

Recto sigmoid pressure

Urinary frequency and urgency (preop: 10-15 times/ day)

Constipation ( Once every 3-4 days, minimal amount of hard formed stool, decreased bowel sounds- 1 in every 30 seconds)

Legend: Manifestations

Signs and Symptoms