PATHOPHYSIOLOGY

Legend: Disease process ----* Signs / Symptoms Manifested by the patient Undergone by the patient Precipitating Factors Long term use of inadequate oral contraceptives Obesity Hyperestrogenic State Hypertension Nulliparity Multiparity Smoking Miscarriage Hormonal Imbalance (Hormonal Replacement) Anovulation

Predisposing Factors Advancing Age (25-50) Race (African) Early Menarche Menopause Family History

Estrogen Dominance (Stimulated increase in estrogen)

Increase estrogen and other growth factor

Estrogen modulates its effects

Basal layer of the endometrium regenerates the functional layer

Cell proliferation and inhibition of cell death

Binds to estrogen receptor in immune target cell Endometrium becomes thick and more vascular

Decrease cytokine production Luteinizing hormone output increases, stimulating ovulation

Increase cell mitotic rate

Combination of estrogen and progesterone

S/Sx: Asymptomatic

Endometrium reaches the peak of its thickening and vascularization Formation of neoplasm Stress within the myometrium Continuous growth of neoplasm caused by estrogen and lack of tumor suppressor cell

Overgrowth of endometrial tissue

DEVELOP INTO UTERINE FIBROID

Submucous

Subserous

____

Pedunculated

S/Sx: Pelvic pain Back pain Constipation and bloating A generalized feeling of heaviness or pressure Frequent urination Abdominal cramping and pain

Intramural

Parasitic

Intraligamentous

Cervical

WITH INTERVENTIONS

WITHOUT INTERVENTIONS

Fibroid Growth Increase Diagnostic Tests: X-ray Electrocardiogram RBS Ultrasound Magnetic Resonance Imaging Biopsy Laparoscopy Cardio Pulmonary Clearance

Interference in vascular supply

Increasing endometrial surface area

Distort uterine lining

Degeneration in the interior part of the fibroid Red Carnecous Degeneration

Excessive bleeding

Laboratory Tests: Hematology * Urinalysis Blood Chemistry

Hypovolemic Shock

Interfere with implantation or obstructs cervical outlet

Bladder compression, ureters and other urinary accessory organs Urinary Problems

Uterine Cancer

S/Sx: Unexplained weight loss Vaginal bleeding

Infertility Proteolytic liquefaction S/Sx: Hypotension Tachycardia Tachypnea

Pregnancy Complications and delivery risks

Kidney Failure

S/Sx: Swelling, especially of the legs and feet. Little or no urine output . Thirst and a dry mouth. Rapid heart rate.

Pharmacologic/Medications: GnRH Agonist Nsaids

Hypermenorrhea

Hypermetrorrhagia

Anemia Surgery and other Procedures: Hysterectomy Abdominal, Laparoscopic or Hysteroscopic Myomectomy Myolysis Uterine Artery Embolization Blood Transfusion Total Abdominal Hysterectomy and Bilateral SalpingoOopherectomy.

S/Sx: fatigue; decreased energy; weakness; shortness of breath; lightheadedness; palpitations (feeling of the heart racing or beating irregularly); and looking pale. chest pain, angina, or heart attack; dizziness; fainting or passing out; and rapid heart rate.

Feeling dizzy when you stand up. Loss of appetite, nausea, and vomiting. Feeling confused, anxious and restless, or sleepy. Pain on one side of the back, just below the rib cage and above the waist (flank pain).

Nursing Management: Make sure that the patient understands the purpose and effects of surgery or a medication shes schedule to have. Administer iron supplements and blood transfusions, as ordered, in patient with severe anemia due to excessive bleeding. Tell patient to immediately report abnormal bleeding or pelvic pain. Encourage patient to verbalize her feelings and concerns related to the disease process.

Death

BAD PROGNOSIS

Alleviation of condition

Patient will exhibit optimum level of functioning

GOOD PROGNOSIS