Medicine an Surgery notes

Apr 24th, 2015
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UTERINE FIBROIDSPresentationPathophysiologySigns and symptomsDiagnosisManagementPrognosisPathophysiologyPathogenesislarge subserosal fibroidMonoclonal tumors Approximately 40 to 50% show karyotypically detectable chromosomal abnormalitiesWhen multiple frequently have unrelated genetic defectsSpecific mutations of the MED 12 protein have been noted in 70 percent of fibroidsExact aetiology is not clearly understoodCurrent working hypothesis: genetic predispositions, prenatal hormone exposure and the effects of hormones, growth factors and xenoestrogens cause fibroid growth. Known risk factors nulliparity obesity polycystic ovary syndrome diabetes hypertension - atherosclerotic inflammatory injury to uterine vesselsGenetic - First degree relatives have a 2.5-fold risk, and nearly 6-fold risk when considering early onset casesOestrogen and progesterone:Have a mitogenic effect on leiomyoma cells Influence (directly and indirectly) a large number of growth factors, cytokines and apoptotic factors as well as other hormones. Actions modulated by with prolactin signalling which controls the expression of respective nuclear receptorsGrossly - round, solid, white or tan,well circumscribed (not encapsulated) nodules Histological section - whorled appearance Location and classificationSchematic drawing of various types of uterine fibroids: a=subserosal fibroids (can pedunculate) b=intramural fibroids, c=submucosal fibroid d=pedunculated submu

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