Health Awareness blog

I am sure some of us may have heard about this term. Uterine fibroid is one of the common benign smooth muscle tumors. It is also known as “leiomyomata”. The occurrence of fibroids is more than 20% among Caucasian women. Peak age is more than 30 years. Classifications:

1.       Subserous – this is when the fibroid project from peritoneal surface of the uterus

2.       Intramural – it means that the fibroid lie within the uterine wall

3.       Submucous – the fibroid intrude on the uterine cavity

4.       Pedunculated – this means that the fibroid arise from either the subserous layer or the submucous layer

Pathophysiology of fibroid is simple. Fibroids arise from smooth muscle cells during reproductive life. It basically increases in size in response to oestrogen. Fibroids usually slightly decrease in size during postmenaupausal stage.

As common as it is, it may remain silent. Majority of women with fibroids are asymptomatic. Sometimes they may only been found by accidental finding, for example on abdominal ultrasound scan during antenatal check up. Symptoms of fibroids are abdominal distension, menorrhagia (heavy menses) and pressure symptoms. Pressure symptoms include urinary frequency and incomplete voidance. Some patients may present with anemia due to severe menorrhagia and may need blood transfusion. Most of them do not complaint of abdominal pain unless the fibroid is too big and compress other structures or there is red degeneration or torsion of pedunculated fibroid. Occasionally, patient may present to clinic with infertility. On abdominal examination, we may reveal a palpable mass rising from the pelvis. We can confirm this finding by doing pelvic examination. The outline of the mass may appear irregular.

There are few investigations that can be offered to the patient. Most of the time blood investigations are not needed unless there is suspicion of malignant tumor. In this case, tumor markers and other baseline blood investigations will be sent. During some circumstances, blood investigations will be ordered by your doctor base on the symptoms that you have present. For example, if you present with menorrhagia, your doctor will send for full blood count to look for hemoglobin level. They will send for coagulation profile to rule out any bleeding disorder. If you present with urinary symptoms they may send for urine FEME to rule out ant urinary tract infection. The investigation that really been use for diagnosis is ultrasonography or ultrasound scan. Exploration under anesthesia or hysteroscopy plus endometrial biopsy will confirm the diagnosis. Usually, the gynaecologists only offer this to you if you have abnormal per vaginal bleeding or if there is any suspicion of malignant tumor.

The treatment is usually not needed hence we can divide the management into 2 either by conservative management or surgical. If the patient is asymptomatic, no treatment is offer to the patient however your gynaecologist will monitor your disease and will discuss about the further step should the fibroid getting bigger or cause problem. Surgical management will be offer if the fibroid is too big, causing pain or abnormal bleeding. The surgical management is either by myomectomy (removal of the fibroid only) or hysterectomy, if the fibroid is too big and you have completed your family.

There are some complications of fibroids include the poor vascularity of the fibroids that encourage degeneration (hyaline, cystic, red, sarcomatous) of the disease. Sometimes the fibroids will become calcified and necrosis. It also may become tort and infected. Rarely, it will become malignant and metastasize.

Related:

• Uterine inversion

Reference:

1.       Gynaecology in focus. Churchill Livingstone. Janice Rymer et al. 2005.

G6PD is a condition where there is a defect in RBC enzyme. In fact, it is the commonest RBC enzyme defect found. It is an X-linked inherited and mainly affect females. The countries that have high prevalence of this disease are in Africa, Mediterranean, Middle and Far East.

Have been diagnosed with G6PD deficiency doesn’t mean that you are sick. Most patients are asymptomatic. However, it is important to remember that you are susceptible to oxidative crisis due to decrease of glutathione production. This thing can happen during ill or exposure to the broad bean Vicia fava (favism). Some drugs like aspirin, primaquine and sulfonamides also may lead to this problem.

During oxidative crisis, you will experience rapid anaemia and jaundice (yellowish discolouration of the skin). Full blood film will show bite cells and blister cells.

In view of diagnosis, usually all the newborns will be screened for G6PD deficiency using a special enzyme assay. However, in adult, the test is not accurate if we do 2-3 weeks after the attack because young red blood cell may have sufficient enzyme and the result may appear normal.

Prevention is better than cure. If you have G6PD deficiency, you have to avoid the precipitators like the bean and some drugs. Whenever you see your doctor or buying any medications in the pharmacy, please note that you are having this condition so they will avoid prescribing any drug that may cause this crisis. In case that your symptom is severe, you may need blood transfusion and may need hospitalization till you are stable.

Reference:
1.       Oxford handbook of Clinical Medicine. 7th edition. Oxford University Press. 2008.