Sol Hanna P.

Nebrida

Anatomy and Physiology

(Clinical Case Presentation )

Case Scenario: Multiple Uterine Fibroids in an 18-year old.

Anatomy & Physiology of Female Reproductive System

Ovaries
Most females have two ovaries, one on each side of the uterus. They are about the
shape and size of an almond and have two key functions: producing hormones and
releasing eggs.
Fallopian Tubes
These are 2 thin tubes that connect the ovaries to the uterus, allowing the egg to be
transported.
Uterus
The uterus is an organ that is about the shape and size of a pear. It is also known as
the womb. If pregnancy occurs, the fertilized egg will implant in the uterus and grow
into a fetus and then later on develop into a baby.
Cervix
The cervix is a narrow structure at the bottom of the uterus. It produces mucus and
protects against bacteria from entering the uterus and this also allow fluids to drain.
Vagina
Tubular structure that connects the internal and external reproductive organs. It
provides a passageway for blood and mucosal tissue from the uterus during a
woman’s monthly period, receives the penis during sexual intercourse and holds the
sperm until they pass into the uterus and provides a passageway for childbirth.
Case Report
An 18-year-old nulliparous was reported to have multiple uterine fibroids with
followings diagnostic results:
• Pelvic ultrasonography revealed an anteverted and markedly enlarged uterus
with multiple well defined, hypoechoic solid masses of varying sizes, the
largest measured 13.4cm x 8.5cm located in the fundus. Sub serous and sub
mucous components were also seen. Thirteen fibroid nodules were
enucleated with the smallest size measuring 2cm and the largest 16cm.
• Intraoperative findings of a 20-week sized fibroid riddled uterus with multiple
sub-serous, intramural and sub mucous fibroids.

Submucosal fibroids:
Submucosal fibroids are a type of uterine fibroids. They are noncancerous growth of
the uterus that often appear during reproductive years. Submucosal fibroids develop
in the muscle layer of the uterus, underneath the uterine inner lining, and grow into
the uterine cavity. They can be single or multiple. They are usually embedded into
the uterine wall, but at times, they can be pedunculated and hanging into the uterine
cavity with a stalk.

Intramural fibroids:
Intramural fibroids are the most common kind of uterine fibroid. These non-
cancerous growths grow in the muscular wall of the uterus (womb).Intramural
fibroids are usually harmless and do not always cause symptoms. Sometimes, they
can be problematic and cause heavy periods, spotting between periods, lower back
pain, and painful intercourse. Intramural fibroids can sometimes cause reproductive
challenges.

Subserosal fibroids:
A subserosal fibroid, or subserosal leiomyoma, is a benign growth on the outer
uterine wall. They may be attached directly to the uterus or by a thin stalk, also
known as a pedunculated fibroid. Subserosal fibroids don’t typically cause heavy
bleeding—a common symptom of most kinds of uterine fibroids—but they can cause
severe pelvic pain. This type of fibroid can also put pressure on the surrounding
organs.

The Effects of Fibroids on Other Organs

Fibroids can have a chain reaction effect that includes:

Rectum.
A large enough fibroid can push down on the rectum, making bowel movements
difficult. “If the fibroid is on the underside of the uterus, you could have constipation
or pain when defecating,” explains John C. Petrozza, MD, board-certified ob-gyn and
chief of reproductive medicine and IVF at Massachusetts General Hospital Fertility
Center in Boston. Hemorrhoids can be another unpleasant result of rectal pressure
and difficulty moving your bowels.
Bladder.
“If the fibroid is on the other side of the uterus, growing toward your bladder, you
might find you get up three or four times a night to go to the bathroom — you don’t
have the capacity to hold urine because of it,” says Dr. Petrozza. In addition to
having to urinate more often, you might have difficulty or pain while urinating.
Stomach.
Pelvic symptoms of fibroids include feeling like you have a full stomach. A fibroid can
push up to your stomach creating “early satiety,” explains Petrozza. You feel full
faster and may not be able to eat as much as previously, oftentimes leading to
weight loss. If the fibroid grows big enough, your lower abdomen can look enlarged,
as though you were pregnant.
Kidneys.
In very rare instances, says Goldstein, a fibroid can grow large enough to affect the
ureter, the tube that connects the kidney and the bladder. If the flow of urine is
backed up because of a fibroid pressing on a ureter, the back-pressure can cause
the kidney to swell, a condition called hydronephrosis. Symptoms may include
painful urination, a greater urge to go or going more often, and pain on one side.
Kidney damage may result. In this case, in Goldstein’s opinion, the only option is
surgery to remove the fibroids.