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Miomatosis uterina
- 2. • MIOMAS, FIBROMAS, FIBROMIOMAS. • Tumores de color blanco o rosa pálido compuestos por musculo liso con cantidades de tejido conjuntivo fibroso. • 95% surge en el cuerpo uterino • 5% en el cérvix • Raramente en trompas de Falopio o ligamento redondo.
- 3. • Representan el 10% de los problemas ginecológicos. • Mayor incidencia en la menopausia (50 años). • Miomas crecen como respuesta al estrógeno por tanto el crecimiento es mas intenso durante el embarazo.
- 4. Submucosos: Se encuentran debajo del endometrio y tienden a comprimirlo a medida que crecen hacia la cavidad uterina, son los más propensos a producir hemorragias profusas. Intramurales: Se sitúan en la musculatura uterina (miometrio). Si son múltiples y de gran tamaño aumentan en forma considerable el volumen uterino. SUBSEROSOS: Se hallan en la superficie serosa del útero y pueden protruir hacia la cavidad peritoneal, tienden a ser pediculados y semejar neoplasia ovárica pueden extenderse entre las dos capas peritoneales del ligamento ancho, volviéndose miomas intraligamentarios. Otras presentaciones son vaginal y ovárica. Los miomas pueden ser únicos o múltiples y abarcar toda la extensión del útero
- 5. SUBPERITONEAL SUBMUCOSO El crecimiento ocurre cuando aun desarrollándose el mioma de la capa muscular, lo hace en un punto muy aproximo a la superficie peritoneal. SUBSEROSO El mioma crece levantando el peritoneo y haciendo prominencia en la cavidad peritoneal en forma polipoidea. El mioma crece en forma central, deformando a la vez la superficie intracavitaria del útero y la superficie peritoneal. INTRAMURAL
- 7. TAMAÑO: oscila desde el de un grano de mijo a 30 o mas cm de diámetro. Puede crecer hasta alcanzar mas de los 45 kg. Tienen pocos vasos sanguíneos por lo que son mal irrigados. Mioma telangiectoide mioma don dilatación de vasos sanguíneos Puede ser único o múltiple, siempre esta formado por nódulos esféricos.
- 8. Hemorra- gia uterina anormal Dolor Infertilidad Amenorrea Leucorrea La mayor parte de los casos son asintomáticos. Sólo del 20 al 50% cursan con síntomas y éstos dependen del tamaño, localización y número de miomas.
- 9. Anemia Policitemia secundaria Aumento en el perímetro abdominal Pesadez pélvica Polaquiuria
- 11. • 3.9 % delos embarazos • Primigestas después de los 30 años o mujeres sin hijos. • Pueden existir complicaciones durante cualquier etapa de la gestación en un 10%
- 12. • Peligro para el feto • Afectando la circulación causando un aborto, parto prematuro, presentación anormal. Falta de encajamiento, distocia, hemorragia puerperal, roturas de membranas, crecimiento intrauterino retardado, desprendimiento de placenta y placenta previa.
- 13. Cesárea en caso de la existencia de un mioma voluminoso interponiéndose como un tumor previo. Uso de tocolíticos y Trabajo de parto prematuro. MAYORES COMPLICACIONES • Mioma aparezca en la fase de alumbramiento
- 14. La degeneración mas característica es la necrobiosis aséptica sobre todo en los que el volumen supera los 200cm³ apareciendo en el transcurso del 2 trimestre o a principios del 3.
- 15. • Dolor intenso en ocasiones acompañado de contracciones uterinas. • Fiebre • Leucocitosis • Palidez • Astenia • Nauseas • Vómitos.
- 16. •Sirven para clarificar la naturaleza de la masa pélvica y permiten, con una seguridad del 80%, el diagnóstico diferencial de una gestación, masa ovárica, o mioma subseroso sólido. Ultrasonidos: •Es más exacta para predecir las características histológicas de un tumor. Es útil para la investigación o en casos de dificultades diagnósticas, por su alto nivel de exactitud, pero no es necesaria en el manejo rutinario de los miomas. Resonancia nuclear magnética: • miomas de no más de 2 a 3 pulgadas de tamaño, nos facilitará la posibilidad de extirpar pequeños miomas. Laparoscopía:
- 17. • Depende de diversas variables como: numero, tamaño, localización, cuadro clínico, edad y la posibilidad de la malignidad.
- 18. •Reducir o abolir la pérdida menstrual en paciente con menorragia.D isminución del 20% del volumen del mioma uterino. Esteroides andrógenos (danazol y gestrinona): •se pueden usar en el alivio del dolor pélvico de mujeres incluyendo el dolor de la degeneración del mismo. Inhibidores de la síntesis de prostaglandinas (PG)
- 19. •Extirpación completa del útero HISTERECTOMÍA •Extirpación exclusivamente del fibroma o mioma sin extirpar el útero. MIOMECTOMÍA
- 21. Cuidados Preoperatorios: Cuidados en el día de la Operación: Verificar que los exámenes de laboratorio estén completos Brindar apoyo emocional. Control de funciones vitales. Desde la mañana hasta la tarde mantener con dieta Liquida. vendaje de los miembros inferiores Acompañarlo a la sala de operación colocar dos enemas evacuantes (8 – 10 pm) y a las (6 am) para evacuar todo contenido gástrico en los intestinos. Prepara la zona que va hacer intervenida: baño, recorte de bello pubiana Retirar todo tipo de prótesis y verificar que las uñas no estén pintadas, para observar si entra a un cuadro de hipoxia.
- 22. Cuidados Post Operatorios: Monitorizar las funciones vitales. primer día brindar dieta liquida, el segundo dieta blanda y después dieta completa. Observar los apósitos de la herida operatoria. curación de la herida operatoria. Realizar palpación a nivel del abdomen para verificar si esta distendido por presencia de gases. movilización al paciente e incluso a la de ambulación prevenir y evitar las hemorragias, el estreñimiento y ayudar a expandir los pulmones a realizando globos y ejercicios respiratorios. Vigilar las evacuaciones intestinales (diuresis y deposiciones)
- 23. • A.José,Nuñez Clavero, Tratado de Ginecología, Ed. Díaz de Santos, 14ª Edición. • Pernoll L. Martin, Benson.Pernoll, Manual de Obstetricia y Ginecología, Ed. Graw Hill, 10ª Edición. • http://clubensayos.com/Ciencia/Cuidados-Enfermeria- Miomatosis/5064.html
Notas del editor
- Animated picture list with color text tabs(Intermediate)To reproduce the SmartArt effects on this page, do the following:On the Home tab, in the Slides group, click Layout, and then clickBlank. On the Insert tab, in the Illustrations group, click SmartArt.In the Choose a SmartArt Graphic dialog box, in the left pane, click List. In the List pane, double-click Horizontal Picture List (fifth row, second option from the left) to insert the graphic into the slide. Press and hold CTRL, and select the picture placeholder and text shape (top and bottom shape) in one of the objects. Under SmartArt Tools,on the Design tab, in the Create Graphic group, click Add Shape, and then click Add Shape After. Repeat this process one more time for a total of five picture placeholders and text shapes. Select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following:In the Height box, enter 4.44”.In the Width box, enter 9.25”.Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following:Click Align to Slide.Click Align Middle. Click Align Center. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text.Press and hold CTRL, and then select all five text boxes in the graphic. On the Home tab, in the Font group, select Corbel from the Font list,and then enter 22 in the Font Size box.Select the graphic. Under SmartArtTools, on the Design tab, in the SmartArtStyles group, do the following: Click ChangeColors, and then under Colorful click Colorful Range – Accent Colors 2 to 3 (second option from the left).Click More, and then under Best Match for Document click Moderate Effect (fourth option from the left).Select the rounded rectangle at the top of the graphic. Under SmartArtTools, on the Format tab, in the ShapeStyles group, click the arrow next to ShapeFill, and then under Theme Colors clickWhite, Background 1, Darker 35% (fifth row, first option from the left).Click each of the five picture placeholders in the SmartArt graphic, select a picture, and then click Insert.To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Advanced Animations group, click Animation Pane.On the slide, select the graphic. On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and under Entrance, click Float In.In the Animation group, click Effect Options, and under Sequence, click One by One. In the Timing group, in the Duration list, click 01.00.In the Animation Pane, click the double-arrow below the animation effect to expand the list of effects, then do the following to modify the list of effects:Select the first animation effect, and then do the following:On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and then click More Entrance Effects. In the Change Entrance Effects dialog box, under Moderate, click Basic Zoom.Click Effect Options, and under Zoom, click Out Slightly. In the Timing group, in the Start list, select With Previous.Also in the Timing group, in the Duration list, click 01.00.Press and hold CTRL, select the third, fifth, seventh, ninth, and 11th animation effects (effects for the text shapes), and then do the following:On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and then click More Entrance Effects. In the Change Entrance Effects dialog box, under Basic, click Peek In, and then click OK. In the Animation group, click Effect Options, and underDirection, click From Top.In the Timing group, in the Duration list, click 01.00.Press and hold CTRL, select the second, fourth, sixth, eighth, and 10th animation effects (effects for the pictures). In the Timing group, in the Start list, selectAfter Previous.To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Down (first row, second option from the left).Under Gradient stops, click Add gradient stop or Remove gradient stop until two stops appear on the slider, then customize the gradient stops as follows:Select the first stop in the slider, and then do the following:In the Position box, enter 0%.Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 130, Green: 126, and Blue: 102.Select the last stop on the slider, and then do the following: In the Position box, enter 71%.Click the button next to Color, and then click Black, Text 1(first row, second option from the left).
- Animated picture list with color text tabs(Intermediate)To reproduce the SmartArt effects on this page, do the following:On the Home tab, in the Slides group, click Layout, and then clickBlank. On the Insert tab, in the Illustrations group, click SmartArt.In the Choose a SmartArt Graphic dialog box, in the left pane, click List. In the List pane, double-click Horizontal Picture List (fifth row, second option from the left) to insert the graphic into the slide. Press and hold CTRL, and select the picture placeholder and text shape (top and bottom shape) in one of the objects. Under SmartArt Tools,on the Design tab, in the Create Graphic group, click Add Shape, and then click Add Shape After. Repeat this process one more time for a total of five picture placeholders and text shapes. Select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following:In the Height box, enter 4.44”.In the Width box, enter 9.25”.Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following:Click Align to Slide.Click Align Middle. Click Align Center. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text.Press and hold CTRL, and then select all five text boxes in the graphic. On the Home tab, in the Font group, select Corbel from the Font list,and then enter 22 in the Font Size box.Select the graphic. Under SmartArtTools, on the Design tab, in the SmartArtStyles group, do the following: Click ChangeColors, and then under Colorful click Colorful Range – Accent Colors 2 to 3 (second option from the left).Click More, and then under Best Match for Document click Moderate Effect (fourth option from the left).Select the rounded rectangle at the top of the graphic. Under SmartArtTools, on the Format tab, in the ShapeStyles group, click the arrow next to ShapeFill, and then under Theme Colors clickWhite, Background 1, Darker 35% (fifth row, first option from the left).Click each of the five picture placeholders in the SmartArt graphic, select a picture, and then click Insert.To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Advanced Animations group, click Animation Pane.On the slide, select the graphic. On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and under Entrance, click Float In.In the Animation group, click Effect Options, and under Sequence, click One by One. In the Timing group, in the Duration list, click 01.00.In the Animation Pane, click the double-arrow below the animation effect to expand the list of effects, then do the following to modify the list of effects:Select the first animation effect, and then do the following:On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and then click More Entrance Effects. In the Change Entrance Effects dialog box, under Moderate, click Basic Zoom.Click Effect Options, and under Zoom, click Out Slightly. In the Timing group, in the Start list, select With Previous.Also in the Timing group, in the Duration list, click 01.00.Press and hold CTRL, select the third, fifth, seventh, ninth, and 11th animation effects (effects for the text shapes), and then do the following:On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and then click More Entrance Effects. In the Change Entrance Effects dialog box, under Basic, click Peek In, and then click OK. In the Animation group, click Effect Options, and underDirection, click From Top.In the Timing group, in the Duration list, click 01.00.Press and hold CTRL, select the second, fourth, sixth, eighth, and 10th animation effects (effects for the pictures). In the Timing group, in the Start list, selectAfter Previous.To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Down (first row, second option from the left).Under Gradient stops, click Add gradient stop or Remove gradient stop until two stops appear on the slider, then customize the gradient stops as follows:Select the first stop in the slider, and then do the following:In the Position box, enter 0%.Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 130, Green: 126, and Blue: 102.Select the last stop on the slider, and then do the following: In the Position box, enter 71%.Click the button next to Color, and then click Black, Text 1(first row, second option from the left).
- Animated picture list with color text tabs(Intermediate)To reproduce the SmartArt effects on this page, do the following:On the Home tab, in the Slides group, click Layout, and then clickBlank. On the Insert tab, in the Illustrations group, click SmartArt.In the Choose a SmartArt Graphic dialog box, in the left pane, click List. In the List pane, double-click Horizontal Picture List (fifth row, second option from the left) to insert the graphic into the slide. Press and hold CTRL, and select the picture placeholder and text shape (top and bottom shape) in one of the objects. Under SmartArt Tools,on the Design tab, in the Create Graphic group, click Add Shape, and then click Add Shape After. Repeat this process one more time for a total of five picture placeholders and text shapes. Select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following:In the Height box, enter 4.44”.In the Width box, enter 9.25”.Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following:Click Align to Slide.Click Align Middle. Click Align Center. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text.Press and hold CTRL, and then select all five text boxes in the graphic. On the Home tab, in the Font group, select Corbel from the Font list,and then enter 22 in the Font Size box.Select the graphic. Under SmartArtTools, on the Design tab, in the SmartArtStyles group, do the following: Click ChangeColors, and then under Colorful click Colorful Range – Accent Colors 2 to 3 (second option from the left).Click More, and then under Best Match for Document click Moderate Effect (fourth option from the left).Select the rounded rectangle at the top of the graphic. Under SmartArtTools, on the Format tab, in the ShapeStyles group, click the arrow next to ShapeFill, and then under Theme Colors clickWhite, Background 1, Darker 35% (fifth row, first option from the left).Click each of the five picture placeholders in the SmartArt graphic, select a picture, and then click Insert.To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Advanced Animations group, click Animation Pane.On the slide, select the graphic. On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and under Entrance, click Float In.In the Animation group, click Effect Options, and under Sequence, click One by One. In the Timing group, in the Duration list, click 01.00.In the Animation Pane, click the double-arrow below the animation effect to expand the list of effects, then do the following to modify the list of effects:Select the first animation effect, and then do the following:On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and then click More Entrance Effects. In the Change Entrance Effects dialog box, under Moderate, click Basic Zoom.Click Effect Options, and under Zoom, click Out Slightly. In the Timing group, in the Start list, select With Previous.Also in the Timing group, in the Duration list, click 01.00.Press and hold CTRL, select the third, fifth, seventh, ninth, and 11th animation effects (effects for the text shapes), and then do the following:On the Animations tab, in the Animation group, click the More arrow at the Effects Gallery and then click More Entrance Effects. In the Change Entrance Effects dialog box, under Basic, click Peek In, and then click OK. In the Animation group, click Effect Options, and underDirection, click From Top.In the Timing group, in the Duration list, click 01.00.Press and hold CTRL, select the second, fourth, sixth, eighth, and 10th animation effects (effects for the pictures). In the Timing group, in the Start list, selectAfter Previous.To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Down (first row, second option from the left).Under Gradient stops, click Add gradient stop or Remove gradient stop until two stops appear on the slider, then customize the gradient stops as follows:Select the first stop in the slider, and then do the following:In the Position box, enter 0%.Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 130, Green: 126, and Blue: 102.Select the last stop on the slider, and then do the following: In the Position box, enter 71%.Click the button next to Color, and then click Black, Text 1(first row, second option from the left).