I.

Current Health History:

A case of R.B 34 years old came in due to enlargement of the abdomen secondary to the mass of the
uterus.

II. Laboratory/ Diagnostic

1. Complete pelvic exam including manually examining the ovaries and uterus.
2. Up-to-date Pap smear .
3. Pelvic ultrasound may be appropriate.
4. A complete blood count and an attempt to correct anemia if possible.
III. Anatomy and Physiology.
1.Fallopian tube/Oviduct – 4 inches long from each side of the uterus (fundus). It transports
the mature ova form the ovaries to the uterus and provide a place for fertilization of the ova by
the sperm in it’s outer 3rd or outer half. Parts:
• Interstitial – lies within the uterine wall
• Isthmus – portion that is cut or sealed in a tubal ligation.
• Ampulla – widest, longest portion that spreads into fingerlike projections/fimbriae and
it is where fertilization usually occurs.
• Infundibulum - rim of the funnel covered by fimbriated cells (hair covered fingerlike
projections) that help to guide the ova into the fallopian tube.
2. Ovaries – Oval, almond sized, dull white sex glands on either side of the uterus that measures 4
by 2 cm in diameter and 1.5 cm thick. It is responsible for the production, maturation and
discharge of ova and secretion of estrogen and progesterone.
3. Uterus – hollow, pear-shaped muscular organ, 3 inches long, 2 inches wide, weighing 50-60
grams held in place by broad and round ligaments, and abundant blood supply from the uterine
and ovarian arteries. It is located in the lower pelvis, posterior to the bladder and anterior to the
rectum. Organ of menstruation, site of implantation and provide nourishment to the products of
conception.
Layers:

1. Perimetrium – outermost layer of the uterus comprised of connective tissue, it

offers added strenght and support to the structure.
2. Myometrium – middle layer, comprised of smooth muscles running in 3 directions;
expels fetus during birth process then contracts around blood vessels to prevent
hemorrhage.
3. Endometrium – Inner layer which is visibly vascular and is shed during
menstruation and following delivery.

Divisions of the Uterus:

1. Fundus – upper rounded, dome-shaped portion that can be palpated to determine

uterine growth during pregnancy and the force of contractions and for the
assessment that the uterus is returning to it’s non-pregnant state following child
birth.
 2. Corpus – body of the uterus.
3. Isthmus – area between corpus and cervix which forms part of the lower uterine
segment. It enlarges greatly to aid in accommodating the fetus. The portion that is
cut when a fetus is delivered by a caesarian section.
4. Cervix – lower cylindrical portion that represents 1/3 of the total uterus. Half of it
lies above the vagina; half of it extends to the vagina. The cavity is termed the
cervical canal. It has 2 openings/Os: internal os that open to the uterine cavity and
the external os that opens to the vagina.
5. Vagina – a 3-4 inch long dilatable canal located between the bladder and the
rectum, it contains rugnae which permit considerable stretching without tearing. It
acts as a organ of intercourse/copulation and passageway for menstrual discharges
and fetus. Doderlein’s bacillus is the normal flora of the vagina which makes the pH
of vagina acidic, detrimental to the growth of pathologic bacteria.

IV. Pathophysiology