Bahan Tutorial Skenario Ke 6

8/2/2019 Bahan Tutorial Skenario Ke 6

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Polip Endometrium

Polip endometrium ditandai dengan adanya perdarahan abnormal per vaginam,paling umum menometroragia atau perdarahan bercak ringan pasca menopause.Polip tcrjadi dari umur 29-59 tahun dengan kejadian terbanyak setelah umur 50

tahun. Insiden popil tanpa gejala pada wanita pasca menopause kira-kira 10%.

Polip endometrium biasanya terjadi pada fundus dan dapat melekat dengan adanyatangkai yang ramping (bertangkai) atau dasar yang lebar (tidak bertangkai). Kadang-kadang polip prolaps melalui scrviks. Secara makroskopis polip endometriumtampak sebagai massa ovoid bcrukuran beberapa mill- meter hingga beberapasentimeter, licin seperti beludru berwarna merah hingga coklat. Secara histologis,polip endometrium mempunyai inti stroma dengan jaringan pembuluh darah yangjelas sena permukaan mukosa endometrium yang dapat melapisi komponenglanduler. Polip di bagian distal dapat menunjukkan perdarahan stroma, sel-selradang, ulerasi dan dilatasi pembuluh darah dilatasi. Kadang-kadang terjadi

poliposis multipel. Varian lain yang jarang adalah adenomioma bertangkai(dibedakan dengan adanya pita penjalin otot polos).

Diagnosis banding meliputi mioma submukosa, sisa produk konsepsi yangtertinggal, kanker endometrium dan sarkoma campuran. Polip sensitif terhadapestrogen dan dapat menjadi keganasan yang prognosisnya lebih baik dibandingkankanker endometrium non polipoid.

Diagnosis mudah dibuat dengan histeroskopi dan pengobatannya adalah eksisi.Tindakan ini mudah dilakukan dengan histeroskopi diikuti kurctase tangkai. Sebuahsenar kawat atau gunting dapat digunakan untuk memotong dasar polip yang besar.Untuk menyingkirkan kanker endometrium, lebih baik diambil sampel kanalisendoservikalis dengan kuretase ketika mengangkat polip. Selama dilakukan D C,lakukan eksplorasi kavum uteri dengan forceps polip Overstreet atau yang serupa.Polip cenderung berulang dan histerektomi merupakan terapi definitif tetapi jarangdilakukan untuk polip endometrium jinak.

Endometrial polypFrom Wikipedia, the free encyclopedia

Endometrial polyp

Classification and external resources


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Endometrial polyp, viewed by sonography.

ICD-10 N84.0

ICD-9 621

An endometrial polyp or uterine polyp is amassin the inner lining of the uterus.[1]

They may have a large

flat base (sessile) or be attached to the uterus by an elongatedpedicle(pedunculated).[1][2]

Pedunculated

polyps are more common than sessile ones.[3]

They range in size from a few millimeters to several

centimeters.[2]

If pedunculated, they can protrude through thecervixinto thevagina.[1][4]

Small blood vessels

may be present, particularly in large polyps.[1]

Contents

1 Cause and symptoms

2 Diagnosis

3 Treatment

4 Prognosis and complications

5 Risk factors and epidemiology

6 Structure

7 See also

8 References

[edit]Cause and symptoms

No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and

grow in response to circulatingestrogen.[2]

They often cause no symptoms.[3]

Where they occur, symptoms

include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual

bleeding (menorrhagia), and vaginal bleeding aftermenopause.[2][5]

Bleeding from the blood vessels of the
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trial_polyp#See_alsohttp://en.wikipedia.org/wiki/Endometrial_polyp#Structurehttp://en.wikipedia.org/wiki/Endometrial_polyp#Risk_factors_and_epidemiologyhttp://en.wikipedia.org/wiki/Endometrial_polyp#Prognosis_and_complicationshttp://en.wikipedia.org/wiki/Endometrial_polyp#Treatmenthttp://en.wikipedia.org/wiki/Endometrial_polyp#Diagnosishttp://en.wikipedia.org/wiki/Endometrial_polyp#Cause_and_symptomshttp://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Cervixhttp://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-Mayo-1http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-SDS-2http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Pedunculatedhttp://en.wikipedia.org/wiki/Pediclehttp://en.wikipedia.org/wiki/Sessility_(medicine)http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Tumorhttp://www.icd9data.com/getICD9Code.ashx?icd9=621http://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10_Chapter_Nhttp://en.wikipedia.org/wiki/ICD-10_Chapter_Nhttp://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems


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polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual

periods, or after menopause.[6]

If the polyp protrudes through the cervix into the vagina, pain

(dysmenorrhea) may result.[4]

[edit]Diagnosis

Micrographof an endometrial polyp.H&E stain.

Endometrial polyps can be detected byvaginalultrasound(sonohysterography),hysteroscopyanddilation

and curettage.[2]

Detection by ultrasonography can be difficult, particularly when there isendometrial

hyperplasia(excessive thickening of the endometrium).[1]

Larger polyps may be missed by curettage.[7]

[edit]Treatment

Polyps can be surgically removed usingcurettagewith or without hysteroscopy.[8]

When curettage is

performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be firstexplored using graspingforcepsat the beginning of the curettage procedure.[6]Hysteroscopy involves

visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through th ecervix.

If it is a large polyp, it can be cut into sections before each section is removed .[6]

Ifcancerouscells are

discovered, ahysterectomy(surgical removal of the uterus) may be performed.[2]

A hysterectomy would

usually not be considered if cancer has been ruled out.[6]

Whichever method is used, polyps are usually

treated undergeneral anesthetic.[7]

[edit]Prognosis and complications

Endometrial polyps are usuallybenignalthough some may beprecancerousorcancerous.[2]

About 0.5% of

endometrial polyps containadenocarcinomacells.[9]Polyps can increase the risk ofmiscarriagein women

undergoingIVFtreatment.[2]

If they develop near thefallopian tubes, they may lead to difficulty in becoming

pregnant.[2]

Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of

endometrial polyps is frequent.[6]

Untreated, small polyps may regress on their own.[10]

[edit]Risk factors and epidemiology

Endometrial polyps usually occur in women in their 40s and 50s.[2]

Risk factors includeobesity,high blood

pressureand a history ofcervical polyps.[2]Takingtamoxifenorhormone replacement therapycan also

increase the risk of uterine polyps.[2][11]

The use of anIntraUterine Systemcontaininglevonorgestrelin
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women taking Tamoxifen may reduce the incidence of polyps.[12]Endometrial polyps occur in up to 10% of

women.[1]

It is estimated that they are present in 25% of women with abnormal vaginal bleeding .[11]

[edit]Structure

Endometrial polyps can be solitary or occur with others.[13]

They are round or oval and measure between a

few millimeters and several centimeters in diameter.[6][13]

They are usually the same red/brown color of the

surrounding endometrium although large ones can appear to be a darker red.[6]

The polyps consist of

dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrialepithelium.[6]

If

they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by

a flat base to the uterine wall.[13]

Pedunculated polyps are more common than sessile ones.[3]

polip endometrium juga disebut polip rahim. Ini adalah pertumbuhan kecil yang tumbuh sangat lambatdalam dinding rahim. Mereka memiliki basis datar besar dan mereka melekat pada rahim melalui gagang

bunga memanjang. Mereka dapat bulat atau oval dalam bentuk dan mereka biasanya berwarna merah.

Besar yang muncul menjadi warna lebih gelap dari merah. Seorang wanita dapat memiliki satu atau polip

endometrium banyak, dan mereka kadang-kadang menonjol melalui vagina menyebabkan kram dan

ketidaknyamanan. Mereka dapat menyebabkan kram karena mereka melanggar pembukaan leher rahim.

Polip ini dapat terjangkit jika mereka bengkok dan kehilangan semua pasokan darah mereka. Ada kejadian

langka saat ini polip menjadi kanker. Wanita yang telah mereka sulit di kali untuk hamil.

Gejala

Tidak ada penyebab pasti dari polip endometrium, tetapi pertumbuhan mereka dapat dipengaruhi oleh

kadar hormon, terutama estrogen. Seringkali tidak ada gejala, tetapi beberapa gejala dapat diidentifikasi

terkait dengan pembentukannya.

* Sebuah kesenjangan antara perdarahan haid

* Tidak teratur atau perdarahan menstruasi yang berkepanjangan

* Perdarahan haid yang terlalu berat

* Rasa sakit atau dismenore (nyeri dengan menstruasi)

Diagnosa dan Pengobatan

polip endometrium dapat dideteksi melalui pelebaran dan kuretase (D & C), CT scan, MRI, ultrasound atau

histeroskopi. Histeroskopi adalah prosedur dimana lingkup kecil dimasukkan melalui leher rahim ke dalam

rongga rahim untuk mencari polip atau kelainan rahim lainnya. polip endometrium dapat dihapus dan

diobati melalui operasi dengan menggunakan kuretase atau histerektomi. Jika kuretase dilakukan, polip

dapat terjawab tapi untuk mengurangi risiko ini, rahim biasanya dieksplorasi oleh histeroskopi pada awal
http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-11http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-11http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-11http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-Dew-10http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-Dew-10http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-Dew-10http://en.wikipedia.org/w/index.php?title=Endometrial_polyp&action=edit&section=6http://en.wikipedia.org/w/index.php?title=Endometrial_polyp&action=edit&section=6http://en.wikipedia.org/w/index.php?title=Endometrial_polyp&action=edit&section=6http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-SDS-2http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-SDS-2http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-SDS-2http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-SDS-2http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Stromal_cellhttp://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-OGDT-5http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-DSTTS-12http://en.wikipedia.org/w/index.php?title=Endometrial_polyp&action=edit&section=6http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-Dew-10http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-PGU-0http://en.wikipedia.org/wiki/Endometrial_polyp#cite_note-11


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proses bedah. Sebuah polip besar dapat dipotong menjadi bagian-bagian sebelum sepenuhnya

disingkirkan. Jika ditemukan polip menjadi kanker, histerektomi harus dilakukan. Ada probabilitas tinggi

kekambuhan polip bahkan dengan perawatan di atas.

Komplikasi dan Faktor Risiko

polip endometrium biasanya sel jinak. Mereka dapat menjadi prakanker atau kanker. Sekitar 0,5 persen

dari polip endometrium mengandung sel-sel adenokarsinoma. Sel-sel ini akhirnya akan berkembang

menjadi kanker. Polip dapat meningkatkan risiko keguguran pada wanita yang menjalani fertilisasi in vitro

dalam perawatan. Jika mereka mengembangkan dekat saluran telur, mereka dapat menjadi penyebab

kesulitan dalam menjadi hamil.

polip rahim biasanya terjadi pada wanita di usia 40-an dan 50-an. Wanita yang memiliki faktor risiko tinggi

adalah mereka yang mengalami obesitas, memiliki tekanan darah tinggi. dan memiliki sejarah polip serviks

dalam keluarga mereka.

Mengambil di tamoxifen atau terapi penggantian hormon dapat meningkatkan faktor risiko terjadinya polip

endometrium. Wanita yang menggunakan hormonal Intra Uterine Device yang tingkat tinggi levonorgestrel

dapat mengurangi kejadian polip. Satu dari setiap sepuluh perempuan dapat memiliki polip endometrium,

dan diperkirakan bahwa sekitar 25 persen dari mereka yang mengalami pendarahan vagina abnormal

memiliki polip endometrium.

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