HYSTERECTOMY Role of P.T. after HYSTERECTOMY By Dr. Ali Abd El-Monsif Thabet.
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Transcript of HYSTERECTOMY Role of P.T. after HYSTERECTOMY By Dr. Ali Abd El-Monsif Thabet.
Role of P.T. after HYSTERECTOMYHYSTERECTOMY
ByByDr. Ali Abd El-Monsif ThabetDr. Ali Abd El-Monsif Thabet
DefinitionDefinition
Surgical removal of the uterus Surgical removal of the uterus through abdominal or vaginal incision through abdominal or vaginal incision
Indications of Indications of HysterectomyHysterectomy
A)A) Obstetrical:Obstetrical:1- Rupture of the uterus.1- Rupture of the uterus.2- Uncontrollable post-partum 2- Uncontrollable post-partum
hemorrhage.hemorrhage.3- Couvelaire's uterus3- Couvelaire's uterus4- Placenta accreta.4- Placenta accreta.
B- Gynecological:1- Inflammatory as some cases of genital
tuberculosis.2- Neoplastic: (a) Benign: some cases of fibroids
and benign ovarian tumors in old patients, (b) Malignant tumors of the cervix, body and ovaries.
3- Displacements: some cases of uterine prolapse.
4- Some cases of endometriosis.5- Some cases of dysfunctional uterine bleeding.
Types of abdominal hysterectomyTypes of abdominal hysterectomy
SubtotalSubtotal TotalTotal PanhysterectomyPanhysterectomy Radical hysterectomyRadical hysterectomy Ultraradical hysterectomyUltraradical hysterectomy
Complication of hysterectomy
1- Respiratory complications2- Excessive abdominal pain3- Deep venous thrombosis &pulmonary
embolism4- Dependant edema5- Intestinal complication6- Hemorrhage
Remote complications
• (a) Complications of the abdominal scar as keloid formation.
• (b) Vagina discharge due to infection at the vaginal vault.
• (c) Vagina vault prolapse after hysterectomy, • (d) Dyspareunia, after hysterectomy • (e) Low backache due to persistent chronic
pelvic cellulitis, • (f) Menopausal symptoms following bilateral
oophorectomy in a young patient.
Pre-operative
Aims of pre-operative treatment:
1- To prepare the patient physically and mentally for the operation.
2-Teach her the exercises that will be done post operatively.
3-To improve circulation.
4-To improve respiration.
5-To strengthen the abdominal muscles
Methods
Post operative aimsPost operative aims
1-Improve pulmonary function &prevent its 1-Improve pulmonary function &prevent its problems.problems.
2-Improve circulatory function &prevent its 2-Improve circulatory function &prevent its problems.problems.
3-Decrease incisional pain.3-Decrease incisional pain.
4-Improve wound healing.4-Improve wound healing.
6- Avoid muscle wasting6- Avoid muscle wasting
7-Correct posture .7-Correct posture .
Program of exercisesProgram of exercises
ElectrotherapyElectrotherapy
AdvicesAdvices
RETROVERSION AND RETROVERSION AND RETROFLEXION OF THE RETROFLEXION OF THE
UTERUSUTERUS
DefinitionDefinition
Retro-versionRetro-version means that the uterus is means that the uterus is directed backwards towards the sacrum directed backwards towards the sacrum by its rotation round a transverse axis by its rotation round a transverse axis passing through the external os.passing through the external os.
Retro-flexionRetro-flexion is backward flexion of is backward flexion of corpus (body) uteri on the cervix at the corpus (body) uteri on the cervix at the level of internal os level of internal os
Varieties of retro-version-Varieties of retro-version-flexionflexion
A)A) CongenitalCongenital Retroversion of a hypoplastic uterusRetroversion of a hypoplastic uterus Retroversion of a normal uterusRetroversion of a normal uterus B)B) Acquired: Acquired: Retroversion complicated by pelvic Retroversion complicated by pelvic
pathological lesionspathological lesions Puerperal retroversionPuerperal retroversion
Degrees of retro-version-Degrees of retro-version-flexionflexion
First degreeFirst degree: the fundus is directed : the fundus is directed towards the promontory of the sacrum. towards the promontory of the sacrum.
Second degreeSecond degree: the fundus is directed : the fundus is directed towards the sacral concavity. towards the sacral concavity.
Third degreeThird degree: the fundus is directed : the fundus is directed towards the tip of the sacrum.towards the tip of the sacrum.
Symptoms of RetroversionSymptoms of Retroversion
BackacheBackache Menorrhagia.Menorrhagia. DyspareuniaDyspareunia LeucorrhoeaLeucorrhoea SterilitySterility IncarcerationIncarceration
Treatment of Treatment of retroversionretroversion
Surgical TreatmentSurgical Treatment
Modified Gilliam's Modified Gilliam's VentrosuspensionVentrosuspension
Fothergill's operationFothergill's operation
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