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Role of P.T. after HYSTERECTOMY

Role of P.T. after HYSTERECTOMY. By Dr. Ali Abd El- Monsif Thabet . Definition. Surgical removal of the uterus through abdominal or vaginal incision. Indications of Hysterectomy. A) Obstetrical: 1- Rupture of the uterus. 2- Uncontrollable post-partum hemorrhage. 3- Couvelaire's uterus

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Role of P.T. after HYSTERECTOMY

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  1. Role of P.T. after HYSTERECTOMY By Dr. Ali Abd El-Monsif Thabet

  2. Definition Surgical removal of the uterus through abdominal or vaginal incision

  3. Indications of Hysterectomy A) Obstetrical: 1- Rupture of the uterus. 2- Uncontrollable post-partum hemorrhage. 3- Couvelaire's uterus 4- Placenta accreta.

  4. 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.

  5. Types of abdominal hysterectomy • Subtotal • Total • Panhysterectomy • Radical hysterectomy • Ultraradical hysterectomy

  6. Complication of hysterectomy 1- Respiratory complications 2- Excessive abdominal pain 3- Deep venous thrombosis &pulmonary embolism 4- Dependant edema 5- Intestinal complication 6- Hemorrhage

  7. 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.

  8. 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

  9. Methods

  10. Post operative aims 1-Improve pulmonary function &prevent its problems. 2-Improve circulatory function &prevent its problems. 3-Decrease incisional pain. 4-Improve wound healing. 6- Avoid muscle wasting 7-Correct posture .

  11. Program of exercises

  12. Electrotherapy

  13. Advices

  14. RETROVERSION AND RETROFLEXION OF THE UTERUS

  15. Definition • Retro-versionmeans that the uterus is directed backwards towards the sacrum by its rotation round a transverse axis passing through the external os. • Retro-flexion is backward flexion of corpus (body) uteri on the cervix at the level of internal os

  16. Varieties of retro-version-flexion • A) Congenital • Retroversion of a hypoplastic uterus • Retroversion of a normal uterus • B) Acquired: • Retroversion complicated by pelvic pathological lesions • Puerperal retroversion

  17. Degrees of retro-version-flexion • First degree: the fundus is directed towards the promontory of the sacrum. • Second degree: the fundus is directed towards the sacral concavity. • Third degree: the fundus is directed towards the tip of the sacrum.

  18. Symptoms of Retroversion • Backache • Menorrhagia. • Dyspareunia • Leucorrhoea • Sterility • Incarceration

  19. Treatment of retroversion

  20. Surgical Treatment • Modified Gilliam's Ventrosuspension • Fothergill's operation

  21. Thank you

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