Hepatic encephalopathy

Diagnosis please.

Findings and diagnosis please.

F.71 years. Shortness of breath 6 days.

Diagnosis please.

30 weeks size mass per abdomen *Chief Complaints* 45 year old Para 2 with previous history of myomectomy presented with mass per abdomen and abdominal doscomfort. *History* 45 year female presented with mass per abdomen. She had two normal deliveries. History of myomectomy done for fibroid uterus 8 years back. Papers of surgery were not available. H/o heaviness in lower abdomen and discomfort. No history of heavy menstrual bleeding. *Vitals* Pulse 88/ min. BP 114/80 mmHg. *Physical Examination* Per abdomen . Mass palpable per abdomen around 30 weeks size of gravid uterus irregular , restricted mobility. Well defined margins, firm in consistency, non tender. No guarding/ rigidity/ free fluid. Per speculum examination revealed cervix and vagina normal. Per vaginal examination. Same mass felt per abdomen and multiple fibroids palpable in uterus on posterior wall and lateral walls *Investigations* Ultraound revealed multiple fibroids largest posterior wall fibroid 20*18 cm. *Diagnosis* Fibroid Uterus *Management* Patient underwent adhesiolysis followed by TAH + BSO. OT findings: Uterus irregularly enlarged to 30 weeks with multiple fibroids largest left postero lateral fibroid 20*18 cm. Dense adhesions noted between posterior wall of uterus and sigmoid and rectum. Also adhesions between left adnexa and left lateral pelvic wall. All adhesions were dissected using sharp dissection and Hysterectomy done.