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Uterine Disorders

Infectious and neoplastic disorders of the uterus

Endometritis infection of the endometrium, common after procedures or surgeries (C-section, D&E, D&C, IUD placement), polymicrobial, usually acute
Acute endometritis s/s, diagnosis elevated WBC count (neutrophils, esp.), uterine tenderness, fever, hx of procedure, may be foul-smelling vaginal d/c
Acute endometritis treatment hospitalize, IV abx
Chronic endometritis treatment doxycycline 100 mg po bid x 14 days
Chronic endometritis diagnosis endometrial bx
Chronic endometritis s/s asymptomatic; chronic irregular bleeding, pelvic pain, and d/c
Pelvic inflammatory disease (PID) infection of the female pelvic organs (bacterial); can be divided into endometritis and salpingitis, polymicrobial
PID most common in: young, sexually active, multiple partners
2 bacteria most commonly responsible for PID N. gonorrheae, C. trachomatis
Minimum diagnostic criteria for PID CMT or pelvic/adnexal pain + no other competing diagnosis; diagnosis is clinical
PID clinical manifestations chills/fever, adnexal/pelvic or abdominal pain, CMT, purulent d/c from os, abnormal bleeding, RUQ pain (if spread to the liver)
PID effects infertility, chronic pelvic pain, pelvic adhesions, ectopic pregnancy risk, dyspareunia
Helpful diagnostic tests for PID endocervical culture (always perform), wet prep (look for WBCs to indicate infx); do NOT wait to start treatment
PID indications for hospital admission HIV, tubo-ovarian abscess, patient cannot outpatient therapy, patient did not tolerate outpatient therapy, pregnancy, severe illness, N/V, high fever, was not able to r/o other surgical emergencies (eg appendicitis)
PID outpatient treatment ceftriaxone 250 mg IM + doxycycline 100 mg po bid x 14 days; can add metronidazole 500 mg po bid x 14 days
Tubo-ovarian abscess an abscess-like complex involving the Fallopian tube and ovary; a complication of PID
Tubo-ovarian abscess presenting s/s PID clinical menifestations, adnexal or rectouterine pouch mass or fullness, fever, leukocytosis
Tubo-ovarian abscess diagnosis US = test of choice
Tubo-ovarian abscess treatment hospitalize, IV abx, possible surgical extraction
Endometrial hyperplasia proliferation of the endometrium; occurs when simple proliferation advances to abnormal proliferation (involving stromal and glandular elements); common cause of AUB; can lead to and co-exist with endometrial cancer
Endometrial hyperplasia cause excess estrogen in the absence of progesterone; excess estrogen may be endogenous (adipose tissue) or exogenous (HRT without progesterone, oophorectomy)
Endometrial hyperplasia is seen in: perimenopause, menopause, obesity, HTN, DM, oligomenorrhea
Endometrial hyperplasia histology simple and complex (limited to architectural changes); atypical simple and complex (involves cellular changes, considered pre-malignant)
Endometrial hyperplasia clinical presentation often presents as long hx of amenorrhea or oligomenorrhea followed by AUB or excessive uterine bleeding
Should always be considered cancer until proven otherwise: uterine bleeding in postmenopausal women
Endometrial hyperplasia diagnosis endometrial biopsy = test of choice; US (evaluate endometrial stripe, more useful in postmenopausal); sonohysterography (evaluate focal patches or global growth)
Atypical endometrial hyperplasia treatment hysterectomy
All forms of endometrial hyperplasia respond to: progesterone
Non-atypical endometrial hyperplasia treatment continuous or cyclic progesterone (oral [Provera], injection [Depo-Provera], micronized vaginal progesterone [Prometrium], IUD [Mirena]); give x 3 months and then re-evaluate; may try D&C
Who should be evaluated for endometrial hyperplasia or cancer: > 40 y.o. w/AUB; < 40 y.o. w/AUB and (anovulation, obesity, tamoxifen use, DM, family hx of certain cancers); failed response to medical tx for AUB; cervical PAP findings that indicate evaluation of cervix
Endometrial cancer carcinoma of the endometrium, 4th most common cancer in American women
Screening mechanism for endometrial cancer: none
75% of endometrial cancer occurs in: postmenopausal women
Prevention method for endometrial cancer: premenopausal, anovulatory women (cyclic progesterones, OCPs, weight control); postmenopausal women (HRT with progesterone component)
Type I endometrial cancer most common (80%); usually due to excess endogenous or exogenous estrogen without progesterone; usually preceded by endometrial hyperplasia
Type II endometrial cancer estrogen-independent; not preceded by hyperplasia; more aggressive; poor prognosis; 20% of cases
Endometrial cancer clinical manifestations AUB, postmenopausal bleeding, may have vaginal d/c, adnexal masses, enlarged uterus, pain usually doesn't present until later stage
Endometrial cancer diagnosis endometrial bx
Endometrial cancer treatment refer, total abdominal hysterectomy and bilateral salpingo-oophorectomy, other options along with; follow up q 3-6 months x 2 years and then q year
Created by: Carrie D.