Infectious and neoplastic disorders of the uterus
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| Endometritis | infection of the endometrium, common after procedures or surgeries (C-section, D&E, D&C, IUD placement), polymicrobial, usually acute
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| Acute endometritis s/s, diagnosis | elevated WBC count (neutrophils, esp.), uterine tenderness, fever, hx of procedure, may be foul-smelling vaginal d/c
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| Acute endometritis treatment | hospitalize, IV abx
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| Chronic endometritis treatment | doxycycline 100 mg po bid x 14 days
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| Chronic endometritis diagnosis | endometrial bx
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| Chronic endometritis s/s | asymptomatic; chronic irregular bleeding, pelvic pain, and d/c
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| Pelvic inflammatory disease (PID) | infection of the female pelvic organs (bacterial); can be divided into endometritis and salpingitis, polymicrobial
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| PID most common in: | young, sexually active, multiple partners
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| 2 bacteria most commonly responsible for PID | N. gonorrheae, C. trachomatis
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| Minimum diagnostic criteria for PID | CMT or pelvic/adnexal pain + no other competing diagnosis; diagnosis is clinical
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| 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)
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| PID effects | infertility, chronic pelvic pain, pelvic adhesions, ectopic pregnancy risk, dyspareunia
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| Helpful diagnostic tests for PID | endocervical culture (always perform), wet prep (look for WBCs to indicate infx); do NOT wait to start treatment
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| 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)
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| 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
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| Tubo-ovarian abscess | an abscess-like complex involving the Fallopian tube and ovary; a complication of PID
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| Tubo-ovarian abscess presenting s/s | PID clinical menifestations, adnexal or rectouterine pouch mass or fullness, fever, leukocytosis
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| Tubo-ovarian abscess diagnosis | US = test of choice
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| Tubo-ovarian abscess treatment | hospitalize, IV abx, possible surgical extraction
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| 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
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| Endometrial hyperplasia cause | excess estrogen in the absence of progesterone; excess estrogen may be endogenous (adipose tissue) or exogenous (HRT without progesterone, oophorectomy)
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| Endometrial hyperplasia is seen in: | perimenopause, menopause, obesity, HTN, DM, oligomenorrhea
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| Endometrial hyperplasia histology | simple and complex (limited to architectural changes); atypical simple and complex (involves cellular changes, considered pre-malignant)
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| Endometrial hyperplasia clinical presentation | often presents as long hx of amenorrhea or oligomenorrhea followed by AUB or excessive uterine bleeding
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| Should always be considered cancer until proven otherwise: | uterine bleeding in postmenopausal women
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| Endometrial hyperplasia diagnosis | endometrial biopsy = test of choice; US (evaluate endometrial stripe, more useful in postmenopausal); sonohysterography (evaluate focal patches or global growth)
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| Atypical endometrial hyperplasia treatment | hysterectomy
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| All forms of endometrial hyperplasia respond to: | progesterone
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| 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
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| 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
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| Endometrial cancer | carcinoma of the endometrium, 4th most common cancer in American women
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| Screening mechanism for endometrial cancer: | none
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| 75% of endometrial cancer occurs in: | postmenopausal women
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| Prevention method for endometrial cancer: | premenopausal, anovulatory women (cyclic progesterones, OCPs, weight control); postmenopausal women (HRT with progesterone component)
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| Type I endometrial cancer | most common (80%); usually due to excess endogenous or exogenous estrogen without progesterone; usually preceded by endometrial hyperplasia
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| Type II endometrial cancer | estrogen-independent; not preceded by hyperplasia; more aggressive; poor prognosis; 20% of cases
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| Endometrial cancer clinical manifestations | AUB, postmenopausal bleeding, may have vaginal d/c, adnexal masses, enlarged uterus, pain usually doesn't present until later stage
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| Endometrial cancer diagnosis | endometrial bx
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| 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
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Created by:
Carrie D.
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