Benign neoplasms etiologies of fallopian tube pathologies:
What is/are the most common cause(s) salpingitis/ PID/ fallopian tube abscess?
Gonorrhea and Chlamydia
T/F: there is increased risk for PID with IUD insertion
True; after initial placement, that is why it is important to culture prior to placement
What is pelvic inflammatory disease?
acute infection of upper genital tract, this includes uterus, ovaries, fallopian tubes, and often with surrounding organs
How is PID diagnosed? (criteria for diagnosis)
Lower abd or pelvic pain PLUS CMT or uterine/adnexal tenderness
What is the timing for treatment of PID?
Treat empirically and do not wait until results confirm the diagnosis, just give them antibiotics
Why would you order CT scan to evaluate PID when ultrasound is the preferred imaging for pelvic organs?
Because appendicitis could also mimic PID, so CT to r/o appendicitis
What is fitz-hugh-curtis?
Perihepatic adhesions (liver adheres to walls of peritoneum and diaphragm) and this can cause RUQ pain.
This is associated with PID
Possibly with laparoscopy to break up adhesions between the liver to the peritoneum walls
Which imaging is recommended post-PID or ectopic pregnancy?
HSG – to evaluate tubes patency
When benign fallopian tube neoplasms are found on exam, when is the time to intervene?
If there is pain/ torsion or growth of the neoplasm
Otherwise just follow with serial US to make sure it is not growing out of control
98% of ectopic pregnancy occurs in _____ while the rest is found in _____
2% is cervical, interstitial, ovarian or abdominal
28 year old patient comes in complaining of lower abdominal pain and irregular spotting that is less than her regular period. LMP was 6 weeks ago. _____ should ALWAYS be in the DDx
Ectopic pregnancy (hallmark sxs are first trimester bleeding and abd pain)
T/F PID is a risk factor for ectopic pregnancy
True; so treat PID with abx to help prevent this
Clinical presentation for ectopic pregnancy:
First trimester spotting
Hypotensive from hemorrhage if ruptures (this is the scariest presentation)
hCG should double in _____ days. Over ______ IU/L should see intrauterine pregnancy on TVUS
Progesterone level during pregnancy should be ____
Less than 10
What are treatments for ectopic pregnancy?
Must terminate via either medical (use of methotrexate) or surgical (salpingectomy vs salpingostomy vs hysterectomy)
T/F: fallopian tube cancers are rare, with no evidence of increased risk with h/o PID, HPV, or hysterectomy
What is the Latzko’s triad?
Signs and symptoms of fallopian tube malignancy
Serosanguinous vaginal discharge (watery and bloody)
Malignant uterine masses include:
Nonmalignant uterine masses include:
Pregnancy (fetus is a benign mass)
T/F: uterine polyps are stimulated by progesterone
False; they are stimulated by estrogen
How do uterine polyps present clinically?
Present as irregular menses, post coital spotting, post menopausal bleeding
T/F: uterine polyps are benign, there is no need to remove unless it is causing severe pain
False; it should be removed via D&C or hysteroscopy
What is uterine leiomyomata?
Benign monoclonal tumors arising from muscle cells of myometrium can be found in various uterine locations
Patient c/o heavy prolonged menses with pelvic pain, GU and infertility issues, think ______
Fibroids, aka uterine leiomyomata
Bimanual exam revealed enlarged uterus and irregular adnexa, likely ______, and this would be confirmed via _____
Ultrasound, (also workup for anemia could point to uterine fibroids)
T/F: It patient is anemic, it is possible that she has uterine fibroids
Treatments for symptomatic uterine leiomyomata:
Uterine artery embolization (UAE)
Mymomectomy (removing a single fibroid)
What is uterine artery embolization?
Destroys artery that is bleeding, contraindicated if the patient wants to become pregnant later, cuz this may affect uterine blood supply
T/F: uterine fibroids can outgrow their blood supply and undergo necrosis; it can also release prostaglandins
True; this occurs when pt has undergone UAE and menopause and ischemic tissue causes pain and shrinkage of fibroid and eventual calcification
What is adenomyosis?
Endometrial glands and stroma grown present WITHIN uterin musculature
Patient c/o severe dysmenorrhea and pelvic pain, bimanual exam revealed enlarged and boggy uterus, you are thinking it is ______, and would treat with ______
Treat medically with hormones or surgically with hysterectomy
T/F: adenomyosis is a type of endometriosis but smaller in endometrial gland growth
False; it is not endometriosis, endometriosis is present of glands and stroma OUTSIDE of the endometrium and uterine musculature, whereas Adenomyosis is WITHIN uterine musculature. Sizes have nothing to do with it, I made it up
______ can present as mass on pelvic ultrasound anywhere, can occur as far away and as bizarrely as in the lungs/ diaphragm
Endometriosis (vs adenomyosis would just be within the uterine musculature)
What is the most common form of uterine cancer?
What is endometrial adenocarcinoma?
Malignant transformation of endometrial glands
Most common form of uterin cancer
60 year old female comes in with postemenopausal bleeding with associated urinary problems and pelvic pain, think _____
Pathological endometrium on ultrasound would show ____ walls
T/F: smoking, coffee and tea use would decreased the risk of endometrial cancer
But don’t go and recommend people to start smoking to prevent endometrial cancer, you’ll probably get sued
What factors could decrease the risk for endometrial cancer?
Combined E&P OCP
Over 25 years of age at last birth
What factors could increased the risk of endometrial cancer?
prolonged estrogen exposure
Late menopause (basically whatever that gives you more estrogen exposure)
Nulliparity (never been pregnant, so always had estrogen at some point)
H/O breast ca
What is the PAP smear screening recs for pt with h/o endometrial cancer?
Need to do it annually because high risk of recurrence occur at vaginal cuff
T/F: pt with endometrial cancer who cannot undergo surgery, can be treated with strong progestins instead