Ambulatory Report – 5.3.17 – Abd Pain and Endometrial Carcinoma

Thanks to Dave Anderson for presenting a case of a 68 yo F h/o HTN presenting with subacute onset of abdominal pain and diarrhea, ultimately found to have likely Endometrial Carcinoma vs. Leiomyosarcoma.
  • First some Pearls from LT & the Attendings:
    • Cope (of Cope’s Early Dx of the Acute Abdomen) notes that “localized rigidity” as a physical exam is far more significant than “rebound”
    • Is the diarrhea from malabsorption?  Look for the greasy ring around the toilet! (LT says things like “floating stools” are not as useful)
    • If you’re wondering about what imaging study to order —> CALL RADS!
    • If you’re in the outpatient setting, and have a serious case but doesn’t need admission, and you’re not 100% sure what to do —> CALL THE INPATIENT SPECIALTY CONSULT PAGERS!
    • Old people with new abdominal pain —> dig deeper than you normally would to find a cause!
  • Quick Dive in Endometrial Carcinoma:
    • Abnormal Uterine Bleeding in 75-90% (though our pt had no AUB)
    • Can see cervical cytologic changes in those with endometrial carcinoma
    • Risk Factors for Endometrial Cancer (and the RR of each)
      • Increasing Age (1.4% prevalence in women 50-70yo)
      • Unopposed Estrogen Tx (RR 2-10)
      • Tamoxifen Tx (RR 2)
      • Late Menopause after 55yo (RR 2)
      • Nulliparity (RR2)
      • Chronic Anovulation (RR 3)
      • Obesity (RR 2-4)
      • Diabetes (RR 2)
    • Work Up for those Suspected of having Endometrial Neoplasia
      • Pelvic Exam (do bimanual to assess uterus size)
      • Labs
        • rule out pregnancy
        • consider a CBC and INR depending on heaviness of bleed
      • Pelvic u/s is first line to assess for AUB
      • Endometrial sampling (get Gyn involved to decide btw EMB, curettage, surgical bx)

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