Gynecologic Conditions, Essay Example

A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac

Analysis of patient information

The important symptoms in this case study relate to dysmenorrhea; painful intercourse; small non-tender retroverted uterus and nodules along the cul de sac with inability to conceive.

Differential diagnosis for the patient in the case study 1

From the above symptoms many differential diagnoses could emerge. However, for the purpose of this essay uterine/ endometrial cancer is the selected differential diagnosis. Endometrial cancers are very common among women in developed nations. It presents as abnormal bleeding, especially, among women in their post-menopausal years; lower abdominal pain and pelvic cramping; swollen lump glands at in the neck, back of head and under the chin; bleeding in between period  with a white clear vaginal discharge during the post-menopausal period (Husson, 2011).

These neoplasms are of two types, either carcinoma or sarcoma. Carcinomas appearing within the endometrium or uterine body are usually carcinomas indicating that they originate from one layer of the epithelial cell. Importantly, based on the clinical presentation and pathogenesis they are further divided into type 1 and 11. Type 1 is predominantly seen in pre-menopausal women, who have been exposed to high levels of estrogen circulating in the blood stream. This type is dominant among white women and the prognosis is very good. Type 11 has a greater risk of developing into an incurable level quickly and is predominant among post-menopausal African American women (Ezendam, 2013).   Sarcomasemerge from non-glandular connective tissue and are considered rare. Risk factors for both types of uterine cancers include obesity; high estrogen levels; breast and ovarian cancers; inadequate exercise; infertility, early menarche; inappropriate diet and age over 35 years old. Diagnosis is confirmed from Pap smear and biopsy. These neoplasms are staged with reference to their location in the uterus and spread. Stages range from 1A pertaining to confinement of tumor towards invasion of cervical glands and neighboring organ tissues within the uterus at 1VB (Ezendam, 2013).

Treatment and management plan for the patient in Case Study 1

A comprehensive treatment management plan for case study 1 relates to evaluation of  signs and symptoms  expressed and observed. For reflection they include dysmenorrhea; painful intercourse; small non-tender retroverted uterus and nodules along the cul de sac with inability to conceive. Dysmenorrhea heads the treatment plan list. The first line overtreatment is pain relief. There are pharmacological interventions as well as non- pharmacological. Pharmacological interventions pertain to administration of codeine 15 mg orally, 6 hourly when needed, continuing at 20 mgs x 4hrly at a maximum of 120 mgs daily. Contraceptives are also used over a long term period, but this is focused on restoring hormone balance and not pain relief. Non pharmacological therapies include reflexology, aroma therapy or gentle massage of the abdomen. In severe cases doctor may recommend acupuncture to align the body (Marjoribanks, Proctor, Farquhar & Derks, 2010).

The differential diagnosis reflects uterine carcinoma, which is an important treatment consideration. In this case study, the first line of treatment for the differential diagnosis surgery. This takes the form of an abdominal hysterectomy, which more highly recommended rather than a vaginal hysterectomy. Other surgical treatment prior to hysterectomy include systolic sampling of peritoneal fluid; laparotomy; along with biopsy of suspicious lymph nodes. Further, a total hysterectomy would involve removal of the both ovaries; fallopian tubes as well as the cervix (Van de Poll-Franse, L. (2011).

Strategies for educating patients on the treatment and management of the disorder identified as your primary diagnosis

The disorder identified in this case study as a primary diagnosis is uterine neoplasm. The patient would be referred to a gynecologist for further evaluations. Meanwhile she is advised to take prescribed pain medications for dysmenorrhea episodes while awaiting a confirmed diagnosis from the gynecologist. Regular mild exercise program is also recommended as well as a very nutritious diet.

References

Husson O. (2011). The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review, Ann Oncol 22; 761–772

Ezendam, N. (2013). Health Care Use Among Endometrial Cancer Survivors: A Study From Profiles, a Population-Based Survivorship Registry. International Journal of Gynecological Cancer, Epub ahead of print.

Marjoribanks, J. Proctor, M. Farquhar, C., & Derks, R. (2010). Nonsteroidal anti-inflammatory drugs for dysmenorrhea. Cochrane database of systematic reviews  (1); CD001751

Van de Poll-Franse, L. (2011). The impact of a cancer Survivorship Care Plan on gynecological cancer patient and health care provider reported outcomes (ROGY Care): study protocol for a pragmatic cluster randomized controlled trial. Trials, 5 (12); 256