Endometriosis

Front 1

Definition of Endometriosis ?

Back 1

Endometriosis is a benign condition in which endometrial glands and stroma are present outside the uterine cavity and walls.

Front 2

Occurrence of Endometriosis ?

Back 2

5 - 15% of women have some degree of the disease.
The typical patient is in her 30s, nulliparous and infertile.
P.S: Many don't fit

Front 3

Pathogenesis of Endometriosis ?

Back 3

- The retrograde menstruation theory of Sampson
( Hematogenous Spread,too )
- The lymphatic spread theory of Halban
- The müllerian metaplasia theory of Meyer
Several factors are involved in the initiation and spread of endometriosis, including retrograde menstruation, coelomic metaplasia, immunologic changes and genetic predisposition.
( Chemical and biological differences of endometrial cells + inflammatory & growth factors of peritoneal fluid )

Front 4

Site of Occurrence of Endometriosis ?

Back 4

Endometriosis occurs most commonly in the dependent portions of the pelvis.Two out of three women with endometriosis have ovarian involvement. Endometriosis is occasionally seen in laparotomy scars.

Front 5

Pathology of Endometriosis ?

Back 5

- Islands of endometriosis respond cyclicly to ovarian steroidal hormone production.
- Lesions may be raised and flat with red, black, or brown coloration; fibrotic scarred areas that are yellow or white in hue; or vesicles that are pink, clear, or red.
- Endometriomas of the ovary are cysts filled with thick, chocolate-colored fluid that sometimes has the black color and tarry consistency of crankcase oil.
- Although endometriosis is a benign process, it shares many characteristics with malignancy.

Front 6

Histologically, two of four characteristics must be found in the specimen to confirm the diagnosis of Endometriomas

Back 6

- Endometrial epithelium
- Endometrial glands
- Endometrial stroma
- Hemosiderin-laden macrophages

Front 7

Staging of Endometriosis ?

Back 7

Correlating infertility potential with the stage of endometriosis.

Front 8

Symptoms of Endometriosis ?

Back 8

- Secondary dysmenorrhea
- Dyspareunia
- Dyschezia
* If the ovarian capsule is involved with endometriosis, ovulatory pain and mid-cycle vaginal bleeding often occur. Rarely, as other organ systems are involved, menstrual hematochezia, hematuria, and other forms of endometriotic sloughing become evident.
* Premenstrual and postmenstrual spotting is a characteristic symptom of endometriosis.

Front 9

Signs of Endometriosis ?

Back 9

- Occasionally, a small tender mulberry spot may be seen in the posterior fornix of the vagina.
- Characteristically, a tender, fixed adnexal mass is appreciated on bimanual examination.
- Occasionally, no signs at all are appreciated on physical examination.

Front 10

Differential diagnosis of Endometriosis ?

Back 10

(1) Chronic pelvic inflammatory disease or recurrent acute salpingitis
(2) Hemorrhagic corpus luteum
(3) Benign or malignant ovarian neoplasm
(4) Ectopic pregnancy

Front 11

Diagnosis of Endometriosis ?

Back 11

-The diagnosis of endometriosis should be suspected in an afebrile patient with the characteristic triad of pelvic pain, a firm, fixed, tender adnexal mass, and tender nodularity in the cul-de-sac and uterosacral ligaments. The characteristic sharp, firm, exquisitely tender "barb" (from barbed wire) felt in the uterosacral ligament is the diagnostic sine qua non of endometriosis.
- The definitive diagnosis is generally made by the characteristic gross and histologic findings obtained at laparoscopy or laparotomy.

Front 12

Management of Endometriosis ?

Back 12

Check the summary

Front 13

Surgical Vs Medical treatments of Endometriosis ?

Back 13

- Surgical intervention is required for an endometrioma larger than 3 cm, gross distortion of pelvic anatomy, involvement of bowel or bladder, and adhesive disease. Surgery may improve fertility for women with severe endometriosis.
- Medical therapy is generally the first line to treat other symptomatic women. There is no convincing evidence that treatment improves fertility in women with mild endometriosis.

Front 14

Define Adenomyosis

Back 14

The extension of endometrial glands and stroma into the uterine musclature more than 2.5mm beneath the basalis layer.

Front 15

Pathology of Adenomyosis ?

Back 15

Diffuse enlargement with a thickened myometrium containing characteristic glandular irregularities, with implants containing both glandular tissue and stroma.

Front 16

Symptoms of Adenomyosis ?

Back 16

- Secondary dysmenorrhea
- Menorrhagia
- Deep-thrust dyspareunia

Front 17

Signs of Adenomyosis ?

Back 17

Generally the uterus is symmetrically enlarged and somewhat boggy and tender premenstrually. It may be asymmetrically enlarged like myoma but softer.

Front 18

Treatment of Adenomyosis ?

Back 18

Depends on symptoms and possibility of other diagnoses
- Conservative management with NSAIDs and hormonal control
- Hysterectomy or Endometrial ablation