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26 Cards in this Set
- Front
- Back
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What are the MC sites of endometriosis? |
1. Ovary 2. Pelvic peritoneum over uterus 3. Anterior/posterior cul-de-sac
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What groups are at risk for endometriosis? |
1. Delayed childbearing 2. Genetic predisposition with disease in first-degree relative |
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What do you surgically dx endometriosis? |
1. Laparoscopy with implant bx |
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What are the pathogenesis theories for endometriosis? |
1. Retrograde menstruation 2. Vascular and/or lymphatic spread 3. Coelomic metaplasia of multi potential cells |
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What are some dx clues for endometrisosi? |
1. Women who do not respond to NSAIDs or OCs for dysmenorrhea 2. Deep dyspareunia 3. Infertility 4. GI complaints |
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What are the clinical signs of endometriosis? |
1. Uterosacral nodularity palpable on pelvic or rectovaginal exam 2. Fixed uterus or ovary on pelvic exam |
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What meds should be given on a trial basis when endometriosis is suspected? |
1. Doxycycline 2. NSAIDs 3. OCs |
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What imaging modality should be used first in an evaluation of endometriosis? |
1. US |
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If the trial meds fail to resolve patient complaints, what is the next step? |
1. GnRH agonist |
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What is the next step if the GnRH agonist fails to resolve ssx? |
1. Laparoscopy 2. Consultation with pain clinic |
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What factors should you take into account when you tx endometriosis? |
1. Pain control 2. Desire for future pregnancy |
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What are the medical tx options for endometriosis? |
1. OCs--- menstruation 2. Progestions-- suppress menstruation 3. Danazol 4. GnRH agonists |
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What are the surgical options for the tx of endometriosis? |
1. Lysis of adhesions 2. Cauterize impalnts 3. Hysterectomy with ooophorectomy |
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What should be in the ddx with ssx of endometriosis? |
1. PID 2. Pelvic adhesions 3. Dyspareunia 4. Irritable bowel, hematochezia 5. Luteal phase defects, cervical polyps |
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How do you ultimately arrive at a dx of endometriosis? |
1. Dx of exclusion 2. Work-up for other disorders is negative |
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What is chronic pelvic pain? |
1. Pain for 6 months duration 2. Must be of sufficient severity to cause functional disability, interfere with normal activities, or lead to medical care |
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In what ages is primary dysmenorrhea most common? |
1. Late teens or 20's 2. Risk decreases with age |
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What is the effect of childbearing on risk for primary dysmenorrhea? |
1. No risk increase |
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What are the MCC of primary dysmenorrhea? |
1. Endometriosis 2. Adhesions 3. IBS 4. Interstitial cystitis |
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What cellular mediator is linked to primary dysmenorrhea? |
1. Prostaglandin F2-alpha |
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What post-menopausal conditions can cause primary dysmenorrhea? |
1. Genital malignancy 2. DM 3. Intestinal disease |
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What should be included in the history for primary dysmenorrhea? |
1. Medical 2. Surgical 3. Sexual 4. Menstrual 5. Social/family |
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How do you tx primary dysmenorrhea? |
1. Bed rest 2. NSAIDs 3. Heat 4. OMT 5. Exercise 6. OCs 7. Supportive care |
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What are the MCC of secondary dysmenorrhea? |
1. Endometriosis 2. Tumors 3. Inflammation 4. Adenomyosis 5. Leiomyoma |
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What is adenomyosis? |
1. Islands of endometrial tissue in the myometrium |
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How is adenomyosis best diagnosed? |
1. MRI 2. Often at time of hysterectomy--- boggy, enlarged uterus |
