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28 Cards in this Set
- Front
- Back
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What is endometriosis and how is it diagnose?
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Ectopic endometrial glands and stroma
diagnose HISTOLOGICALLY |
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what is the typical endometriosis pt?
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30s, nulliparous and infertile
but can occur at any age, regress after menopause |
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What are some theories of enodmetriosis pathogenesis?
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not complete understood
genes have some factor modern life : increasing frequency Three hypothesis: 1)Retrograde menstruation theory 2) Mullerian metaplasia theory, metaplastic transformation 3) Lymphatic spread theory, pelvic lymphatics Multiple factors involved: retrograde menstration, coelomic metaplasia, immunologic changes, genetic predisposition |
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how does endometriosis respond to estrogen? with and without
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responds mainly to E2, proliferates, will slough off when hormonal support is removed
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How do endometriosis lesions present? which ones are active
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raised or flat with red, black or brown color (active)
gray or bluish (old inactive disease) active lesions tend to be red and blood filled and contain the most prostaglandins |
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How does endomeTRIOMA of the ovary present? what is it in
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ovarian cysts filled with thick, chocolate colored fluid, sometimes black color and consistency of "crankcase oil"
fluid is aged hemolyzed blood and desquamated endometrium |
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why is endomeTRIOMA a concern?
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pressure can destroy ovarian tissue, also causes infertility
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when does endometrioma not respond to medical therapy?
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>3cm
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is endometrioma benign or neoplastic?
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benign
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What must you have to confirm endometrioma?
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2 of 4:
Endometrial epithelium Endometrial glands Endometrial stroma Hemosiderin laden macrophages |
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How do you stage endometriosis and what is the correlation to symptoms/outcome?
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American Society of Reproductive medicine (ASRM)
Stage 1: 1-5 cm Stage 2: 6-15 cm Stage 3: 16-40 cm Stage 4: >40 cm Stages DO NOT correlate well with symptoms or outcomes |
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What is the classic triad for endometriosis? what are other symptoms?
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Triad: Dysmenorrhea (menses), Dyspareunia (sex), Dyschezia (poop)
Pelvic pain, backache, dysuria |
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Endometriosis mechanism of pain, when and why, early vs late
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Early: cyclic pain (dymenorrhea)
Late: non-cyclic pain very common starts 1-2 days before menses Mediated by prostaglandin and cytokines and related to premenstrual swelling |
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endometriosis: how does pain correlate to the lesion
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deep infiltrating leasion: more painful than superficial one
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What must you do when you diagnose endometriosis?
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rule out pregnancy
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How does endometriosis feel on pelvic exam?
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Firm, exquisitely tender nodule or "barb"
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What techniques can you use to diagnose endometriosis?
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Laparoscopy (usuallly definitive)
Biopsy to improve diagnostic accuracy tumor marker CA-125 can be helpful |
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Surgical management of endometriosis? What else is recommended? recurrence? what can be given preoperatively
Other considerations? |
TAH-BSO (most comprehensive and effective)
remove all peritoneal implants Appendectomy is recommended 20% recurrence GnRH agonist and Danazol Pregnancy (will become infertile) |
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When should endometriomas be removed?
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>3 cm
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what are some conservative surgery treatments for endometriosis and why
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laparoscopic ablative procedures with partial resection of disease
Still maintain fertility |
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what are some other non surgical therapies for endometriosis?
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Second line medical treatment: Danazol, progestins, GnRH analogue (controversial)
- danazol and GnRH are expensive and time limited Continuous OCs and progestin IUD (may have a role) |
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Short term pain relief for mild to moderate disease?
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trial of NSAIDs and OCs
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How can you prevent progression of endometriosis
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early detectiona and correction may help
- rule out endometriosis when young females present with severe dymenorrhea - more then 1/2 women with varying degree of genital tract obstruction |
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define adenomyosis
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extension of endometrial glands and stroma into the uterine musculature by more than 2.5mm beneath the basalis layer
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What is the correlation between adenomyosis and endometriosis
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15% women with adenomyosis have endometriosis
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what are the characteristics of adenomyosis
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diffuse enlargement with thickened myometrium
symmetrically enlarged when asymmetrical: can be confused for leimyomata |
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what can adenomyosis cause
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major cause of secondary dymenorrhea
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what are the treatments for adenomysis: conservative, surgical
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conservative (mainstay) NSAIDS and hormonal control of any abnormal bleeding
Endometrial ablation to help with bleeding Hysterectomy for unresponsive cases |
