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30 Cards in this Set
- Front
- Back
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Define Endosalpingiosis
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Endometriosis of JUST THE GLANDS
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What are the dif locations we can have endometriosis?
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LOTS! uterosacral ligs, post. cul de sac, bladder serosa, fallopian tubes, ovaries =endometrioma, myo = adenomyosis, appendix lung, C section scar
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Define Endometrial implants
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Endometriosis on peritoneal wall
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How does a pt with endometriosis present?
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Dysmenorrhea (pain at menstruation), Menorrhagia (heavy menstrual bleeding), Dyspareunia (painful sexual intercourse), Chronic pelvic pain, Infertility, Incidental finding on Laparoscopy
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T/F: Amt of endometriosis does not correlate with symptoms
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TRUE
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T/F: Endometriosus means the pt is infertile
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NO
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What percent of infertile pts have endometriosis?
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25-35%
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Whats the pathogenesis theory of endometriosis?
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Lymphatic or hematogenous
retrograde flow Hereditary/embryologic |
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What are the clinical findings for endometriosis?
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Uterosacral nodularity
Cervical motion tenderness Boggy uterus |
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What are the diagnostic criteria for endometriosis?
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Laparoscopic proven with or w/o biopsies, response to Depo Lupron
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Pt comes in with Menorrhagia and on exam you find uterosacral nodularities, her cervix motion test is abnormal, and her uterus feels "boggy". You start her on what?
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Depo Lupron, b/c you suggest endometriosis
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Tx for endometriosis?
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Depo Lupron = GnRH antagonist = pseudomenopause = medical hysterectomy
6 month limit b/c of osteoporosis |
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Pt wants to get preggo but has endometriosis. your plans?
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treat her with depo lupron to quiet endometriosis for a few months then see if she can get preggo
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What do we see laparoscopically with endometriosis?
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chocolate cysts, peritoneal window in cul de sac, implants are clear, brown or black, Hyperemic tissue = tissue looks angry GGGRRRR!!
Normal pelvis |
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What are our treatment options for endometriosis?
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Laser Tissue ablation, LUNA (laparoscopic uterosacral nerve ablation), Depo Lupron, Depo Provera, OCs, NSAIDS,
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Whats the goal of tx with endometriosis?
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Anovulation
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Laparoscopy doesn't cure endometriosis. What does?
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total hysterectomy with bilateral salpingectomy
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After hysterectomy, what do we consider in endometrial pt?
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E2
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Pt presents with Normal external vaginal exam, vagina well supported, no cervical lesion or discharge, + uterosacral tenderness with nodularity, boggy retroverted uterus, = CMT reproducing pain, left adnexal 4 cm tender mass, US shows retroverted uterus 7 cm size, 4 cm complex left ovarian cyst. TX?
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Likely endometriosis,
Likely ON ovary = Tx with Laparoscopy |
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Whats the most common female tumor?
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Leiomyoma (Leiomyomata)
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What are the dif. locations of fibroids?
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Pedunculated, Submucosal, Intramural, Subserosal
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What are the symptoms of fibroids?
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pain, dysmenorrhea, back pain, pelvic fullness, urinary frequency, heavy menses, intramenstrual bleeding
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How do we Dx fiborids?
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Mass on pelvic exam, US, incidentally
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How do we name fibroids?
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Sessile = flat, pedunculated = mushroom like, subserosal, intramural, submucosal
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What causes Fibroid growth?
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E2
Shrink spontaneously |
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Whats the tx for fibroids?
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if asymptomatic, none
Myomectomy Uterine artery embolization, Hysterectomy, Depo Lupron |
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Whats a myomectomy?
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hysteroscopic resection of fibroid, can be done laparoscpically, laparotomy, if transmural, treat like c section
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Define uterine artery embolization
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Plugs uterine artery
Causes infarction of uterus collateral blood flow unclear long term results = depends on size and location |
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Whats the most common cause of hysterectomy?
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fibroids
Most often removed abdominally, can be done vaginally via coring, morcellation, bivalving |
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Pt presents with fibroid thats slightly too large for vaginal hysterectomy. Plan?
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Give Depo lupron to shrink to see if we can remove it vaginally
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