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25 Cards in this Set
- Front
- Back
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Define endometriosis.
Explain the theories of the pathogenesis of endometriosis. Discuss the clinical manifestations of endometriosis. List treatment options for endometriosis. |
Objectives
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Defined as the presence of ________ glands and/or stroma outside the uterus.
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endometrial-like
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Endometriosis Is an __________-dependant disease, so factors that are associated with reduced ________ levels will reduce the risk of developing it
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estrogen
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Name some factors that are associated with reduced estrogen levels
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Includes:
decreased body fat, exercise-induced menstrual disorders, smoking |
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Three theories of the pathogenesis of endometriosis:
1. Retrograde menstruation 2. Hematogenous or lymphatogenous transport 3. Coelomic ______plasia |
metaplasia
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Endometriosis Is a histological diagnosis. Pathologist looks for evidence of menstrual cyclicity ( the presence of tissue hemorrhage or hemosiderin laden ________.
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macrophages
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Clinical manifestations of endometriosis
Asymptomatic Mostly pain bleeding and infertility. Also complain of dysmenorrhea, chronic pelvic pain, dys_________, tenesmus, dys_______, dys______. |
dyschezia
dysuria dyspareunia |
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Factors that influence the symptoms: appearance, location, and _______ of invasion.
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depth
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Physical exam:
Of limited value. Palpate ______ or ________ in cul-de-sac, parametrial thickness, adnexal mass, thick uterosacral ligaments. |
nodularity
tenderness |
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Diagnosis by biopsy of lesions during laparoscopy.
Lesions - _____ powder appearance, red, blue, raised glossy blobs, fibrous adhesions, _____ cyst. |
gun
chocolate |
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Treatment of endometriosis
Geared toward patient goals and fertility desires. 1. ______ management 2. Medical treatment 3. Surgical treatment |
Expectant
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Medical treatment Designed to create a chronic _______ state, a pseudopregnancy, or a menopausal state.
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anovulatory
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D______ : creates a chronic anovulatory state by diminishing midcycle luteinizing hormone and follicle-stimulating hormone surge.
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Danazol
Dose to result in amenorrhea. Usually 600-800mg/day. |
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Danazol Increases free levels of hormones esp. testosterone. Side effects are androgenic and
a) reversible b) irreversible c) minimal d) undesireable |
b) irreversible
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Progesterone : causes endometrial _______.
a) hypertrophy b) atrophy c) hyperplasia |
atrophy
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Depo medroxyprogesterone acetate dose is 150 mg IM every 3 months.
Caution long term use, causes _______ that is reversible. |
osteopenia
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Oral progesterone daily. Provides birth control and ____ relief.
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pain
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Treatment of endometriosis
Oral contraceptives Continuous use for 3-4 months and cycle after 4th pack. Effects similar to ______. |
progesterone
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GnRH analogs : down regulate the pituitary gland resulting in decrease in gonadotropins.
Medical oopherectomy or _________ state. Takes 3-6 wks to see effects. SE are menopausal symptoms. Can treat with estrogen. |
menopausal
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If pt has a Decrease in bone density from GnRH analog: Advise calcium use and check BDS. Consider b____________ use.
Can only use this for 6 months, then need a break for 1 yr. Depo-Lupron 3.75mg IM every month for 6 months. |
bisphosphonate
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Pain medications for endometriosis:
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NSAID’s, narcotics.
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Surgical treatment:
Goal is to _________ Surgical treatment is better for infertility than medical therapy. |
restore normal anatomy.
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Surgical treatment Can be conservative or definitive.
Conservative done with laser, excision, cauterization of lesions visible and in safe location. May include presacral neuroectomy, or _______ ligament transection. |
uterosacral
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What is Definitive surgical therapy?
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= Hysterectomy with bilateral salpingo-oopherectomy
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May also use a combination of surgical and medical therapy i.e., laser then ______ injections.
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depo MPA
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