Endometriosis Flashcards
Endometriosis - definition
Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant) - endometrium in abnormal place - heterotopia. Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.
what about menstrual cycle in endometriosis?
In endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped(spąstai) When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal tissue that binds organs together.
Endometriosis - features
- There is no EM before menarche and after menopause
- The ectopic endometrial cells are ormonoregolate as endometrial cells eutopiche
- The therapeutic aspect is the most important pregnancy: in this period, in fact, the excess of estrogen and progesterone causes a down-regulation of receptors Resulting block Hormone
- Hormone treatments are most effective
Etiology of EM
Multifactor. Causes could be:
- Retrograde menstruation. Bloog goes to tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs.
- Embryonic cell growth. The cells lining the abdominal and pelvic cavities come from embryonic cells.
- Surgical scar implantation.after hysterectomy or C-section
- Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) transports
- Immune system disorder.
Epidemiology of EM
Peak incidence: 35 years. (20-25m asymptomatic,reversible, with pregnance, o 35m adhesions, reversible only surgically, and infertility may be compromised Already)
• frequency in the general population: 12%
• frequency in women with pelvic pain and / or infertility: 20-90%
• Frequent diagnostic delay: in fact, the symptoms usually appear in Conjunction with the
menstruation and, Therefore, macaws is brought back to this
Classification
- EM external (extrauterina):
- intrapelvic: a) intraperitoneale b) extraperitoneale
- extrapelvic (Can Affect other organs,: such as lung, skin, sciatic nerve,pancreas, appendix)
- EM internal or adenomyosis (developed in myometrium)
EM external - intrapelvic
Intraperitoneal:
• Ovary
• Tube
• Uterine ligaments
• Pelvic Peritoneum
Extraperitoneal:
- vaginal
- Bladder (suggested by the presence of hemoglobin in the urine of patients, However, asymptomatic)
- Rretto-sigmoidaria (poi giungere ad oclusion intestinal complete)
Risk factors
- Never giving birth
- One or more relatives (mother, aunt or sister) with endometriosis
- Any medical condition that prevents the normal passage of menstrual flow out of the body. Gal hiperpolimenorrea e menorragia
- History of pelvic infection
- Uterine abnormalities (imperforate hymen, vaginal septum transverse and uterine horn not communicates)
- alterations of COX2: Determine an Increase of PGE2 Which induces an Increase aromatase, estrogen and then, in the ectopic cells. It is important also for infertility (Interference on tubal motility, ovulation and steroidogenesis of the luteal phase. Syndrome lack luteinized follicular rupture, with retentionoocyte
Etiopathogenetic theories
- plant and peritoneal metastatic spread
- Dissemination blood-lymphatic
- surgical Dissemination: in case of caesarean section
- Transformation coelomic (coelomic metaplasia of Meyer): based on totipotentiality of the peritoneal mesothelium, Considered as a secondary Müllerian system, WhichUnder Certain stimuli can become sense endometrial (metaplasia endometriosis)
- Immune tolerance: Functional deficiency of NK lymphocytes normally delegated to lysis of abnormal cells Alteration of the monocyte / macrophage; increased growth factors, cytokines, angiogenic factors
- hormonal dependence(role of estrogen)
- role of enviroment toxins (dioxin, DEMP, bisphenol A ir B)
Pathological anatomy of ovarian EM
the ovary is the organ most affected by endometriosis and is larger for presence of endometrial cysts. Endometriosis Ovarian includes localizations ovarian superficial punctate, the so-called “chocolate cysts”. These cysts are adherent to the peritoneum and are formed as secondary to ovarian endometriosis
at the level of peritoneal endometriosis ovarian dimple. it determines adhesion between peritoneum and ovary, which peritoneal folds on the plant: in a place longer available, Subsequent
ovulations causes the distension of the parenchyma of the impossibility of evacuation of the liquid
follicular and blood material. “pseudomestruation” within the cyst.
From a clinical point of view, in these cases the cyst will be asymptomatic up to 2-3 cm, to then be
symptomatic
Peritoneal endometriosis
Peritoneal Endometriosis: causes pelvic pain, but, unlike the EM (causing pelvic pain for
compression), it leads to a direct nerve stimulation, with nervous symptoms
consequent
EM extragenital
- SIGMO-rectal: determines phenomena of intestinal obstruction
- Urinary (especially bladder detrusor)
- on scars: eg umbilical or by Caesarean section Following
- Appendix
- utero-sacral ligament
Syndrome adhesions
Syndrome adhesions: if in charge of ovary or tube determines infertility. The adhesion is determined
by chronic inflammation and the Resulting fibrosis
Staging
• Stage I: Minimum: presence of isolated systems; not present significant adhesions.
• STAGE II: mild: the presence of surface facilities (total length <5 cm), scattered on the ovaries and
peritoneum; adhesions significant not present.
• Stage III: Moderate: presence of multiple systems, Both superficial and infiltrating; presence of
periannessiali adhesions.
• STAGE IV: severe: the presence of multiple systems, Both superficial and deep, including endometriomas;
presence of thick and tenacious adhesions
General symptoms
General (in order of frequency): it is appropriate to note That in 25-30% of cases, endometriosis is
asymptomatic and detected incidentally in the course of laparoscopic or laporotomici, the carried out for
looking for causes of infertility or other Reasons
- Dysmenorrhea: painful menstruation
- Chronic pelvic pain: pain out of menstruation
- fatigue and asthenia
- nausea, vomiting, dizziness and headache
- Reduced resistance to infections
- Infertility
