Endometeriosis

Question 1

presence of endomterial glands and stroma outside uterus

Answer 1

endometriosis

Question 2

endometrial glands and stroma in the myometrium

Answer 2

adenomyosis/ endometriosis interna

Question 3

common symptom asstd w/ endometritis

Answer 3

pelvic pain

infertility

Question 4

what is sampson theory

Answer 4

endometrial cells backflow from the endometrial cavity to the FT

Question 5

endometriosis found in unusal location such as perineum, and groin supports this theory

Answer 5

theory of lymphatic and vascular spread

Question 6

condition of collapsed lung occurring in cjn with menstrual periods caused primarily by endometriosis of the pleura

Answer 6

catamenial hemothorax

Question 7

what is the coelomic metaplasia theory

Answer 7

endometriosis results from spontaneous metaplastic change (coelomic metaplasia) in the mesothelial cells derived from the coelomic epithelium

Question 8

this theory is attractive in instances of endometriosis in the absence of menses (premenarchal and postmenopausal)

Answer 8

coelomic metaplasia theory

Question 9

this theory states that hormonal or biological factors may induce differentiation of undiffd cells into endometrial tissue

Answer 9

induction theory

Question 10

potent stimulator of endometriosis

Answer 10

estrogen

Question 11

how can estrogen cause endometriosis

Answer 11

estrogen causes an increase in aromatase activity thereby increasing conversion of estrone to estradiol and thus stimulate growth of endometriotic implants

Question 12

androstenedione is converted to estrone by

Answer 12

aromatase

Question 13

estrone is converted to estradiol by

Answer 13

17 B hydroxysteroid dehydrogenase I

Question 14

estradiol is directly secreted by

Answer 14

ovary or produced in perihperal sites ( adipose tissue and skin)

Question 15

major source for circulating estradiol in the postmenopausal period or during ovarian suppresion

Answer 15

peripheral aromatization

Question 16

these mediate pain, inflammation and infertility

Answer 16

prostaglandins and cytokines

Question 17

retrograde menses is common, but why is that other women don’t dev endomet?

Answer 17

these women have an effective immune sys specifically peritoneal macrophages w/c prevents proliferation of endomet cells in the peritoneal cavity

Question 18

px w/ endomet have problems in NK cells, what is the effect of this?

Answer 18

it would bring abt problems in phagocytosis and apoptosis

Question 19

Risk factors of endomet

Answer 19

Familial clustering
Genetic mutations
anatomic defects
environmental toxins

Question 20

genetic mutations ins endometriosis occurs specifically in aberrant products such as

Answer 20

metalloproteinases and integrins

Question 21

Reproductive outflow tract abnormalities examples

Answer 21

blind uterine horns
transverse vaginal septum
imperforate hymen
vaginal atresia
uterine agenesis

Question 22

exposure to this product is a risk factor for endomet

Answer 22

2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD) and other dioxin like products

Question 23

how does TCDD stimulate endometriosis

Answer 23

it acs as estrogen thus increasing IL levels, activation of cytochrome p450 enzymes (aromatase) it also block the progesterone induced regression of endomet

Question 24

most common symptom of endometriosis

Answer 24

pain (cyclic or chronic)

Question 25

endometriosis pain may result from

Answer 25

neuronal invasion of endometriotic implants that subsequently develop a sensory and sympathetic nerve supply w/c may undergo central sensitization

Question 26

symptoms of endometriosis

Answer 26

``` Chronic pelvic pain dysme dyspareunia dysuria dyschezia ```

Question 27

how can dyschezia d/t endomet be differentiated from GIT problems

Answer 27

dyschezia d/t endomet are usu related to menses

Question 28

this symptom denotes that endomet cells has already invaeded the urinary tract

Answer 28

dysuria

Question 29

how can endometriosis lead to infertility?

Answer 29

adhesions can be located in the FT impairing abiility to of fimbriae to capture egg during ovulation folliculogenesis is impaired, oocyte number may decreased in px w/ endomet

Question 30

what can be seen in px with endomet upon speculum exam

Answer 30

blue or red powder burn lesions on the cervix or the posterior fornix of the vagina

Question 31

classic appearance of ovarian endomet cyst due to blood pooling during menstrual reflux in invagination and focal bleeding in the ovary

Answer 31

chocolate cyst

Question 32

form of diagnosis for endomet if ovaries are involved

Answer 32

transvaginal ultrasound

Question 33

if ovaries are not involved and there are just 1 or 2 endomet implants less than 2 mm in size, what would you do to diagnose?

Answer 33

MRI or CT

Question 34

GOLD STANDARD in the diagnosis of endomet

Answer 34

laparoscopy w/ or w/o histologic examination of excised lesion

Question 35

Newer lesions

Answer 35

bleb like lesions

Question 36

older lesions

Answer 36

white lesions

Question 37

classic peritoneal implants

Answer 37

blue-black "powder burn" lesions with fibroids

Question 38

less common lesions of endomet

Answer 38

ovarian adhesions yellow brown patches peritoneal defects

Question 39

type of mgt for younger px who are diagnosed thru UTZ but are asymptomatic

Answer 39

expectant mgt

Question 40

this treatment is beneficial for pain relief and may improve bleeding control of px on OCP

Answer 40

NSAIDS

Question 41

progestin drug given to px w/ endomet

Answer 41

medroxyprogesterone acetate

Question 42

MOA of progestin

Answer 42

it induces decidualization of endometrium so eventually low estrogen but chronic progesterone exposure would lead to endometrial atrophy

Question 43

this is given to control pain and effective in retroperitoneal endomet

Answer 43

levonorgestrel containing IUS

Question 44

first medication indicated for endometriosis

Answer 44

danazol

Question 45

MOA of danazol

Answer 45

it inhibits midcycle urinary LH surge and induces a chronic anovulatory state; it also inhibits steroidogenic enzymes and increases testosterone lvls

Question 46

adverse effect of danazol that px would discontinue using it

Answer 46

deepening of voice

Question 47

this reduces COX-2 lvls and would reduce the pain or improve other symptoms

Answer 47

GnRH agonist

Question 48

intramuscular GnRH

Answer 48

leuprolide acetate

Question 49

SubQ GnRH

Answer 49

Buserelin acetate

Question 50

Treatment for px with adhesions

Answer 50

adhesiolysis

Question 51

treatment for px with endometriotic cyst

Answer 51

cystectomy

Question 52

treatment for px who do not respond to treatment/ no longer desirous of pregnancy

Answer 52

TAHBSO

Question 53

treatment for px who are not candidate for TAHBSO but with severe pain

Answer 53

LUNA (laparoscopic Uterosacral Nerve ablation | presacral neurectomy