Endometriosis Flashcards
(26 cards)
definition
presence of functioning endometrial glands and stroma outside the uterus
Where does the implants commonly occur in?
Pelvis. Can occur in distant sites such as the pleural cavity, liver, kidney and gluteal muscles
What are the features of endometriosis?
- 10%-20% in reproductive age
- 20%-50% infertility
- exposure to ovarian hormone - estrogen
- No racial or socioeconomic predilection
What are the 3 major theories of pathogenesis of endometriosis?
- Sampson’s theory
- Meyers theory
- Halbans theory
What is Sampson’s theory?
Direct implantation of endometrial cells on peritoneal surfaces by retrograde menstruation
Meyers theory?
multipotential peritoneal cells can develop into endometrial cells
Halbans theory?
endometrial cells travel in blood and lymph vessels and cause endometriosis in lymph nodes, pleura, kidney and even brain
What are the different types of endometriosis?
- Deep infiltrating endometriosis (DIE)
- Ovarian endometriotic cysts (EC)
- Superficial endometriosis (SE)
What are the most common sites of endometriosis?
- Surface of the ovary 60%-70%
- Endomerioma - ovary
- Peritoneum over the uterus
- Fallopian tube and mesosalpinx
- Posterior cul-de-sac
- Uterosacral ligaments
- Rectosigmoid
What is the macroscopic appearance of a ovarian endometriosis?
- Red, blue or brown spots
- chocolate cysts
- ovarian cysts filled with thick, dark old blood
What are the common sites of peritoneal endometriosis?
- Uterosacral ligament
- Rectouterine pouch / Pouch of Douglas
What are the lesion types of peritoneal endometriosis?
- Purple spots
- Dark brown spots
- Red lesions
- White lesions
- Peritoneal pockets
- Peritoneal defects
What are the clinical manifestations?
- Pain : dysmenorrhea, dyspaurenia, dysuria, dyschesia, non cyclic pelvic pain
- Infertility
- Palpable pelvic mass
- Abnormal uterine bleeding : irregular menstrual bleeding, premenstrual spotting, hematuria and rectal bleeding
- Acute abdominal emergency due to rupture or torsion of endometrioma
- Miscarriages and preeclampsia
What are the pelvic examination findings? (Bimanual or vaginal rectal adbdominal examination)
- Early stages : subtle / no positive signs
- Pelvic tenderness
- Fixed retroverted uterus
- Tender nodules on uterosacral ligament/rectouterine pouch (advanced stages)
- Palpable, tender and adnexal masses - suggests that the ovary is involved (endometriosis)
Diagnosis
- Anamnesis such as pain and infertility
- Physical examination
- Biochemical markers - serum CA 125
- Imaging - ultrasound, MRI and CT
- Laproscopy for direct visualization
- Histopathological examination
What is the gold standard diagnostic
Laproscopy
What are the GOALS of treatment of endometriosis?
- Alleviate pain
- Delay recurrence
- Help patients get pregnant
What does the choice of treatment depend on?
- Symptoms and severity
- Location and severity
- Desire of future childbearing
Mild symptoms/adolescent girls who wish to get pregnant
Medical treatment
Young patients, severe endometriosis, wish to have children
Fertility preserving surgery
Young patients, severe endometriosis, do not wish to have children
Ovary preserving surgery and medication
Old patients, severe endometriosis, do not wish to have children
Radical surgery : (hysterectomy+bilateral salpingo-oophorectomy)
What are the 2 aims of medical therapy?
- Pseudopregnancy
- Pseudomenopause
Pseudopregnancy
- Combined low dose contraceptive pills - inhibits ovulation and menstruation
- Progestins - avoid estrogen side effects - MPA, DMPA and dienogest
