Flashcards in Endometriosis Deck (19):
What is endometriosis?
disease in which endometrial glands and stroma implant and grow in areas outside of the uterus
Where are implants most commonly found?
ovaries, anterior and posterior cul de sac, broad ligaments, uterosacral ligaments, uterus, fallopian tubes, sigmoid colon, and appendix, round ligaments
Where can lesions occur?
pleural cavity, liver, kidney, gluteal muscle, bladder, anywhere
How many women will get edometriosis?
2-50%, 21-47% will be infertile
What age is the most common, why?
25-35 years, because of ovarian hormone
What are the theories of etiology?
sampson's theory- retrograde menses and peritoneal implantation; meyer's theory- ceolomic metaplasia; Halban's theory- hematogenous or lymphatic spread to distant tissues; immunogenic defect- deficient cellular immunity
What is the appearance of enometriotic lesions?
varies! flame-like patches, whitish opacifications, yellow brown discoloration, translucent blebs, reddish blue irregularly shaped islands
What are powder burns?
appearance of blue brown lesions description
How is endometriosis staged?
based on extent of involvement; stage 1: minimal, stage 2: mild, stage3: moderate, stage 4: severe, includes adhesions
What is the clinical presentation of endometriosis?
pelvic pain, infertility, pelvic mass, dysmenorrhea, dyspareunia, bowel upset, bowel pain, dysuria
How can pelvic pain present?
cyclic or acyclic, can have associated sx (dysparunia, dysuria, dyschezia)
Where besides pelvis can endometriosis pain present?
muscle regions, distant tissues
Physical findings of endometriosis?
tender nodules along utero sacral ligaments or in culdesac, esp before menses, pain or induration w/out nodules commonly in cul-de-sac or recto vaginal septum, uterine or adnexal fixation, or adnexal mass
How is endometriosis diagnosed?
there are no lab tests, can measure CA125, usually it's greater than 35 U/ml in endometriosis, can do laparoscopy to see implants, MRI is best, U/S helps too, biopsy
What is on the dif diagnosis?
ectopic pregnancy, PID, interstitial cystitis, adenomyosis, ovarian neoplasms, adhesions from surgery, IBS, colon CA, diverticular disease, uterine fibroids or adenomysosis
What is the treatment of endometriosis?
surgery, or medical therapy for pain, surgery, ovulation induction, or assisted reproductive technology for infertility
How is pain managed?
ablation of endometrial implants, lysis of adhesions, ablation of uterosacral nerves, resection of endometriomas
What is some medical management?
oral contraceptives, progestin, danazol, GnRH agonist w/ add back estrogen, alternating GnRH agonist and OCs, aromatase inhibitors (suppress estrogen)