Endometriosis Flashcards Preview

A1. Women's Health > Endometriosis > Flashcards

Flashcards in Endometriosis Deck (27)
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1
Q

Define Endometriosis

A

Chronic, benign, estrogen dependant condition where endometrial glands + stroma are found outside the endometrial cavity.

2
Q

There are 6 main theories regarding the cause of endometriosis. What are they?

A
  1. Endometrium reflux back through tubes and then grows onto pelvic structures
  2. Coelemic meatplasia
  3. Embryonic remnant theory
  4. Surgical transplantation - CS sites or Lap sites
  5. Haematogenous/Lymphatic spread
  6. Trans-coelemic spread
3
Q

What are the 2 most common locations of endometriosis to be found?

A

Uterosacral ligament and peritoneum of the Pouch of Douglas

4
Q

What are the 3 main clinical features associated with endometriosis?

A
  1. Pelvic Pain - due to direct stimulation of sensory nerves + adhesion formation
  2. Dysmenorrhoea
  3. Dyspareunia
5
Q

Subfertility is a problem associated with endometriosis. Why?

A
  1. Adhesions - blocking the path of the ovum
  2. Dysparenua - inability to have sex due to pain
  3. Change in peritoneal fluid –> toxic
6
Q

What are some other clinical features based on the various locations of the anastamoses. e.g bladder or intestinal

A

Bladder –> increased frequency, increased urgency and haematuria
Intestinal –> change in bowel habit OR dyschezia (pain on opening bowels)

7
Q

What will be found on examination of a patient with endometriosis?

A
  • Bimanual examination may revel tenderness, fixation and nodularity in the Pouch of Douglas.
  • tenderness on palpation of uterosacral ligaments + tightening
  • in majority of patients -> no obvious clinical signs though
8
Q

Explain the role that oestrogen and progesterone play in the endometrium.

A

Oestrogen - growth/proliferation of endometrium
Progesterone - INHIBITS proliferation + makes endometrium secretory
if oestrogen + progesterone = progesterone inhibits endometrial proliferation
if NO oestrogen or progesterone (premenarche or menopause) = no endometrial growth -> no endometriosis

9
Q

What 3 investigations can be carried out in the setting of suspected endometriosis? One of these is the gold standard.

A

Gold Standard: Laproscopy for diagnosis and determining extent of disease

  • MRI to find deep lying endometriosis involving the bowel
  • Preoperative high res U/S = laprascopic findings
10
Q

Name 4 differentials to be excluded when suspecting a patient to have endometriosis.

A
  1. PID
  2. Primary dysmenorrhoea
  3. appendicitis
  4. GIT diseases
11
Q

What are the two main considerations when discussing the management of this patient with endometriosis?

A

Symptoms and Fertility Status. If patient is trying to conceive its necessary to have surgical management because medical management is basically a contraceptive.

12
Q

What are the 3 main goals of medical management of a patient with endometriosis?

A
  1. Inhibition of PG synthesis
  2. Effective decidualisation
  3. Atrophy of ectopic endometrium
13
Q

What are the 4 main options when it comes to the medical management of endometriosis?

A
  1. NSAIDs
  2. OCP
  3. Oral Progestins/Injectable Progestin/Progestin implant
  4. GnRH analogue/danazol
14
Q

How do NSAIDs work in managing this condition?

A

Decreased PG synthesis -> Decreased vigourous contractions of the uterus which means decreased discomfort.

15
Q

How does the OCP work in managing this condition?

A

OCP suppresses ovulation. Reduces growth of endometrial tissue. Increases apoptosis of ectopic endometrium.

16
Q

How do progestins (in all their forms) work to manage this condition?

A

Inhibition of endometrial growth. Direct effect of causing decidualisation and atrophy. indirect via decrease in endogenous oestrogen through inhibition of hypothalmic pituitary axis.

17
Q

How do GnRH analogues/danazol work to manage this condition?

A

Suppresses the hypothalmic-pituitary-axis.

18
Q

What are the side effects of no estrogen (GnRH analogue)?

A
  1. Vasomotor
  2. Dryness
  3. Osteoporosis
  4. Adverse lipid profile
19
Q

What are the side effects of increased androgens (danazol)?

A
  1. Hirsutism
  2. Acne
  3. Weight gain
  4. Voice change
20
Q

Put simply, what are the goals of surgical treatment of sites of endometriosis?

A
  1. Resect it
  2. Burn it
  3. Hysterectomy - will stop new retrograde endometriosis
  4. Castration - remove ovaries because of the hormones it produces and it is essentially the same as the GnRH analogues but long term
21
Q

Mx scenario: big endometrial cyst

A

Resection

22
Q

Mx scenario: if want pregnancy

A

Dithermy

23
Q

Mx scenario: dotting + splits

A

Ablation

24
Q

Mx scenario: older, have many symptoms, finish child bearing, finish other treatment

A

Hysterectomy

25
Q

Mx scenario: younger patients, not kids now, no cysts

A

Pill

26
Q

Mx scenario: older patient, milder disease

A

Progestin pills

27
Q

Mx scenario: bad disease, not pregnant

A

GnRH analogue