Endometriosis and Adenomyosis Flashcards by Susan Choe

what is endometeriosis

benign BUT progressive condition where endometrial-like glands and stroma are present outside the uterus

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is endometriosis considered to be ectopic

yes; the clumps of tissue respond to hormones just as if they were in the uterus

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what is the cardinal feature of endometriosis

hemosiderin-laden macrophages

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what are the 3 components of endometriosis

endometrial epithelium, glands, and stroma

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what specific structures are endometriosis located in

on the peritoneum or surface of pelvic structres (ovaries, fallopina, outside of bowel, outside of bladder)

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what are the three implant types

pigmented
non-pigmented
cryptic

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how does a pigmented implant look like

anything that looks like blood (kind of like a volcano)

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how does a non-pigmented implant look like

no blood hue so considered “inactive” endometriosis

BUT we treat it the same ways as a pigmented

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how does a cryptic implant look like

lots of inflammation around it that it develops into a hole and endometriosis is inside there

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what is an endometrioma

cyst that forms BENEATH the surface of ovary and is filled with CHOCOLATE-colored fluid

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what are present in the cyst wall

endometrial glands and stroma

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where are endometrioma found

broad ligament, fallopian tube, or pelvic sidewall

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how does endometrioma attach to other sections

it ruptures and causes a rapid spread

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is endometrioma staged

yup

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what is the classic triad of symptoms for endometriosis

Dysmenorrhea
Dyspareunia
Dyschezia

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what is endometrioma clinical presentation

cyclic pelvic pain in association with menses - in the earlier stages
(ie. triad, name them, GO!)
infertility
- when endometrioma is treated, infertility decreases

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what is the etiology of endometriosis

Unknown

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endometriosis is associated iwth genital outflow tract obstruction in…

adolescents

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Incidence of endometriosis:
10% ?
40%
80%

10%- general pop
40% - infertile females
80% - chronic pelvic pain (PID)

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where is endometriosis most commonly found

surface of ovaries 60%

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what other weird places are endometriosis found

laparotomy scars, umbilicus, pelvic lymph nodes (30 %), nose.
lung and brain (during autopsies)

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what are the 5 theories of endometriosis development

retrograde menstruation
mullerian (coelomis) metaplsia
lymphatic and vascular transport
immunologic defects
genetic predisposition

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what is retrograde menstruation

endometrial implants are shed throught the tubes at menstraution and implant and grow in the pelvis

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retrograde menstruation is supported by…

observing retrograde flow of blood at laparoscopy

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retrograde menstr: increased likilihood in ... or ... in who age group

cervical stenosis or vaginal atresia/imperforate hymen in adolescents

what is the theory behind lymphatic and vascular transport

endometrial tissue is taken up into the lymphamtics and vascular systems draining the uterus and transported to various sites where they grow -explaining how ppl get it metasized

what is the theory behind immunologic defect

specific defect in local CMI in women with endometriosis | - higher titers of Ab to endometrial antigens in these women

i dont know how to explain mullerian metaplasia

sorry

what are the signs for endometriosis

1. tender, fixed adnexal mass 2. retroverted uterus 3. sharp, firm, tender, "barb" felt on utero-sacral ligament

what is the classic way to diagnose endometriosis

- laparoscopy** (which is done after BCP and NSAIDs dont work) - histologic - hemosiderin-laden macrophages

is U/S reliable for endometriosis

nope

when is an U/S used

endometrioma

CA-125 is or isnt specific diganostic tool

NOT specific | -too many to list

what do you find in a laparoscopic finding

isolated implants, adnexal mass, cul-de-sac oblieration

what 2 things can an adnexal mass mean

1. ovarian endometrioma | 2. encapsulated adhesions

what is cul-de-sac oblieration

entire pelvis is rock solid - aggressive adnexal mass

how important is staging for endometriosis

VERY IMPORTANT! | -quanitify the severity thus guiding your treatment

the stage of endometriosis has a reverse correlation to ... and a direct correlation to ...

pain; infertility | - pain is more linked to the depth of infiltration then the severity of the disease

what are the 4 stages of endometriosis

Stage 1 Minimal disease 1-5 points Stage 2 Mild disease 6-15 points Stage 3 Moderate 16-40 points Stage 4 Severe >40 points

what do the pts based on

related to type, location and amount of endometriosis present

what does treatment of endometriosis depend on

severity age future fertility threat of impingement on surrounding organs

what are the 2 types of treatment available for endomet

surgical and medication

what are the 3 surgical types

resection ablation -killling the tissue hysterectomy - remove BOTH ovaries and tubes

what types of medcations are available

``` NSAIDS- continuous or episodic BCP - cyclic or continuous Prgestin - continuous Danocrine - continuous GnRH agonists ```

how long do you prescribe GnRH agonist for

6 months

medical treatment is effective for

pelvic pain

medical treatment is ineffective for

fertility

is endometriosis benign

yes BUT it can spread like cancer

what is adenomyosis

extension of endometrial glands and stroma into the uterine MUSCLES

adenomyosis aka ...

endometriosis interna

at what age is adenomyosis mostly found

women in their 40's

T/F pts with adenomyosis has associated endometriosis

True but only 15%

what is adenomyosis gross appearance

diffuse enlargement, thickened myometrium w/ glandular irregularties -swiss cheese on u/s

how does adenomyosis look histologically

superficial extension of endometrium in the myometrium

what is the most common type of adenomyosis

diffuse, non-encapsulated

what is it called when its local, encapsulated

adenomyoma | -project into the uterine cavity

what can adenomyoma be mistaken for

submucous fibroid

what are the signs for adenomyosis

1. uterus is SYMMETRICALLY enlarged 2. soft, boggy (mostly) BUT it can be firm and asymmetrical (-which is why it can get mistaken for fibroid uterus)

what are the symptoms for adenomyosis

menorrhagia, dysmenorrhea | BUT many are asymto

why menorrhgia for adeno

- Increased surface area of endometrial cavity | - Can interfere with the normal contractility of the uterine muscle leading to increased bleeding

why dymenorrhea for adeno

- The muscles start to clamp down | - More likely when glandular invasion exceeds 80% or more of the endometrium

how do you diagnose adenomyosis

- s/s, - definitive ONLY after hysterectomy (histological) - excessive bleeding that didnt repsond to hormonal treatments*

how do you treat adenomyosis

need to rule out endometrial cancer by doing a D&C or biopsy BUT ONLY TREATMENT IS hysterectomy!

Endometriosis and Adenomyosis Flashcards

(63 cards)