Endometriosis and Adenomyosis

Question 1

what is the diagnositic test of of choice for endometriosis?

Answer 1

laparoscopy

Question 2

what does the tissue biospy of endometriosis show? (if anything, focus on the major two findings)

Answer 2

endometrial glands, hemosiderin-laden macrophages, and stroma (remember, endometrial glands and stroma should be found in the uterus and NOT outside)

Question 3

what are the two most common sites of endometriosis?

Answer 3

ovary and pouch of douglas

Question 4

what is the age range in which endometriosis is most common?

Answer 4

20s and 30s

Question 5

t or f: endometriosis is common in multiparous women

Answer 5

FALSE; common in nulliparous women (THINK about this .. focus on estrogen relationship)

Question 6

t or f: endometriosis is the most likely cause of infertility in women over the age of 30 without a hx of PID

Answer 6

TRUE

Question 7

t or f: pelvic lymph nodes are a common site of endometriosis

Answer 7

TRUE

Question 8

t or f: severity of symptoms correlates with quantity of ectopic endometrial tissue

Answer 8

FALSE: instead, it may correlate with the DEPTH of the ectopic tissue

Question 9

t or f: the prolonged bleeding of endometriosis can cause scarring (adhesions)

Answer 9

TRUE (this is what may result in the chronic pelvic pain; the adhesions also with contribute to infertility)

Question 10

t or f: with a positive family hx a pt may develop endometriosis at an earlier age than the family member

Answer 10

TRUE

Question 11

what is the official term for pain with defecation?

Answer 11

dyschezia (how is this related to the deck? it may point towards implants on rectosigmoid

Question 12

what is the most popular theory behind endometriosis?

Answer 12

retrograde menstruation

Question 13

explain the theory of retrograde menstruation

Answer 13

endometrial tissue fragments are retrogradely transportred through the fallopian tubes and implant there or intra-abdominally w/ prediliction for ovaries

Question 14

which theory of endometriosis explains its location outside of the pelvis?

Answer 14

vascular/lymphatic transport

Question 15

t or f: endometrial glands and stroma can be implanted during clinician procedures (ex: c-section)

Answer 15

TRUE - called iatrogenic dissemination

Question 16

what is the typical endometriosis uterus?

Answer 16

tender FIXED RETROflexed (with scarring POSTERIOR to uterus)

Question 17

what is characteristic of the uterosacral ligaments with endometriosis?

Answer 17

nodular in nature or thickening and induration

Question 18

women with endometriosis can develop a type of ovarian cyst called what?

Answer 18

endometrioma/chocolate cyst (these are tender, palpable, and freely mobile mplanted masses that occurs within the ovarian capsule and bleed)

Question 19

t or f: endometrial tissue must be biopsied for definitive diagnosis of endometriosis

Answer 19

TRUE (remember, the gold std for diagnosis is lapratomy with biopsy proven hemodierin laden macrophages)

Question 20

an endometrial implant red in color signifies what in terms of duration of time for the implant?

Answer 20

red - new

Question 21

an endometrial implant brown in color signifies what in terms of duration of time for the implant?

Answer 21

brown - older

Question 22

what color are the oldest implants? (which indicates scar tissue)

Answer 22

white

Question 23

what is the maximum amount of time to be on estrogen suppression for treatment of endometriosis?

Answer 23

six months

Question 24

t or f: often there is improvement with pregnancy with endometriosis symptoms

Answer 24

TRUE - secondary to tempory cessation of menses

Question 25

t or f: the primary goal with medical treatment of endometriosis is to induce amenorrhea

Answer 25

TRUE

Question 26

GnRH agonists (such as leuprolide) suppresses what hormone, inducing what state?

Answer 26

FSH; pseudomenopause - (remember, these should only be used for six months total as they are associated with osteoporosis

Question 27

what is the definitive treatment of endometriosis?

Answer 27

TAH/BSO

Question 28

englarged, globular, "boggy" uterus on physical exam is indicative of what?

Answer 28

adenomyosis

Question 29

what is the major difference btwn endometriosis and adenomyosis?

Answer 29

ectopic endometrial tissue does NOT function like normal uterine tissue and is NONresponsive to hormones in the normal manner.

Question 30

what is the definition of adenomyosis?

Answer 30

ectopic endometrial glands and strom found within the myometrium leading to SYMMETRICALLY ENLARGED AND GLOBULAR UTERUS

Question 31

how can you differentiate btw adenomyosis and fibroids?

Answer 31

TVUS

Question 32

t or f: adenomyosis is most common in nulliparous women

Answer 32

FALSE - rare!!!

Question 33

t or f: adenomyosis pain is commonly cyclical

Answer 33

FALSE - commonly NON-cyclical

Question 34

t or f: adenomyosis is typically associated with an assymetrically enlarged uterus

Answer 34

FALSE - symmetrical!!

Question 35

what is the definitive treatment of adenomyosis?

Answer 35

hysterectomy

Question 36

t or f: endometrial ablation will not improve adenomyosis symptoms

Answer 36

TRUE

Question 37

what is proven medical therapy for adenomyosis?

Answer 37

none - no proven medical tx.

Question 38

adenomyosis or endometriosis: typically found in older, multiparous women

Answer 38

adenomyosis

Question 39

adenomyosis or endometriosis: the tissueis responsive to hormonal stimulation

Answer 39

endometriosis

Question 40

adenomyosis or endometriosis: associated with cyclical pain

Answer 40

endometriosis