16- Pelvic Pain- Endometriosis Flashcards
Who Are in the endometriosis risk groups?
Delayed childbearing
Genetic predisposition with disease in FDR
How is endometriosis diagnosed?
Surgical diagnosis- laparoscopy with implant biopsy for histologic confirmation of presence of endometrial cells
What are some pathogenesis theories of endometriosis?
Retrograde menstruation
Vascular and or lymphatic spread
Coelomic metaplasia of multipotential cells
What are the symptoms of endometriosis ?
Deep dyspareunia
Infertility
Women who do not respond to NSAIDs or OCs for dysmenorrhea
GI complaints- can be cyclic
Severity of symptoms does not equal severity of disease
What are the clinical signs of endometriosis ?
Uterosacral nodularity palpable on pelvic or rectovaginal exam
Fixed uterus or ovary on pelvic exam
How to evaluate the pelvic pain?
History and physical exam CBC, ESR, UA Pelvic US Check for gonorrhea, chlamydia Trial of doxycycline Trial of NSAIDs Trial of OCs Do not want to do the same trial if patient is not responding to initial therapy
How to manage a patient with chronic pelvic pain?
After history and physical exam
Patient can be on OCs or GnRH agonist
If patient does not want any of the treatment due to desire to get pregnant
You can do a laparoscopy
What are the treatment considerations ?
Pain control
Desire for future pregnancy
What are the medical treatment objectives ?
Induce atrophy of endometrial tissue
Possibility of recurrence after medical treatment
No effect on adhesions or fibrosis
What are the treatment options?
OCs- control menstruation Progestins-suppress menstruation GnRH agonists- down regulate the pituitary Danazol- pseudo menopause GnRH antagonist- blocker oriliss
What are the surgical options?
Conservative- lysis of adhesions, cauterize implants
Ablative- hysterectomy with oophorectomy . Patient may need HRT post op
What are the possible differential diagnosis with endometriosis ?
PID Pelvic adhesions Dyspareunia GI- Irritable bowel, hematochezia Vaginal bleeding
Which of the following list the common sites of endometriosis from most to least?
Ovary
Vagina
Lungs
What is the best method of diagnosing endometriosis ?
Laparoscopy with implant biopsy
What is the best order of treatment following an evaluation for chronic pelvic pain without a specific pathology?
NSAIDs and/or oral contraceptives, GnRH agonist, laparoscopy
