9 - Gynae - Endometriosis + Chronic Pelvic Pain - Endometriosis

Question 1

what age range esp?
What is it?
Most common in who?

Answer 1

30-45
presence and growth of endometrium like tissue outside the uterus
nulliparous women

Question 2

Pathology - dependent on?

• regresses when? (2 times)
• can occur throughout pelvis but esp where? (2 places)
• accumulated altered blood - colour? can form what? where?
• endometriosis causes ? with progressive fibrosis and ?
• in most severe cases pelvis is ? (organs ?) by adhesions

Answer 2

oestrogen
preg and post meno
on/behind ovaries, uterosacral ligs
dark brown
chocolate cyst / endometrioma
ovaries
inflam
adhesions
frozen - immobile

Question 3

Aetiology - probably due to ?menstruation (in pelvis)

• this is common and not always ass w endometriosis
• distant foci may be from what 3 types of spread?
• some ? link

Answer 3

retrograde
mechanic, blood, lymph
genetic

Question 4

Hx points - often ?

• important cause of ? ? pain
• usual pattern?
• PCs include…? before onset of period, ? dyspareunia, ?, pain on ? ? during menses, occasionally ? problems
• what causes acute pain and could be first Sx?
• what three Sx are uncommon but suggest severe disease?

Answer 4

aSx
chronic pelvic pain
cyclical
dysmenorrhea
deep
subfertility
passing stool
menstrual
rupture of a endometrioma
rectal bleeding, cyclical haematuria, umbilical bleeding

Question 5

DDx of endometriosis - 5 things

Answer 5

IBS
Adenomyosis
other causes of pelvic masses
chronic PID
CPP

Question 6

Ex points - if mild, the pelvis may feel ?

• 2 common findings on VE?
• advanced cases - uterus is ? and ? from adhesions, and a ? nodule of endometriosis may be found on ??/visible on ? Ex

Answer 6

normal
tenderness, thickening behind uterus/adnexa
immobile and retroverted 
rectovaginal
digital exam
speculum

Question 7

Ix - sometimes ? is raised

- name 3 Ixs and what can be added to them?

Answer 7

• CA125
• Laparoscopy +/- biopsy
• TVUSS
• MRI +/- IV pyelogram and barium studies

Question 8

Ix - Laparoscopy

• diagnosis only made after ? +/- ?
• active lesions are ? resicles or ? marks on peritoneum
• what shows less active disease?
• what shows severe disease?

Answer 8

visualisation +/- biopsy
red
punctate
white scars/brown spots
extensive adhesions and ovarian endometriomas

Question 9

Ix - TVUSS - useful for diagnosing what? may also show what ?

• peritoneal endometriosis not seen on USS but may be on ?
• what warrants assessment w MRI +/- IV pyelogram and barium studies?

Answer 9

ovarian endometrioma
adenomyosis
MRI
evidence of deeply infiltrating endometriosis, ureteric, bladder and bowel involvement