Adeno& Endometriosis Flashcards
Def
Incidence
Theories
1-Presence of endometrial gland and stroma outside the uterine cavity
2-10% in childbearing period, 20% in pelvic pain, 30% in infertility woman
3-
•Sampson’s theory of retrograde menstruation :
Retrograde menstruation happens via fallopian tube, leading to intra-abdominal pelvic implants. It’s the most accurate, doesn’t explain the extra-pelvic pathology.
•Altered immune response : During menstruation retrograde, there’s altered immune response, leading to failure to clear the endometrial cells in the pelvis
•Halban’s theory of lymphatic system :
The endometrial cells are transported in the lymphatic vessels to various intra-peritoneal sites. Doesn’t explain the distant organs, lung, breast, brain.
•Meyer’s coelomic metablasia :
The multi-potential peritoneal cells got into metablasia to become functioning endometrial cells.
Risk factors
Marlon Monroe
-Genetic Maternal
- Race White
- High socio-economic standard
-Child-bearing period 25 to 35
-Nulli gravida or low parity
- Infertile
Patho
Site
Size
1-
•Pelvic (most common) :ovaries, douglas pouch, utero sacral ligament, pelvic peritoneum.
•Extrapelvic(rare) :
2-Size
•Pelvic endometriosis :Dark blue or brown altered blood lined with endometrial lining. Resembling burn match head spot.
•ovaries
-superficial: dark brown lesions with adhesions, (powder burns)
-deep (chocolate cyst or endometrioma) :
Cysts with endometrial lining,
moderate in size
, chocolate in color due to presence of haemocedrin laden cells.
Symptoms
Signs
-Type of patient
- White race
-high socio-economic standard
- 25 to 35
-Nulli gravida or low parity
-infertile
-Symptoms (3)
•Asymptomatic
•pain, 6
1-Chronic pelvic pain above 6 months is suggestive to endometriosis
2-2ry dysmenorrhea (3)
-Secondary dysmenorrhea is one of the commonest presentations.
-During menstruation, the pain increases due to blood distention of the ectopic endometrial glands
-After menstruation, the pain decreases due to blood absorption but still occurs due to fibrosis.
3-Dysperonia
4-dysuria with cyclic hematuria
5-dyschezia with cyclic bleeding rectum
6-symptoms according to the organ
•infertility due to peritoneal and pre tubal adhesions.
Signs
General ~> x
Abd ~> endometrioma
Pv and bimanual ~>
- rvf ut
- tender nodules in dogglas pouch
D.d ( tb, endo, krukunberg)
- endomertrioma
Inv
1-Laparoscopy
-is the gold standard in diagnosis and staging
2- US
-is done in cases of endometrioma~> Ground glass appearance is pathognomonic for endometriosis
3-CA-125 (4)
-Antigen on coelomic epitheliam
-5-35.
-In some cases of endometriosis, it increases slight to moderately But it’s not accurate as it can indicate GIT problems instead
-It’s prognostic.
Management
(3)
1-Conservative TTT
-in young patient with mild symptoms
-for pain
•nsaids and analgesics
•following up
2-Medical TTT
-Marked symptoms
-Improvement during pregnancy (PRG is the upper hand ~>Atrophy )and Menopause( E2 is low )
•OCPs
~AIM Amenorrhea and pseudopregnancy state ~Mechanism atrophy and degeneration of endometrial glands
~Dose 3 to 6 months
~Disadvantage hormonal side effects
•Gestigens
~Aim Amenorrhea and pseudopregnancy state ~Mechanism Degeneration of endometrial glands
~Dose : 3:6 months
.nor ethisterone acetate
.Dmpa
~Disadvantage :pMS-like syndrome
• GnRH agonists
~ Aim Like menorrhea state
~ Mechanism Hypoestrogenemia
~Dose 3 to 6 months
~Disadvantage Expensive ,Menopausal symptoms But can avoid with low-dose estrogen
•Denazole : Increases androgen, decreases estrogen Not used due to irreversible androgenic side effects due to prolonged use
3-Surgical Ttt
- Conservative surgery (3)
1-
•excision, fulguration, ablation of endometrial cells
•lysis of pre-tubal and the periovarian adhesions
•cystectomy of ovarian endometrioma> 4 cm.
2-laproscopy or laprotomy.
3-GnRH agonist is taken preoperative to reduce the vascularity and the nodular size.
-Definitive surgery (3)
1-pan-total hysterectomy ( tah&bso)
2-In multi-pairs, no desire of pregnancy, completing her family
3-postoperative ERT is taken for menopausal symptoms.
Def
Risk factors
Et
Of adenomyosis
1-Presence of endometrial gland and stroma inside the myometrium.
2-
•Multiparous women.
•Low socioeconomic standard.
3-
•Infiltration of the myometrium by endometrial gland and stroma during involution.
•Smooth muscle fibers. Hypertrophy around these ectopic glands.
Patho
Sym
Signs
Of adenomyosis
-patho
•Diffuse type: Symmetrical enlargement of uterus, globular in shape, firm consistency.
•Localized type. Ant wall or post wall etc. Very similar to leiomyomata, but it’s tender and not encapsulated
-sym
•Type of patient :Multi-pairs Low socio-economic Standard
•Menorrhagia and 2ry dysmenorrhea
-Signs
•General anemia
• Abdominal ± enlarged uterus
• pV and bimanual :
Free adnexies
Halban’s sign (Enlarged symmetrical tender uterus)
Dd
Inv of
Adenomyosis
1- preg ( not tender or firm )
2- fibroid ( not tender , encapsulated)
Inv
Like fibroid
Us is the gold standard
Ttt of adenomyosis
(3)
1-Conservative TTT
- Bleeding
•antifibrolytics :transexamic acid,
•venotonic daflon
-Pain
Nsaids, and analgesics
2-Hormonal TTT
- OCPs and gestigens, but in a cyclic manner Regulate the symptoms
-LNG IUD
3-Surgical
-Hysterectomy
