beaton endometriosus Flashcards
(36 cards)
T/F: a patient with a ton of endometriosus lesions disseminated throughout the body will have extreme pain while a woman with a speck of it on here uterus will be relatively asymptomatic
FALSE the amount of lesions does not correlate with pain
T/F: there appears to be some genetic predisposition to endometriosus
true, monozygotic twins have high concordance rates
What is the classic way to diagnose endometriosus?
LAPAROSCOPY, you have to see it to believe it. This is the evidence that you need and some places would even require biopsy
What is the most popular theory to explain endometriosus?
retrograde menstruation
What effect does continuous GnRH release have on endometriosus lesions?
Reversal; it is the fluctuation in hormones that causes the Sx in the first place
What is the extension of endometrial glands into the uterine musculature?
adenomyosis
Hemosiderin laden MO in the lungs = ____________. Hemosiderine laden MO in OB/GYN questions = ___________
Heart failure cells; associated with endometriosis, specifically it is a result of the “ectopic menses” that occur, so when resident MO go to eat up the dead tissue, the heme becomes hemosiderin
What are 2 mutually independent presentations of endometriosus?
1) Cyclic pelvic pain in association with menses 2) infertility, can have one without the other or both
Where is the most common location for endometriosus?
on the ovaries (60% tend to occur on the germinal epithelium which = peritoneum)
5 medical Tx for endometriosus
1) NSAIDs for pain 2) Oral contraceptives 3) Progestins CONTINUOUS 4) Danocrine CONTINOUS 5) GnRH agonists (leuprolide, gosrelin) CONTINUOUS? If given cyclical it would just cause exacerbations of the endometriosus
What was the original name for adenomyosis?
endometriosis interna
Why do adenomyosis patients often present with menorrhagia?
because the growth of the glands into the uterine musculature intervene with the ability of the uterine musculature to effectively clamp down on the helical vessels when menses occurs and this results in excessive bleeding
What is the treatment of adenomyosis
first you must rule out cancer since there is excessive bleeding and second the ONLY REAL TREATMENT IS HYSTERECTOMY
What is an endometrioma? Be VERY specific regarding its location
It is endometriosus WITHIN the ovary not the peritoneum (germinal epithelium) surrounding the ovary
Describe the triad of endometriosus
1) Dysmenorrhea 2) Dyspareunia and 3) Dyschezia (pain with bowel movements)
Who described the retrograde menstruation theory in 1927?
John Sampson
What will you see on the histologic diagnosis of endometriosus?
aside from endometrial tissue, HEMOSIDERIN LADEN MO
How will the feel of the uterus be different with adenomyosis vs. fibroids?
fibroids are benign neoplasms of smooth muscle so will feel much more firm whereas adenomyosis is glandular so will feel spongier
T/F: adenomyosis patients never present with dysmenorrhea
false they often do when greater than 80% of the musculature is involved
What urological issue may endometriosus be associated with in adolescents?
Genital outflow obstructions
Which theory may account for the ability for endometriosus to get to distant sites such as lung, brain and nose?
lymphatic and vascular spread theory
Hypothetically, a woman is never treated for her endometriosus, when can you expect it to go away?
Menopause since there will no longer be menses (since the hormone fluctuations are what causes the Sx)
What is the correlation of stage of endometriosus with A) pain and B) fertility
A) higher stage USUALLY less pain 2) higher stage usually more infertile because there is more fibrosis in the way
How long are ppl usually on GnRH agonists for endometriosus? Why not any longer?
6 months is the standard length; any longer and they can begin to feel as if they are in menopause and there is also associated osteopenia
