beaton endometriosus Flashcards
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
Swiss cheese uterus on ultrasound
adenomyosis
A benign but progressive condition in which endometrial-like glands AND STROMA are present outside of the uterus
endometriosis!
Describe the following lesion types of endometriosis 1) Pigmented 2) Non-Pigmented and 3) Cryptic
Pigmented look like a volcano on the peritoneum, they have either blood or hemosiderin which is the pigment? 2) non pigmented look the same as pigmented minus the pigment 3) Cryptic look different from the other 2 and are associated with so much inflammation that the surrounding tissue ends up enveloping them like a manhole so that they are hidden, or “cryptic”
Explain, in terms of diagnostic confusion with endometriosus, why CA-125 is best for post-menopausal pts as a tumor marker
CA-125 is from coelomic epithelium i.e. both the ovaries and endometrium. So, in pre-menopausal years, when endometriosus is most active, it can raise CA-125, thus lowering the specificity for its use as an ovarian CA marker. In post-meno years, endometriosus incidence is much lower, so high CA-125 more likely to be ovarian CA
What happens if a chocolate cyst ruptures?
It will lead to spread of endometriosus to other areas
When is ultrasound reliable for diagnosing endometriosus?
Only if there is an endometrioma (chocolate cyst of ovary)
What is true of the use of medical Tx for A) pelvic pain and B) infertility in endometriosus?
A) medical Tx is effective for pelvic pain but B) not effective for infertility
How does endometriosus present on a bimanual pelvic exam?
tender adnexal mass that is FIXED, a mucinous cyst would not feel like that
What is cul-de-sac obliteration?
When the pelvis looks completely fibrotic and obliterated d/t to severe endometriosus; however, recall that pain does not correlate to Dz severity, so these pts can still be asymptomatic
What is the surgical mgmt of endometriosus?
either resection, ablation, or hysterectomy? Failure to remove the ovaries as well (i.e. bilateral oopherectomy) corresponds to HIGHER RECURRENCE RATES
How is an endometrioma often described?
CHOCOLATE CYST; however, this is not strictly speaking pathognomonic as chocolate cysts may describe other endometriosus lesions
Where does the tumor marker, CA-125 come from?
derivatives of coelomic epithelium i.e. ovaries etc.
