beaton endometriosus

Question 1

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

Answer 1

FALSE the amount of lesions does not correlate with pain

Question 1

T/F: there appears to be some genetic predisposition to endometriosus

Answer 1

true, monozygotic twins have high concordance rates

Question 1

What is the classic way to diagnose endometriosus?

Answer 1

LAPAROSCOPY, you have to see it to believe it. This is the evidence that you need and some places would even require biopsy

Question 3

What is the most popular theory to explain endometriosus?

Answer 3

retrograde menstruation

Question 4

What effect does continuous GnRH release have on endometriosus lesions?

Answer 4

Reversal; it is the fluctuation in hormones that causes the Sx in the first place

Question 5

What is the extension of endometrial glands into the uterine musculature?

Answer 5

adenomyosis

Question 6

Hemosiderin laden MO in the lungs = ____________. Hemosiderine laden MO in OB/GYN questions = ___________

Answer 6

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

Question 6

What are 2 mutually independent presentations of endometriosus?

Answer 6

1) Cyclic pelvic pain in association with menses 2) infertility, can have one without the other or both

Question 7

Where is the most common location for endometriosus?

Answer 7

on the ovaries (60% tend to occur on the germinal epithelium which = peritoneum)

Question 7

5 medical Tx for endometriosus

Answer 7

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

Question 8

What was the original name for adenomyosis?

Answer 8

endometriosis interna

Question 9

Why do adenomyosis patients often present with menorrhagia?

Answer 9

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

Question 9

What is the treatment of adenomyosis

Answer 9

first you must rule out cancer since there is excessive bleeding and second the ONLY REAL TREATMENT IS HYSTERECTOMY

Question 10

What is an endometrioma? Be VERY specific regarding its location

Answer 10

It is endometriosus WITHIN the ovary not the peritoneum (germinal epithelium) surrounding the ovary

Question 11

Describe the triad of endometriosus

Answer 11

1) Dysmenorrhea 2) Dyspareunia and 3) Dyschezia (pain with bowel movements)

Question 13

Who described the retrograde menstruation theory in 1927?

Answer 13

John Sampson

Question 14

What will you see on the histologic diagnosis of endometriosus?

Answer 14

aside from endometrial tissue, HEMOSIDERIN LADEN MO

Question 15

How will the feel of the uterus be different with adenomyosis vs. fibroids?

Answer 15

fibroids are benign neoplasms of smooth muscle so will feel much more firm whereas adenomyosis is glandular so will feel spongier

Question 16

T/F: adenomyosis patients never present with dysmenorrhea

Answer 16

false they often do when greater than 80% of the musculature is involved

Question 18

What urological issue may endometriosus be associated with in adolescents?

Answer 18

Genital outflow obstructions

Question 18

Which theory may account for the ability for endometriosus to get to distant sites such as lung, brain and nose?

Answer 18

lymphatic and vascular spread theory

Question 19

Hypothetically, a woman is never treated for her endometriosus, when can you expect it to go away?

Answer 19

Menopause since there will no longer be menses (since the hormone fluctuations are what causes the Sx)

Question 20

What is the correlation of stage of endometriosus with A) pain and B) fertility

Answer 20

A) higher stage USUALLY less pain 2) higher stage usually more infertile because there is more fibrosis in the way

Question 21

How long are ppl usually on GnRH agonists for endometriosus? Why not any longer?

Answer 21

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

Question 21

Swiss cheese uterus on ultrasound

Answer 21

adenomyosis

Question 23

A benign but progressive condition in which endometrial-like glands AND STROMA are present outside of the uterus

Answer 23

endometriosis!

Question 24

Describe the following lesion types of endometriosis 1) Pigmented 2) Non-Pigmented and 3) Cryptic

Answer 24

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”

Question 26

Explain, in terms of diagnostic confusion with endometriosus, why CA-125 is best for post-menopausal pts as a tumor marker

Answer 26

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

Question 27

What happens if a chocolate cyst ruptures?

Answer 27

It will lead to spread of endometriosus to other areas

Question 28

When is ultrasound reliable for diagnosing endometriosus?

Answer 28

Only if there is an endometrioma (chocolate cyst of ovary)

Question 30

What is true of the use of medical Tx for A) pelvic pain and B) infertility in endometriosus?

Answer 30

A) medical Tx is effective for pelvic pain but B) not effective for infertility

Question 32

How does endometriosus present on a bimanual pelvic exam?

Answer 32

tender adnexal mass that is FIXED, a mucinous cyst would not feel like that

Question 33

What is cul-de-sac obliteration?

Answer 33

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

Question 34

What is the surgical mgmt of endometriosus?

Answer 34

either resection, ablation, or hysterectomy? Failure to remove the ovaries as well (i.e. bilateral oopherectomy) corresponds to HIGHER RECURRENCE RATES

Question 35

How is an endometrioma often described?

Answer 35

CHOCOLATE CYST; however, this is not strictly speaking pathognomonic as chocolate cysts may describe other endometriosus lesions

Question 36

Where does the tumor marker, CA-125 come from?

Answer 36

derivatives of coelomic epithelium i.e. ovaries etc.