Endometeriosis Flashcards
presence of endomterial glands and stroma outside uterus
endometriosis
endometrial glands and stroma in the myometrium
adenomyosis/ endometriosis interna
common symptom asstd w/ endometritis
pelvic pain
infertility
what is sampson theory
endometrial cells backflow from the endometrial cavity to the FT
endometriosis found in unusal location such as perineum, and groin supports this theory
theory of lymphatic and vascular spread
condition of collapsed lung occurring in cjn with menstrual periods caused primarily by endometriosis of the pleura
catamenial hemothorax
what is the coelomic metaplasia theory
endometriosis results from spontaneous metaplastic change (coelomic metaplasia) in the mesothelial cells derived from the coelomic epithelium
this theory is attractive in instances of endometriosis in the absence of menses (premenarchal and postmenopausal)
coelomic metaplasia theory
this theory states that hormonal or biological factors may induce differentiation of undiffd cells into endometrial tissue
induction theory
potent stimulator of endometriosis
estrogen
how can estrogen cause endometriosis
estrogen causes an increase in aromatase activity thereby increasing conversion of estrone to estradiol and thus stimulate growth of endometriotic implants
androstenedione is converted to estrone by
aromatase
estrone is converted to estradiol by
17 B hydroxysteroid dehydrogenase I
estradiol is directly secreted by
ovary or produced in perihperal sites ( adipose tissue and skin)
major source for circulating estradiol in the postmenopausal period or during ovarian suppresion
peripheral aromatization
these mediate pain, inflammation and infertility
prostaglandins and cytokines
retrograde menses is common, but why is that other women don’t dev endomet?
these women have an effective immune sys specifically peritoneal macrophages w/c prevents proliferation of endomet cells in the peritoneal cavity
px w/ endomet have problems in NK cells, what is the effect of this?
it would bring abt problems in phagocytosis and apoptosis
Risk factors of endomet
Familial clustering
Genetic mutations
anatomic defects
environmental toxins
genetic mutations ins endometriosis occurs specifically in aberrant products such as
metalloproteinases and integrins
Reproductive outflow tract abnormalities examples
blind uterine horns transverse vaginal septum imperforate hymen vaginal atresia uterine agenesis
exposure to this product is a risk factor for endomet
2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD) and other dioxin like products
how does TCDD stimulate endometriosis
it acs as estrogen thus increasing IL levels, activation of cytochrome p450 enzymes (aromatase) it also block the progesterone induced regression of endomet
most common symptom of endometriosis
pain (cyclic or chronic)
endometriosis pain may result from
neuronal invasion of endometriotic implants that subsequently develop a sensory and sympathetic nerve supply w/c may undergo central sensitization
symptoms of endometriosis
Chronic pelvic pain dysme dyspareunia dysuria dyschezia
how can dyschezia d/t endomet be differentiated from GIT problems
dyschezia d/t endomet are usu related to menses
this symptom denotes that endomet cells has already invaeded the urinary tract
dysuria
how can endometriosis lead to infertility?
adhesions can be located in the FT impairing abiility to of fimbriae to capture egg during ovulation
folliculogenesis is impaired, oocyte number may decreased in px w/ endomet
what can be seen in px with endomet upon speculum exam
blue or red powder burn lesions on the cervix or the posterior fornix of the vagina
classic appearance of ovarian endomet cyst due to blood pooling during menstrual reflux in invagination and focal bleeding in the ovary
chocolate cyst
form of diagnosis for endomet if ovaries are involved
transvaginal ultrasound
if ovaries are not involved and there are just 1 or 2 endomet implants less than 2 mm in size, what would you do to diagnose?
MRI or CT
GOLD STANDARD in the diagnosis of endomet
laparoscopy w/ or w/o histologic examination of excised lesion
Newer lesions
bleb like lesions
older lesions
white lesions
classic peritoneal implants
blue-black “powder burn” lesions with fibroids
less common lesions of endomet
ovarian adhesions
yellow brown patches
peritoneal defects
type of mgt for younger px who are diagnosed thru UTZ but are asymptomatic
expectant mgt
this treatment is beneficial for pain relief and may improve bleeding control of px on OCP
NSAIDS
progestin drug given to px w/ endomet
medroxyprogesterone acetate
MOA of progestin
it induces decidualization of endometrium so eventually low estrogen but chronic progesterone exposure would lead to endometrial atrophy
this is given to control pain and effective in retroperitoneal endomet
levonorgestrel containing IUS
first medication indicated for endometriosis
danazol
MOA of danazol
it inhibits midcycle urinary LH surge and induces a chronic anovulatory state; it also inhibits steroidogenic enzymes and increases testosterone lvls
adverse effect of danazol that px would discontinue using it
deepening of voice
this reduces COX-2 lvls and would reduce the pain or improve other symptoms
GnRH agonist
intramuscular GnRH
leuprolide acetate
SubQ GnRH
Buserelin acetate
Treatment for px with adhesions
adhesiolysis
treatment for px with endometriotic cyst
cystectomy
treatment for px who do not respond to treatment/ no longer desirous of pregnancy
TAHBSO
treatment for px who are not candidate for TAHBSO but with severe pain
LUNA (laparoscopic Uterosacral Nerve ablation
presacral neurectomy
