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Block 14 module 7 > Endometeriosis > Flashcards

Endometeriosis Flashcards

1
Q

presence of endomterial glands and stroma outside uterus

A

endometriosis

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2
Q

endometrial glands and stroma in the myometrium

A

adenomyosis/ endometriosis interna

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3
Q

common symptom asstd w/ endometritis

A

pelvic pain

infertility

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4
Q

what is sampson theory

A

endometrial cells backflow from the endometrial cavity to the FT

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5
Q

endometriosis found in unusal location such as perineum, and groin supports this theory

A

theory of lymphatic and vascular spread

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6
Q

condition of collapsed lung occurring in cjn with menstrual periods caused primarily by endometriosis of the pleura

A

catamenial hemothorax

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7
Q

what is the coelomic metaplasia theory

A

endometriosis results from spontaneous metaplastic change (coelomic metaplasia) in the mesothelial cells derived from the coelomic epithelium

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8
Q

this theory is attractive in instances of endometriosis in the absence of menses (premenarchal and postmenopausal)

A

coelomic metaplasia theory

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9
Q

this theory states that hormonal or biological factors may induce differentiation of undiffd cells into endometrial tissue

A

induction theory

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10
Q

potent stimulator of endometriosis

A

estrogen

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11
Q

how can estrogen cause endometriosis

A

estrogen causes an increase in aromatase activity thereby increasing conversion of estrone to estradiol and thus stimulate growth of endometriotic implants

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12
Q

androstenedione is converted to estrone by

A

aromatase

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13
Q

estrone is converted to estradiol by

A

17 B hydroxysteroid dehydrogenase I

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14
Q

estradiol is directly secreted by

A

ovary or produced in perihperal sites ( adipose tissue and skin)

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15
Q

major source for circulating estradiol in the postmenopausal period or during ovarian suppresion

A

peripheral aromatization

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16
Q

these mediate pain, inflammation and infertility

A

prostaglandins and cytokines

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17
Q

retrograde menses is common, but why is that other women don’t dev endomet?

A

these women have an effective immune sys specifically peritoneal macrophages w/c prevents proliferation of endomet cells in the peritoneal cavity

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18
Q

px w/ endomet have problems in NK cells, what is the effect of this?

A

it would bring abt problems in phagocytosis and apoptosis

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19
Q

Risk factors of endomet

A

Familial clustering
Genetic mutations
anatomic defects
environmental toxins

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20
Q

genetic mutations ins endometriosis occurs specifically in aberrant products such as

A

metalloproteinases and integrins

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21
Q

Reproductive outflow tract abnormalities examples

A 
blind uterine horns
transverse vaginal septum
imperforate hymen
vaginal atresia
uterine agenesis
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22
Q

exposure to this product is a risk factor for endomet

A

2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD) and other dioxin like products

23
Q

how does TCDD stimulate endometriosis

A

it acs as estrogen thus increasing IL levels, activation of cytochrome p450 enzymes (aromatase) it also block the progesterone induced regression of endomet

24
Q

most common symptom of endometriosis

A

pain (cyclic or chronic)

25
Q

endometriosis pain may result from

A

neuronal invasion of endometriotic implants that subsequently develop a sensory and sympathetic nerve supply w/c may undergo central sensitization

26
Q

symptoms of endometriosis

A 
Chronic pelvic pain
dysme
dyspareunia
dysuria
dyschezia
27
Q

how can dyschezia d/t endomet be differentiated from GIT problems

A

dyschezia d/t endomet are usu related to menses

28
Q

this symptom denotes that endomet cells has already invaeded the urinary tract

A

dysuria

29
Q

how can endometriosis lead to infertility?

A

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

30
Q

what can be seen in px with endomet upon speculum exam

A

blue or red powder burn lesions on the cervix or the posterior fornix of the vagina

31
Q

classic appearance of ovarian endomet cyst due to blood pooling during menstrual reflux in invagination and focal bleeding in the ovary

A

chocolate cyst

32
Q

form of diagnosis for endomet if ovaries are involved

A

transvaginal ultrasound

33
Q

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?

A

MRI or CT

34
Q

GOLD STANDARD in the diagnosis of endomet

A

laparoscopy w/ or w/o histologic examination of excised lesion

35
Q

Newer lesions

A

bleb like lesions

36
Q

older lesions

A

white lesions

37
Q

classic peritoneal implants

A

blue-black “powder burn” lesions with fibroids

38
Q

less common lesions of endomet

A

ovarian adhesions
yellow brown patches
peritoneal defects

39
Q

type of mgt for younger px who are diagnosed thru UTZ but are asymptomatic

A

expectant mgt

40
Q

this treatment is beneficial for pain relief and may improve bleeding control of px on OCP

A

NSAIDS

41
Q

progestin drug given to px w/ endomet

A

medroxyprogesterone acetate

42
Q

MOA of progestin

A

it induces decidualization of endometrium so eventually low estrogen but chronic progesterone exposure would lead to endometrial atrophy

43
Q

this is given to control pain and effective in retroperitoneal endomet

A

levonorgestrel containing IUS

44
Q

first medication indicated for endometriosis

A

danazol

45
Q

MOA of danazol

A

it inhibits midcycle urinary LH surge and induces a chronic anovulatory state; it also inhibits steroidogenic enzymes and increases testosterone lvls

46
Q

adverse effect of danazol that px would discontinue using it

A

deepening of voice

47
Q

this reduces COX-2 lvls and would reduce the pain or improve other symptoms

A

GnRH agonist

48
Q

intramuscular GnRH

A

leuprolide acetate

49
Q

SubQ GnRH

A

Buserelin acetate

50
Q

Treatment for px with adhesions

A

adhesiolysis

51
Q

treatment for px with endometriotic cyst

A

cystectomy

52
Q

treatment for px who do not respond to treatment/ no longer desirous of pregnancy

A

TAHBSO

53
Q

treatment for px who are not candidate for TAHBSO but with severe pain

A

LUNA (laparoscopic Uterosacral Nerve ablation

presacral neurectomy

Block 14 module 7 (6 decks)

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