Endometriosis Flashcards
What is endometriosis?
It is is a defined as a chronic condition in which there is ectopic endometrial tissue that grows outside of the uterine cavity
In what seven locations can endometriosis occur?
Ovaries
Pouch of Douglas
Uterosacral ligament
Pelvic peritoneum
Bladder
Umbilicus
Lungs
What is endometrioma?
A lump of endometrial tissue outside the uterus
What is the pathophysiological cause of endometriosis?
The pathophysiology is unclear
However, it is proposed that retrograde menstruation occurs, in which endometrial cells travel backwards from the uterine cavity, through the fallopian tubes and out into the pelvis and peritoneum – where they can deposit and grow
What are the ten risk factors associated with endometriosis?
White Race
Family History
Autoimmune Disease
Early Menarche
Late Menopause
Delayed Childbearing
Nulliparity
Uterine Defects
Low Body Mass Index
Smoking
What are the eleven clinical features of endometriosis?
Chronic Pelvic Pain
Dysmenorrhoea
Deep Dyspareunia
Reduced Organ Mobility
Tender Nodule Posterior Vaginal Fornix
Visible Vaginal Endometriotic Lesions
Subfertility
Dysuria
Urinary Urgency
Haematuria
Dyschezia
What is the most common presenting symptom of endometriosis?
Chronic Pelvic Pain
Describe the pelvic pain associated with endometriosis
It tends to present cyclically, occurring a few days before menstruation
However, in cases where adhesions have formed, the pain may be constant
What is dyschezia?
It is defined as painful bowel movements
What are the three investigations used to diagnose endometriosis?
Urine Pregnancy Test
Transvaginal Ultrasound Scan
Laparoscopy
How are urine pregnancy tests used to investigate endometriosis?
They should be conducted in all women of a reproductive age in order to exclude a diagnosis of pregnancy
What is a feature of endometriosis on transvaginal ultrasound scans?
Endometriomas
What is important to note about transvaginal ultrasound scans in diagnosing endometriosis?
A normal scan doesn’t exclude a diagnosis of endometriosis
What is the gold standard investigation used for endometriosis?
Laparoscopy
What are the two features of endometriosis on laparoscopy?
Endometriomas
Chocolate Cysts
What are the three pharmacological managements used to treat endometriosis?
Simple Analgesia
Contraceptive Management
GnRH Analogues
What is the first line pharmacologcial option for endometriosis?
Simple Analgesia
Name two simple analgesics used to manage endometriosis
NSAIDs
AND/OR
Paracetamol
When are contraceptives used to manage endometriosis?
They are the second pharmacological management option of endometriosis
How are contraceptives used to manage endometriosis?
They supress ovulation and reduce endometrial thickening, which causes atrophy of the endometrial lesions
Name three contraceptives are used to manage endometriosis
Combined Oral Contraceptive Pill
Medroxyprogesterone Acetate
Mirena Intrauterine System
When are GnRH analogues used to manage endometriosis?
They are the third line pharmacological mangement option
How are GnRH analogues used to treat endometriosis?
They induce a psuedomenopause, in which oestrogen levels are reduced and ovulation is supressed
This causes atrophy of endometrial lesions
Name two GnRH analogues used to manage endometriosis
Zoladex
Prostap
What are the three surgical management options of endometriosis?
Laparoscopic Endometrial Excision
Laparoscopic Endometrial Ablation
Laparoscopic Hysterectomy
When is laparoscopic endometrial excision used to manage endometriosis?
It is a surgical management option recommended in women who wish to preserve their fertility
What is laparoscopic endometrial excision?
It involves laparoscopic excision of endometriomas
What is important to note about laparoscopic endoemtrial excision management of endometriosis?
This surgical management option will result in relapses and therefore surgery may have to be repeated
When is laparoscopic endoemtrial ablation used to manage endometriosis?
It is a surgical management option recommended in women who wish to preserve their fertility
What is laparoscopic endoemetrial ablation?
It involves laparoscopic application of heat to destroy endometriomas
What is important to note about laparoscopic endoemtrial ablation management of endometriosis?
This surgical management option will result in relapses and therefore surgery may have to be repeated
When is laparoscopic hysterectomy used to manage endometriosis?
It is the surgical management option recommended in women who don’t wish to preserve their fertility
What is laparoscopic hysterectomy?
It involves surgical removal of the uterus
What two endoemtriosis management options improve fertility?
Laparoscopic Endometrial Excision
Laparoscopic Endometrial Ablation
What are the four complications assoicated with endometriosis?
Endometrioma Rupture
Endometrioma Adhesions
Bladder Obstruction
Infertility
What is the clinical feature of endometrioma rupture?
Intense pelvic pain, which is not cyclical with menstruation
What is the investigation used to diagnose endoemtrioma rupture?
Ultrasound Scan
What is a feature of endometrioma rupture on US?
Pelvic Free Fluid
