endometriosis

Question 1

what is endometriosis ?

Answer 1

the presence of endometrial tissue and glands outside the uterus

Question 2

at what age is it more common to see endometriosis ?

Answer 2

reproductive age

Question 3

where are the sites of endometriosis ?

Answer 3

pelvic:
pelvic peritoneum and viscera
extra pelvic :
umbilicus, scars, lungs and pleura

Question 4

what are the signs and symptoms of endometriosis ?

Answer 4

1. chronic pelvic pain
2. period-related pain affecting daily activities (dysmenorrhea)
3. deep pain during sexual intercourse ( dyspareunia)
4. cyclic GIT symptoms ( symptoms that come with each period)
5. urinary symptoms ( blood in urine or pain on passing urine)
6. infertility in association with the symptoms above

Question 5

what type of examination should be done on a woman with suspected endometriosis ?

Answer 5

abdominal and pelvic examination and if pelvic examination is not suitable then abdominal examination to exclude abdominal masses

Question 6

what investigations could be carries out in the case of suspected endometriosis ?

Answer 6

ultrasound
serum CA125
MRI
diagnostic laparoscopy

Question 7

what is the golden standard in the diagnosis of endometriosis ?

Answer 7

diagnostic laparoscopy

Question 8

how can we use CA125 to aid in our diagnosis of endometriosis ?

Answer 8

a raised serum level of CA125 may be consistent with a diagnosis of endometriosis
but endometriosis can still be present with a normal level of CA125

Question 9

what is the use of using MRI inn endometriosis ?

Answer 9

to see the extent of involvement of nearby organs

Question 10

what is an endometrioma ?

Answer 10

when the endometrial tissue migrates to the ovaries creating a cyst known as a chocolate cyst

Question 11

what is the treatment for endometriosis ?

Answer 11

if not surgical then follow up is mandatory especially if the patient has :

1. deep endometriosis involving the bowel, bladder or ureter
2. one or more endometrioma

Question 12

what is the pharmacological management of endometrioma ?

Answer 12

analgesics: paracetamol, NSAIDS
continuous combined oral contraceptive pills
Progestogens

Question 13

what are the different examples of progestogens ?

Answer 13

medroxyprogesterone acetate

dienogest ( vissane )

Question 14

what are the indications for the surgical treatment of endometriosis ?

Answer 14

1. failure of medical treatment to control symptoms
2. presence of large endometrioma ( more than 7 cm )
3. presence of dense adhesions especially in patients complaining of infertility

Question 15

what are the indications for laparoscopic treatment during diagnostic laparoscopy ?

Answer 15

1. laparoscopic excision of peritoneal endometriosis not involving the bowel, bladder or uterus
2. laparoscopic ovarian cystectomy of endometrioma especially if more than 3 cm

Question 16

what other surgical procedure can be done to control pain that comes with endometriosis ?

Answer 16

presacral neurectomy