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#Phase 2.2: Obs n Gynae > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

What is Endometriosis?

A

Condition where there is Ectopic endometrial tissue OUTSIDE uterus

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2
Q

What is Adenomyosis?

A

Endometrial tissue in myometrium (muscle layer of uterus)

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3
Q

What is the main age group for Endometriosis?

A

25-40 yrs

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4
Q

Is the pathophysiology of Endometriosis clear?

A

No

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5
Q

What is the Retrograde Menstruation theory for Endometriosis? (2 steps)

A
  1. Endometrial cells travel backwards from uterine cavity –> Fallopian tubes –> Pelvis / Peritoneum
  2. Endometrial cells seed + grow here
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6
Q

What is another theory for Endometriosis pathophysiology?

A

Endometrial cells travel through lymphatic system (same way as cancer spreads)

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7
Q

What is endometrial tissue sensitive to?

A

Oestrogen

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8
Q

During menstruation, what happens to the ectopic endometrial tissue?

A

Bleeds, just like normal endometrial tissue

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9
Q

What does the bleeding of ectopic endometrial tissue cause? (2 things)

A
  1. Pain
  2. Bloating / distension @ ectopic sites
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10
Q

What can repeated bleeding and inflammation at ectopic sites lead to?

A

Scarring –> Adhesions

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11
Q

When are the symptoms of endometriosis reduced? (2 things)

A
  1. Pregnancy
  2. Menopause
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12
Q

What are the RF for Endometriosis? (6 things)

A
  1. Early menarche
  2. FHx Endometriosis
  3. Short menstrual cycles
  4. Long duration of menstrual bleeding
  5. Heavy menstrual bleeding
  6. Defects in uterus / fallopian tubes
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13
Q

What are the CF of Endometriosis?

A
  1. Pelvic / abdominal pain (cyclic)
  2. Dyspareunia (pain @ intercourse)
  3. Dysmenorrhoea
  4. Infertility
  5. Dysuria / Dyschezia
  6. Cyclic bleeding @ other sites (e.g haematuria)
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14
Q

What examinations can you do for sus Endometriosis? (2 things)

A
  1. Bimanual examination
  2. Speculum examination
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15
Q

What might you find @ examination of sus Endometriosis? (3 things)

A
  1. Endometrial tissue visible in vagina (esp post fornix)
  2. Fixed retroverted cervix
  3. Tenderness in vagina / cervix / adnexa
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16
Q

What does an enlarged, tender, boggy uterus indicate?

A

Adenomysosis

17
Q

What are some DDx that present similarly to Endometriosis? (4 things)

A
  1. PID
  2. Ectopic pregnancy
  3. Fibroids
  4. IBS
18
Q

How does PID present similarly to Endometriosis? (3 things)

A
  1. Pelvic pain
  2. Dyspareunia
  3. Abn / heavy bleeding
19
Q

How does Ectopic pregnancy present similarly to Endometriosis? (4 things)

A
  1. Pelvic pain
  2. Dyspareunia
  3. Abn / heavy bleeding
  4. Collapse
20
Q

How does Fibroids present similarly to Endometriosis? (4 things)

A
  1. Pelvic pain
  2. Long duration of menstrual bleeding
  3. Heavy menstrual bleeding
  4. Bloating / feeling of a mass
21
Q

How does IBS present similarly to Endometriosis? (3 things)

A
  1. Abd pain
  2. Dyspareunia
  3. Bloating
22
Q

What is the GOLD standard investigation for sus Endometriosis?

A

Laparoscopy

23
Q

What are the typical findings of Endometriosis on Laparoscopy? (4 things)

A
  1. Endometriotic lesions (see pic)
  2. Chocolate cysts (endometriosis of ovaries)
  3. Peritoneal deposits
  4. Adhesions
24
Q

What are the benefits of doing a Laparoscopy for sus Endometriosis? (2 things)

A
  1. Take biopsy (for definitive dx)
  2. Surgically remove deposits (can improve symptoms)
25
Q

What other investigation can be done for sus Endometriosis?

A

Pelvic US

(Usually unremarkable tho and will be referred to gynae for Laparoscopy)

26
Q

What does NICE recommend instead of using a staging system for Endometriosis?

A

Detailed documentation of endometriosis

27
Q

What are the 3 components of Mx of Endometriosis?

A
  1. Pain
  2. Hormonal
  3. Surgical
28
Q

How do you manage the pain of Endometriosis?

A

Analgesia / NSAIDS (follow analgesia ladder)

29
Q

What is a benefit of Hormonal Mx of Endometriosis?

A

Can be tried even before definitive Dx with laparoscopy

30
Q

What are the options for Hormonal Mx of Endometriosis? (5 things)

A
  1. COCP
  2. POP (Norethisterone)
  3. Depo-Provera injection
  4. IUD (Mirena coil)
  5. GnRH agonists
31
Q

How do COCP / POP / Depo / IUD work to manage Endometriosis? (3 steps)

A
  1. Suppresses ovulation
  2. Causes atrophy of endometriosis lesions
  3. Reduces symptoms
32
Q

How do GnRH agonists work to manage Endometriosis? (3 steps)

A
  1. Induce menopause-like state
  2. Female sex hormones reduced
  3. Reduces symptoms
33
Q

What are the side fx of using menopause-like inducing meds like GnRH agonists? (3 things)

A
  1. Hot flushes
  2. Night sweats
  3. Osteoporosis
34
Q

What are the Surgical Mx options of Endometriosis? (2 things)

A
  1. Laparoscopy
  2. Hysterectomy
35
Q

What can be done in Laparoscopic Tx of Endometriosis? (3 things)

A
  1. Excision
  2. Ablation
  3. Adhesiolysis
36
Q

What is the benefit of Laparoscopic Tx over Hormonal Tx of Endometriosis?

A

Laparoscopic Tx can improve fertility

37
Q

When is Hysterectomy a better option than Laparoscopic Tx of Endometriosis?

A

Beh relapses (which almost always occur after laparoscopic tx)

#Phase 2.2: Obs n Gynae (27 decks)

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