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endometriosis Flashcards

1
Q

What is Endometriosis

A

chronic inflammatory condition caused by growth of endometrial tissue in ectopic locations
estrogen-dependent disease

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2
Q

what is the incidence of endometriosis

A

2nd to fibroids in frequency
commonly diagnosed 25-30yo
10% of reproductive aged people affected

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3
Q

what is the challenge with diagnosing endometriosis?

A

the sx are non-specific
there is no correlation w/ #, location, extent. this creates a long differential list
limited diagnostic testing

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4
Q

factors INCREASING risk of endometriosis

A

anything that makes you bleed more
ex: long heavy flow, short cycles, early menarche, late menopause, outflow obstruction, delayed or no pregnancy, LOW BMI, high alcohol or caffeine

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5
Q

factors LOWERING risk of endometriosis

A

reduced estrogen
menstrual d/o
less BODY FAT
MORE smoking
pregnancy or contraceptives

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6
Q

List the 7 current theories of endometriosis etiology

A

transplantation/ retrograde menstruation theory
tranformation theory
immunologic theory
genetic theory
embryonic theory
environmental
cell adhesion factors theory

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7
Q

what is the most widely accepted etiology theory? explain it.

A

transplantation theory- endometrial tissue is refluxed through fallopian tubes and implants elsewhere

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8
Q

what are some things we’ve seen that supports the most widely accepted theory

A

we’ve found endometrial tissue in brain, lungs, etc
this is evidence of lymphatic and vascular metastases

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9
Q

4 most common symptoms of endometriosis

A

chronic pelvic pain
dysmenorrhea usually before menstruation
dyspareunia
infertility or sub-fertility

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10
Q

what is dyspareunia

A

genital pain before, during or after sex

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11
Q

what is dysmenorrhea

A

painful periods

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12
Q

relationship between disease & symptom severity

A

they are not directly equated! someone can have really bad symptoms and not a bad disease and someone can have mild sx with a really bad disease

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13
Q

less common sx of endometriosis

A

spotting, low back pain w/ menses
dysuria, hematuria, frequent urination
rectal pain or dyschezia
generalized sx– nausea, low fever, fatigue, bloating, etc

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14
Q

what is dyschezia

A

painful shits

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15
Q

5 things pain could be related to

A

bleeding
inflammation–fibrosis– adhesions
hormones or chemicals from lesions
cysts
nerve entrapment

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16
Q

what might you fight on PE with advanced EM?

A

nodules, adhesions, fixed retroverted uterus, bluish lesions

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17
Q

what is the best time of cycle to do speculum exam if suspicious of endometriosis?

A

right before or in early menses because everything is worse

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18
Q

how is endometriosis diagnosed?

A

mostly from exclusion and clinical presentation
can do definitive diagnosis

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19
Q

what is required for definitive diagnosis?

A

visualization and histologic confirmation (biopsy) via laparoscopy

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20
Q

what are two helpful imaging studies for diagnosis?

A

transvaginal US–initial imaging
MRI for individual lesions

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21
Q

what are you looking for with a transvaginal US?

A

look for endometrial cyst (cyst on ovary) and endometriomas (chocolate cyst on ovary)

22
Q

when do you use MRI?

A

deep infiltrating endometriosis (nodules)

23
Q

what are the two goals of treatment?

A

relieve pain
improve fertility

24
Q

what are the 3 first line type of medications?

A

NSAIDs, acetaminophen, antidepressants
Contraceptives
Progestins

25
how do contraceptives treat endometriosis? which contraceptives can do this?
slows growth, decreases likelihood of tissue reflex; ovarian suppression OCP, Nuvaring, Patch
26
how do progestins treat endometriosis? example of pregestin
pseudo-pregnancy state- decrease estrogen & menstrual flow & reflux oppose estrogen effects, converts estradiol to estrone Depo shot, Mirena IUD
27
how do the SE of contraceptives compare with progestin?
a lot of similarities but with progestins theres higher breakthrough bleeding, edema and less weight gain depo has delayed ovulation and fertility return
28
what are the 2nd line treatments for endometriosis?
GnRH agonist, antagonist androgenic agent combo antiestrogenic, antiprogesterone, androgenic agent
29
how does GnRH agonist treat endometriosis?
continuous treatment of GnRH causes downregulation and decreases steroidogenesis. This stops LH/FSH release--> prevents ovulation--> pseudo menopause (estrogen levels similar to menopause levels)
30
common consequence of 2nd line treatments?
they have to use barrier contraceptive method
31
if GnRH agonist/antagonists stop ovulation, why do they need barrier contraceptives?
even though chances are small, taking GnRH increases chances of miscarriage or fetal abnormalities if pregnancy somehow occurred. OCP tend to increase estrogen they are working to reduce
32
what are some SE of GnRH meds
bone loss, hot flashes, mood swings vaginal dryness, insomnia, decreased libido, depression
33
how do androgenic agents treat endometriosis? name one med
increases HDL, decreases LDL its a testosterone derivative--> ATROPHY of endometrial implants Danazol
34
what are some SE of Danazol & Gestrinone?
wt gain, muscle cramp, less breasts oily skin, acne, sweating hirsutism, voice deepening
35
how does combo pills treat endometriosis? name one med
decreases estrogen, progesterone and also androgenic Gestrinone
36
when can you treat with CONSERVATIVE surgery?
if interested in pregnancy or in significant pain despite other tx
37
Laparoscopy vs Laparotomy
Laparoscopy is for mild to moderate disease; decreased adhesion formation Laparotomy is for severe, deep infiltrating lesions; more invasive Both are conservative surgeries
38
when can you treat w/ SEMIconservative surgery? examples?
long standing disease, uncontrollable pain, no concerns w/ fertility hysterectomy and endometrial lesion removal
39
Conservative vs Semiconservative surgery
both can have recurrence with semiconservative the time is longer till recurrence & could have surgical menopause with conservative you can have repeat surgery
40
what can you do to avoid 2nd surgery?
combination treatment surgery + hypoestrogenic treatment this could increase pregnancy
41
how do you help someone with EARLY stage EM get pregnant?
surgery + supraovulation
42
what is supraovulation
ovarian stimulation so more than one egg gets released
43
how do you help someone with ADVANCED EM get pregnant?
3mo medical therapy THEN surgery + IVF
44
endometriosis vs adenomyosis pathology
w/ adenomyosis, endometrial tissue goes deeper to implant in myometrium!
45
what are sx of ademomyosis?
spasms severe menorrhagia disabling dysmenorrhea pelvic pain, painful intercourse many are asymptomatic!
46
incidence of adenomyosis?
mainly in peri-menopausal; 20-30% of uteri can also have endometriosis
47
possible PE findings for adenomyosis
high normal or enlarged globular uterus diffuse of nodular tender uterus
48
Pharm. Tx for symptomatic relief of adenomyosis
NSAIDs + OCP, GnRH agonist
49
Tx for people who have been pregnant before
uterine artery embolization could reduce symptoms
50
what is the only guaranteed treatment for adenomyosis
hysterectomy for symptomatic patients; preserve ovaries in younger patients!
51
why would you save the ovaries w/ hysterectomy in younger patients?
saving ovary is associated w/ lower risk of CHD and cancer related mortality
52
how does GnRH antagonists tx endometriosis?
inhbit GnRH receptors in pituitary--> decrease FSH/LH--> EST & PROG need barrier contraceptive

WH Unit 1 (5 decks)

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