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wh unit 1 > endometriosis > Flashcards

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
Q

how do contraceptives treat endometriosis? which contraceptives can do this?

A

slows growth, decreases likelihood of tissue reflex; ovarian suppression
OCP, Nuvaring, Patch

26
Q

how do progestins treat endometriosis? example of pregestin

A

pseudo-pregnancy state- decrease estrogen & menstrual flow & reflux
oppose estrogen effects, converts estradiol to estrone
Depo shot, Mirena IUD

27
Q

how do the SE of contraceptives compare with progestin?

A

a lot of similarities but with progestins theres higher breakthrough bleeding, edema and less weight gain
depo has delayed ovulation and fertility return

28
Q

what are the 2nd line treatments for endometriosis?

A

GnRH agonist, antagonist
androgenic agent
combo antiestrogenic, antiprogesterone, androgenic agent

29
Q

how does GnRH agonist treat endometriosis?

A

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
Q

common consequence of 2nd line treatments?

A

they have to use barrier contraceptive method

31
Q

if GnRH agonist/antagonists stop ovulation, why do they need barrier contraceptives?

A

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
Q

what are some SE of GnRH meds

A

bone loss, hot flashes, mood swings
vaginal dryness, insomnia, decreased libido, depression

33
Q

how do androgenic agents treat endometriosis? name one med

A

increases HDL, decreases LDL
its a testosterone derivative–> ATROPHY of endometrial implants
Danazol

34
Q

what are some SE of Danazol & Gestrinone?

A

wt gain, muscle cramp, less breasts
oily skin, acne, sweating
hirsutism, voice deepening

35
Q

how does combo pills treat endometriosis? name one med

A

decreases estrogen, progesterone and also androgenic
Gestrinone

36
Q

when can you treat with CONSERVATIVE surgery?

A

if interested in pregnancy or in significant pain despite other tx

37
Q

Laparoscopy vs Laparotomy

A

Laparoscopy is for mild to moderate disease; decreased adhesion formation
Laparotomy is for severe, deep infiltrating lesions; more invasive
Both are conservative surgeries

38
Q

when can you treat w/ SEMIconservative surgery? examples?

A

long standing disease, uncontrollable pain, no concerns w/ fertility
hysterectomy and endometrial lesion removal

39
Q

Conservative vs Semiconservative surgery

A

both can have recurrence
with semiconservative the time is longer till recurrence & could have surgical menopause
with conservative you can have repeat surgery

40
Q

what can you do to avoid 2nd surgery?

A

combination treatment
surgery + hypoestrogenic treatment
this could increase pregnancy

41
Q

how do you help someone with EARLY stage EM get pregnant?

A

surgery + supraovulation

42
Q

what is supraovulation

A

ovarian stimulation so more than one egg gets released

43
Q

how do you help someone with ADVANCED EM get pregnant?

A

3mo medical therapy THEN surgery + IVF

44
Q

endometriosis vs adenomyosis pathology

A

w/ adenomyosis, endometrial tissue goes deeper to implant in myometrium!

45
Q

what are sx of ademomyosis?

A

spasms
severe menorrhagia disabling dysmenorrhea
pelvic pain, painful intercourse
many are asymptomatic!

46
Q

incidence of adenomyosis?

A

mainly in peri-menopausal; 20-30% of uteri
can also have endometriosis

47
Q

possible PE findings for adenomyosis

A

high normal or enlarged globular uterus
diffuse of nodular
tender uterus

48
Q

Pharm. Tx for symptomatic relief of adenomyosis

A

NSAIDs + OCP, GnRH agonist

49
Q

Tx for people who have been pregnant before

A

uterine artery embolization could reduce symptoms

50
Q

what is the only guaranteed treatment for adenomyosis

A

hysterectomy for symptomatic patients; preserve ovaries in younger patients!

51
Q

why would you save the ovaries w/ hysterectomy in younger patients?

A

saving ovary is associated w/ lower risk of CHD and cancer related mortality

52
Q

how does GnRH antagonists tx endometriosis?

A

inhbit GnRH receptors in pituitary–> decrease FSH/LH–> EST & PROG
need barrier contraceptive

wh unit 1 (5 decks)

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