endometriosis

Question 1

possible pathophysiology of endometriosis

Answer 1

retrograde menstruation
lymphatic spread
metaplasia
genetic factor

Question 2

symptoms of endometriosis

Answer 2

cyclical pain (heavy, dull burning)

may have urinary/ faecal bleeding

adhesions can cause chronic non cyclical abdo/pelvic pain (sharp, stabbing, +/- N&V)

menorrhagia, bleeding in between periods, pain with sex, fatigue, bloating

Question 3

gold standard for diagnosis of endometriosis

Answer 3

explorative laparoscopic surgery

pelvic USS largely unhelpful

Question 4

staging of endometriosis

Answer 4

1. small, superfiscial leisons
2. deeper leisons on pelvic lining
3. more extensive deeper leisons on ovary and pelvic lining
4. as above with extensive adhesions

Question 5

medical management options for endometriosis

Answer 5

analgesia
hormonal medication (COCP, Depo, IUS) to prevent ovulation and endometrial thickening
induction of medical menopause (GnRH analogues)

Question 6

surgical options for endometriosis management

Answer 6

laparoscopic excision/ cautery
removal of adhesions
hysterectomy and bilateral salpingooparectomy