endometriosis Flashcards
what are the causes of endometriosis?
genetics?
retrograde menstruation
embyronic development
lymphatic system
metaplasia
what is endometriosis?
ectopic endometrial tissue outside uterus
what is an endometrioma?
- Lump of endometrial tissue outside
what do endometriomas look like within ovaries?
chocolate cysts
how can embryonic cells potentially cause endometriosis?
: cells destined to be endometrial tissue develop outside uterus from early development
what is retrograde menstruation?
ectopic endometrial tissue during menstruation flows backwards and out into pelvis and peritoneum
- Endometrial tissue then just seeds into those areas
how can lymphatic system cause endometriosis?
spread of endometrial cells similar to cancer
how can metaplasia cause endometriosis?
cells outside of uterus change
what is the pathophys of endometriosis?
Main symptom is pelvic pain
- Endometrial tissue outside uterus responds to hormones in same way that it does within
- During menstruation is sheds like inside irritation and inflammation
- Resulting in cyclical, dull, heavy, burning pain
what does endometriosis within bladder/ bowel result in?
blood in urine/ stools
how can adhesions cause endometriosis?
Adhesions: localised bleeding and inflamm causes adhesions and the damage and scar tissue binds organs together
- Ovaries may be fixed to peritoneum/ utuerus attached to bowel
- Can occur post surgery
- Resulting in chronic, non-cyclical pain sharp and stabbing, associated with nausea
how can endometriosis result in reduced infertility?
: potentially linked ot adhesions around ovaries and fallopian tubes which blocks release of eggs or kinks tubes
- Endometriomas in ovaries may damage eggs or prevent effective ovulation
how may endometriosis present?
- Cyclical abdo/ pelvic pain
- Deep dyspareunia (pain on sexual intercourse)
- Infertility
- Cyclical bleeding from other sites eg haematuria
- Other cyclical symptoms: urinary, bowel
on examination, how might endometriosis present?
Examination: endometrial tissue visible from vagina on speculum
- Fixed cervix on bimanual examination
- Tenderness in vagina, cervix and adnexa
how do you diagnose endometriosis?
pelvic US
laproscopic surgery
how would a pelvic US show endometriosis?
Pelvic US: large endometriomas and chocolate cysts
- Tend to be unremarkable
- Need gynae referral for laproscopy
why is laproscopic surgical investigation best?
Laproscopic surgery: gold standard
- Need biopsy
- Surgeons can remove deposits whilst there
what is initial management of endometriosis?
Initial:
1. Establish diagnosis + clear explanation
2. Analgesia – NSAIDS and paracetamol
what are hormonal options for managing endometriosis?
Hormonal: options can be tried prior to definite diagnosis
- Combined oral contraceptive can be used back to back to be period free
- POP
- Medroxyprogesterone acetate injection – depo
- Nexplanon implant
- Mirena coil
- GnRH agonists
what are surgical options for managing endometriosis?
Surgical:
- Laproscopic to excise/ ablate to endometrial tissue and remove adhesions may improve fertility `
- Hysterectomy
