endometriosis

Question 1

what are the causes of endometriosis?

Answer 1

genetics?
retrograde menstruation
embyronic development
lymphatic system
metaplasia

Question 2

what is endometriosis?

Answer 2

ectopic endometrial tissue outside uterus

Question 3

what is an endometrioma?

Answer 3

• Lump of endometrial tissue outside

Question 4

what do endometriomas look like within ovaries?

Answer 4

chocolate cysts

Question 5

how can embryonic cells potentially cause endometriosis?

Answer 5

: cells destined to be endometrial tissue develop outside uterus from early development

Question 5

what is retrograde menstruation?

Answer 5

ectopic endometrial tissue during menstruation flows backwards and out into pelvis and peritoneum
- Endometrial tissue then just seeds into those areas

Question 6

how can lymphatic system cause endometriosis?

Answer 6

spread of endometrial cells  similar to cancer

Question 6

how can metaplasia cause endometriosis?

Answer 6

cells outside of uterus change

Question 7

what is the pathophys of endometriosis?

Answer 7

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

Question 8

what does endometriosis within bladder/ bowel result in?

Answer 8

blood in urine/ stools

Question 9

how can adhesions cause endometriosis?

Answer 9

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

Question 10

how can endometriosis result in reduced infertility?

Answer 10

: 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

Question 11

how may endometriosis present?

Answer 11

• Cyclical abdo/ pelvic pain
• Deep dyspareunia (pain on sexual intercourse)
• Infertility
• Cyclical bleeding from other sites eg haematuria
• Other cyclical symptoms: urinary, bowel

Question 12

on examination, how might endometriosis present?

Answer 12

Examination: endometrial tissue visible from vagina on speculum
- Fixed cervix on bimanual examination
- Tenderness in vagina, cervix and adnexa

Question 13

how do you diagnose endometriosis?

Answer 13

pelvic US
laproscopic surgery

Question 14

how would a pelvic US show endometriosis?

Answer 14

Pelvic US: large endometriomas and chocolate cysts
- Tend to be unremarkable
- Need gynae referral for laproscopy

Question 15

why is laproscopic surgical investigation best?

Answer 15

Laproscopic surgery: gold standard
- Need biopsy
- Surgeons can remove deposits whilst there

Question 16

what is initial management of endometriosis?

Answer 16

Initial:
1. Establish diagnosis + clear explanation
2. Analgesia – NSAIDS and paracetamol

Question 17

what are hormonal options for managing endometriosis?

Answer 17

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

Question 18

what are surgical options for managing endometriosis?

Answer 18

Surgical:
- Laproscopic to excise/ ablate to endometrial tissue and remove adhesions  may improve fertility `
- Hysterectomy