Endometriosis

Question 1

Gun powered burns is seen in

Answer 1

Endometriosis

Question 2

Chocolate cysts represents

Answer 2

Endometriosis

Question 3

Endometrial tissues lying outside the uterine cavity mis called

Answer 3

Endometriosis

Question 4

What causes the fibrosis in endometriosis?

Answer 4

Repeated episodes of bleeding and healing

Question 5

Incidence

Answer 5

5-10% of women of reproductive age
1/3 of women undergoing diagnostic laparoscopy for pelvic pain and infertility

Question 6

Etiology

Answer 6

1. Sampson’s implantation theory
2. Meyer’s coelomic metaplasia theory
3. Lymphatic and vascular spread
4. Genetic and immunologic theory

Question 7

Characteristics of endometriosis

Answer 7

1. Oestrogen dependent
2. Never appears before puberty and regresses after menopause
3. Responds to cyclic hormonal changes

Question 8

Most common site

Answer 8

Ovary

Question 9

Other sites it can occur

Answer 9

Pouch of Douglas/posterior cul-de-sac
Broad ligament
Uterosacral ligament
Rectosigmoid colon
Bladder
Abd scar

Question 10

Risk factors

Answer 10

Age 30-45yrs
Family hx
Early menarche
Nulliparity
Heavy menses
Short menstrual period
Infertility

Question 11

Clinical features

Answer 11

Dysmenorrhoea
Infertility
Dyspareunia

Heavy or irregular bleeding
Chronic pelvic pain
Lower abdominal pain, back pain
Urinary frequency, dysuria, hematuria
Dyschezia, diarrhoea, constipation, melena
Hemoptysis

Question 12

Investigations

Answer 12

1. TVUSS
   Chocolate cysts
2. MRI
   detects lesions >5mm in size in deep tissues
3. Laparoscopy
   Blue-black appearance or powdered-burned appearance
4. CA 125
5. FBC
6. Urinalysis and Urine MCS

Question 13

Treatment plan for endometriosis (Medical)

Answer 13

1. Analgesics
   NSAIDS not codeine/opiates because of the bowel symptoms
2. COCP
   pseudopregnancy
3. Progestogen (when COCP is contraindicated) achieves amenorrhea
   LARCs, depot-medroxyprogesterone acetate and LNG-IUS
4. GnRH agonist
   Creates medical oophorectomy, a stste of low circulating estrogen and amenorrhoea.
   Leuprolide, naferelin, goserelin
5. Others - danazol and Gestrinone
   Not used cos of weight gain, greasy skin and acne, lipid profile alterations and live function
6. Mifepristone

Question 14

Treatment plan for endometriosis (surgical)

Answer 14

1. Conservative Surgery
   Laparoscopic ablation or excision of the endometriotic tissues by electrodiathermy or laser vaporisation

LUNA when serve pain is present

2. Definitive Surgery
   hysterectomy with BSO