Endometriosis

Question 1

def. endometriosis

Answer 1

presence of endometrial glands and stroma outside of the urteus

Question 2

proposed path of endo

Answer 2

• retrograde menstruation
• hematogenous or lymph transport
• altered immune response
• coelmic metaplasia

Question 3

evidence for retrograde menstruation

Answer 3

• common (90%)
• lesions on on dependent portions
• cells transplanted grow in vivi and in vitro

Question 4

what does hematogenous spread explain

Answer 4

endo at ditant sites

Question 5

what is immunologic theory

Answer 5

altered immunity may limit clearance of transplanted cells

- MAY be reduced MK cells

Question 6

epi of endo

Answer 6

common, especially in infertile and chronic pain

Question 7

what is delay in diagnosis

Answer 7

on average 7 years b/w Sx and laprascopic diagnosis

Question 8

classic triad of endo Sx

Answer 8

• dysmenorrehea
• deep dyspareunia
• infertility

Question 9

other endo Sx

Answer 9

• menstrual irreg
• dyschezia + hemo
• dysuria + hemo

Question 10

4 physical findings

Answer 10

1. focal tenderness
2. uterosacral
3. fixed retroversion of uterus
4. adnexal mass with tenderness

Question 11

what is seen on US

Answer 11

cyst (chocholate)

Question 12

how to diagnose

Answer 12

presumtive - based on Sx and hist

definitive- direct visualization at surg followed by histo

Question 13

what are laprascopic findings

Answer 13

lesions

- number does not correlate with Sx, but depth does

Question 14

what might lesions look like (5)

Answer 14

1. draining endometrioma (choco)
2. classic lesions
3. cluster of red lesions
4. plaque-like deposits
5. partial oblitera tion of the cul de sac

Question 15

*** 4 key points

Answer 15

1. common
2. varied presentation
3. surgery required for def. diagnoiss
4. findings correlate poorly with Sx

Question 16

med treatments

Answer 16

1. NSAIDs (1st line)
2. OCP (1)
3. progestin (1)
4. dienogest (2nd line)
5. anti E (danazol) (2)
6. GnRH agonist (2)

Question 17

how do NSAIDs work

Answer 17

cox inhibitions

• reduces PGE and PGF which cause vasoconstriciton
• 50% response rate

Question 18

how does OCP work

Answer 18

leads to decidual reaction

• supresses endometrium
• 50% response rate

Question 19

how does progestin work

Answer 19

leads to decidual reaction

• supresses endometrium
• 80% response rate

Question 20

how does dienogest work

Answer 20

• progestin analog - inhib GnRH

80% response

Question 21

how does danazol work

Answer 21

testosterone derivative

• anti-estrogen effect
• 80% RR
• SE virilization and hepatic

Question 22

how does GnRH agonsist work

Answer 22

stims GnRH and leads to downreg. of in gondaotropin release
- hypoestrogenation
- decrease menstruation and implants
SE : menopause, osteoporosis

Question 23

surgical treatment (2)

Answer 23

1. ablate spots

2. definitive surgery - remove all

Question 24

def. endometrioma

Answer 24

if cyst over 3cm

• esp if torsion
• ovarian cystectomy or aspiration with cauterization

Question 25

treatments for fertility in endo

Answer 25

1. conservative surgery
2. minimize loss of ovarian tissues
3. IVF

Question 26

relate bw endo and CA

Answer 26

low

- 1.2-1.9 OR

Question 27

sampson criteria to confrim transformation (4)

Answer 27

1. presence of both in same ovary must be demonstrated
2. carcinoma must arise from the endo, not adjacent tissue
3. specimen must contain hist of endo (glands and stroma)
4. morphological continuum between benign and maligant

Question 28

3 key points**

Answer 28

1. meds first line for pain, but not infetility
2. use of more effective therapies limited by SEs
3. surgery may be good in mild and seveere