Endometriosis Flashcards
def. endometriosis
presence of endometrial glands and stroma outside of the urteus
proposed path of endo
- retrograde menstruation
- hematogenous or lymph transport
- altered immune response
- coelmic metaplasia
evidence for retrograde menstruation
- common (90%)
- lesions on on dependent portions
- cells transplanted grow in vivi and in vitro
what does hematogenous spread explain
endo at ditant sites
what is immunologic theory
altered immunity may limit clearance of transplanted cells
- MAY be reduced MK cells
epi of endo
common, especially in infertile and chronic pain
what is delay in diagnosis
on average 7 years b/w Sx and laprascopic diagnosis
classic triad of endo Sx
- dysmenorrehea
- deep dyspareunia
- infertility
other endo Sx
- menstrual irreg
- dyschezia + hemo
- dysuria + hemo
4 physical findings
- focal tenderness
- uterosacral
- fixed retroversion of uterus
- adnexal mass with tenderness
what is seen on US
cyst (chocholate)
how to diagnose
presumtive - based on Sx and hist
definitive- direct visualization at surg followed by histo
what are laprascopic findings
lesions
- number does not correlate with Sx, but depth does
what might lesions look like (5)
- draining endometrioma (choco)
- classic lesions
- cluster of red lesions
- plaque-like deposits
- partial oblitera tion of the cul de sac
*** 4 key points
- common
- varied presentation
- surgery required for def. diagnoiss
- findings correlate poorly with Sx
med treatments
- NSAIDs (1st line)
- OCP (1)
- progestin (1)
- dienogest (2nd line)
- anti E (danazol) (2)
- GnRH agonist (2)
how do NSAIDs work
cox inhibitions
- reduces PGE and PGF which cause vasoconstriciton
- 50% response rate
how does OCP work
leads to decidual reaction
- supresses endometrium
- 50% response rate
how does progestin work
leads to decidual reaction
- supresses endometrium
- 80% response rate
how does dienogest work
- progestin analog - inhib GnRH
80% response
how does danazol work
testosterone derivative
- anti-estrogen effect
- 80% RR
- SE virilization and hepatic
how does GnRH agonsist work
stims GnRH and leads to downreg. of in gondaotropin release
- hypoestrogenation
- decrease menstruation and implants
SE : menopause, osteoporosis
surgical treatment (2)
- ablate spots
2. definitive surgery - remove all
def. endometrioma
if cyst over 3cm
- esp if torsion
- ovarian cystectomy or aspiration with cauterization
treatments for fertility in endo
- conservative surgery
- minimize loss of ovarian tissues
- IVF
relate bw endo and CA
low
- 1.2-1.9 OR
sampson criteria to confrim transformation (4)
- presence of both in same ovary must be demonstrated
- carcinoma must arise from the endo, not adjacent tissue
- specimen must contain hist of endo (glands and stroma)
- morphological continuum between benign and maligant
3 key points**
- meds first line for pain, but not infetility
- use of more effective therapies limited by SEs
- surgery may be good in mild and seveere
