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Gen Med: Ob/gyn > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

Define endometriosis

A
  1. Functional endometrial tissue implanted outside the uterine cavity
  2. Infertility is common
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2
Q

Define adenomyosis

A

Extension of endometrial glands into the myometrium

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3
Q

What is the etiology/pathogenesis of endometriosis?

A
  1. Inc Retrograde flow of menstruation through fallopian tubes 2° to congenital outflow obstruction
  2. Altered immune response to displaced endometrial tissue
  3. Implants of glands & stroma (connective tissue) identical to endometrium
    A. Implants contain estrogen & progesterone receptors that grow & bleed in response to hormone levels during menstrual cycle
    B. Bleeding leads to inflammation & scarring
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4
Q

What are the rf for endometrosis?

A
  1. Familial/genetic predisposition
  2. Delayed childbearing
  3. Short 8 d
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5
Q

what can endometriosis lead to?

A
  1. Impairs fertility

2. Distortion of pelvic anatomy

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6
Q

What are implants commonly located?

A
  1. Ovaries (mc)
  2. Posterior cul-de-sac
  3. Broad ligament
  4. Uterosacral ligament
  5. Rectosigmoid colon
  6. Bladder
  7. Distal ureter
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7
Q

What are the sxs of implants on the colon?

A
  1. Obstruction
  2. Constipation
  3. Pain w/defecation
  4. Abdominal bloating
  5. Rectal bleeding w/menses
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8
Q

What are the sxs of implants on the ovaries?

A

Endometrioma (cyst of endometriosis)

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9
Q

What are the sxs of implants on the bladder?

A
  1. Dysuria
  2. Hematuria
  3. Suprapubic pain w/voiding
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10
Q

What are the sxs of implants on the adenexa?

A
  1. Adhesions
  2. Pain
  3. Mass
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11
Q

What are the sxs of extrapelvic implants?

A

Vague abdominal pain

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12
Q

What are the common general sxs of endometriosis?

A
  1. Dysmenorrhea
  2. DUB
  3. Infertility
  4. Dyspareunia
  5. Painful defecation
  6. Painful urination
  7. Difficulty conceiving
    A. Interferes w/ tubal motility, folliculogenesis, & corpus luteum function
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13
Q

What is seen on the PE for endometriosis?

A
  1. Most common finding is nonspecific pelvic tenderness
  2. Normal pelvis or retroverted & fixed
  3. +/- ovarian enlargement, ovarian masses
  4. Uterosacral ligament nodularity
  5. Pelvic tenderness
  6. Pelvic mass
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14
Q

What are the ddx for endometriosis?

A 
1. Based on location
A. PID
B. IBS/UC/Crohns
C. Colon CA
D. UTI
E. Dysmenorrhea of other etiology
F. Adenomyosis, cervical stenosis, fibroids
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15
Q

What dx studies are used for endometriosis?

A
  1. CBC
  2. UA/UC
  3. Cervical Gm stain & Cx
  4. Pelvic USN, CT, MRI (advanced stages)
    A. “Chocolate cyst”
  5. Hysterosalpingography → tubal occlusion
    6.*** Laparoscopy w/ Bx
    A. Clear, red, brown, black implants (powder burn lesions)
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16
Q

How is endometriosis staged?

A

1-4 (minimal, mild, moderate, severe)

17
Q

What are the new upcoming tests for endometriosis?

A
  1. Autoantibodies against Thomsen-Friedenreich (T) antigen (Gal beta1-3GalNAc)
  2. CCR1 mRNA in peripheral blood leukocytes is significantly higher in women with endometriosis
18
Q

How is mild endometriosis treated?

A 
1. NSAID’S 
A. +/- effective 
2. Ovarian suppression in mild Dz
A.  Inhibits growth & activity of endometrial implants
B. *Tx improves fertility rates
19
Q

What are the forms of ovarian suppression?

A
  1. OCP
    2, Progestins (Provera)
  2. Androgens (Danazol)
  3. GnRH agonists (Leuprolide/Lupron SQ, Nafarelin/Synarel NS)
    A. Limited to 6 mo Tx
    B. Induces pseudo-menopause
  4. Recurrence is typical after stopping Tx
20
Q

How is endometriosis managed surgically?

A
  1. Ablation &/or excision of implants for moderate or severe Dz
  2. TAH/BSO for intractable pain after completion of childbearing
  3. Spontaneously resolves in 1/3 of women not treated
21
Q

What are the protective factors against endometriosis?

A
  1. Multiple pregnancies
  2. OCP (continuous or cyclic)
  3. Regular exercise
22
Q

What does a pt with endometriosis need to be educated on?

A
  1. Multiple side effects w/ androgen, progesterone and GnRH agonists
  2. Infertility education
  3. High rate of recurrence

Gen Med: Ob/gyn (13 decks)

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