Endometriosis Flashcards
Define endometriosis
- Functional endometrial tissue implanted outside the uterine cavity
- Infertility is common
Define adenomyosis
Extension of endometrial glands into the myometrium
What is the etiology/pathogenesis of endometriosis?
- Inc Retrograde flow of menstruation through fallopian tubes 2° to congenital outflow obstruction
- Altered immune response to displaced endometrial tissue
- 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
What are the rf for endometrosis?
- Familial/genetic predisposition
- Delayed childbearing
- Short 8 d
what can endometriosis lead to?
- Impairs fertility
2. Distortion of pelvic anatomy
What are implants commonly located?
- Ovaries (mc)
- Posterior cul-de-sac
- Broad ligament
- Uterosacral ligament
- Rectosigmoid colon
- Bladder
- Distal ureter
What are the sxs of implants on the colon?
- Obstruction
- Constipation
- Pain w/defecation
- Abdominal bloating
- Rectal bleeding w/menses
What are the sxs of implants on the ovaries?
Endometrioma (cyst of endometriosis)
What are the sxs of implants on the bladder?
- Dysuria
- Hematuria
- Suprapubic pain w/voiding
What are the sxs of implants on the adenexa?
- Adhesions
- Pain
- Mass
What are the sxs of extrapelvic implants?
Vague abdominal pain
What are the common general sxs of endometriosis?
- Dysmenorrhea
- DUB
- Infertility
- Dyspareunia
- Painful defecation
- Painful urination
- Difficulty conceiving
A. Interferes w/ tubal motility, folliculogenesis, & corpus luteum function
What is seen on the PE for endometriosis?
- Most common finding is nonspecific pelvic tenderness
- Normal pelvis or retroverted & fixed
- +/- ovarian enlargement, ovarian masses
- Uterosacral ligament nodularity
- Pelvic tenderness
- Pelvic mass
What are the ddx for endometriosis?
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
What dx studies are used for endometriosis?
- CBC
- UA/UC
- Cervical Gm stain & Cx
- Pelvic USN, CT, MRI (advanced stages)
A. “Chocolate cyst” - Hysterosalpingography → tubal occlusion
6.*** Laparoscopy w/ Bx
A. Clear, red, brown, black implants (powder burn lesions)
How is endometriosis staged?
1-4 (minimal, mild, moderate, severe)
What are the new upcoming tests for endometriosis?
- Autoantibodies against Thomsen-Friedenreich (T) antigen (Gal beta1-3GalNAc)
- CCR1 mRNA in peripheral blood leukocytes is significantly higher in women with endometriosis
How is mild endometriosis treated?
1. NSAID’S A. +/- effective 2. Ovarian suppression in mild Dz A. Inhibits growth & activity of endometrial implants B. *Tx improves fertility rates
What are the forms of ovarian suppression?
- OCP
2, Progestins (Provera) - Androgens (Danazol)
- GnRH agonists (Leuprolide/Lupron SQ, Nafarelin/Synarel NS)
A. Limited to 6 mo Tx
B. Induces pseudo-menopause - Recurrence is typical after stopping Tx
How is endometriosis managed surgically?
- Ablation &/or excision of implants for moderate or severe Dz
- TAH/BSO for intractable pain after completion of childbearing
- Spontaneously resolves in 1/3 of women not treated
What are the protective factors against endometriosis?
- Multiple pregnancies
- OCP (continuous or cyclic)
- Regular exercise
What does a pt with endometriosis need to be educated on?
- Multiple side effects w/ androgen, progesterone and GnRH agonists
- Infertility education
- High rate of recurrence
