Endometriosis Flashcards
definition: endometriosis
chronic gynecologic disorder:
- chronic pelvic pain
- infertility
what are the pathogenic mechanisms of endometriosis?
- retrograde menstruation
- vascular lymphatic dissemination
- coelomic metaplasia
definition: retrograde menstruation
- direct implantation of endometrial cells
- consistent with predilection for ovaries and pelvic peritoneum and found in abdominal or episiotomy scar
- “Sampson theory”
definition: vascular lymphatic dissemination
- distant sites of endometriosis can be explained by this - pleura, kidney
- “Halban theory”
definition: coelomic metaplasia
- multipotent cells in the peritoneal cavity
- under certain conditions, these cells can develop into functional endometrial cells
- “Meyer theory”
what are the risk factors for endometriosis?
- early menarche (before 11)
- shorter cycle interval
- prolonged heavy bleeding
what are protective factors for endometriosis?
- higher parity
- increased duration of lactation
- regular exercise
where is endometriosis usually found?
- ovaries (most common)
- pouch of douglas
- round ligament
- fallopian tubes
- sigmoid tubes
what are the clinical manifestations of endometriosis?
- progressive dysmenorrhea
- deep dyspareunia
- chronic pelvic pain
- sacral back ache
- dyschezia
what is a “chocolate cyst”?
endometrioma
when should endometriosis be suspected? what are differentials?
dysmenorrhea that does not respond to oral contraceptives or NSAIDs
- chronic PID
- pelvic adhesions
- GI dysfunction
- ovarian cyst
- symptomatic uterine retroversion
- interstitial cystitis
how is the definitive diagnosis for endometriosis made? what is observed?
histology obtained by biopsy
endometrial glands and stroma
what are the goals for endometriosis treatment?
- reduction in pelvic pain
- minimize surgical intervention
- preserve fertility
what is the medical management of endometriosis? when is this indicated?
exogenous hormones to induce atrophy of the endometrial tissue
good for if patient wants to get pregnant in the future
what are the medical options for endometriosis treatment?
- combined contraceptives with an NSAID
- progesterone
- danazol
- GnRH
what is the mechanism of combined contraceptives with an NSAID for endometriosis?
induces decidual reaction in the functioning endometriotic tissue
what is the mechanism of progesterone for endometriosis?
suppresses FSH / LH release and the resulting ovarian steroidogenesis
what is the mechanism of danazol for endometriosis?
suppresses FSH / LH - significant side effects related to hypoestrogenic and androgenic properties which might not resolve
what is the mechanism of GnRH agonists?
ultimately downregulate the pituitary - side effects less severe and reversible - hot flashes, night sweats, vaginal dryness
what is the default development sex?
female
in the absence of the SRY gene what happens to the mesonephric duct?
regresses
the gonads arise from what embryological structure and germ layer?
intermediate mesoderm within the urogenital ridges of the embryo
the genital ducts arise from what embryological structures?
paired mesonephric and paramesonephric ducts
what embryological structures give rise to the male genital ducts?
mesonephric ducts
what embryological structures give rise to the female genital ducts?
paramesonephric ducts
the paramesonephric is also known as what?
mullerian duct
the paramesonephric ducts develop into what structures in the female?
fallopian tubes
uterus
upper 1/3 of vagina
the urogenital sinus develops into what structures in the female?
lower 2/3 vagina
bulbourethral glands
vestibule
fallopian tubes
uterus
upper 1/3 of vagina
these develop from what embryological structure?
paramesonephric ducts
lower 2/3 vagina
bulbourethral glands
vestibule
these develop from what embryological structure?
urogenital sinus
how do mullerian anomalies develop?
incomplete fusion or incomplete resorption of the septum
pathogenesis: septate uterus
incomplete resorption of uterine septum
pathogenesis: bicornate uterus
incomplete fusion of mullerian ducts (two separate structures but one cervix)
pathogenesis: uterine didelphys
complete failure of fusion of mullerian ducts (double uterus vagina, and cervix)
