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Year 2 OBGYN > Endometriosis > Flashcards

Endometriosis Flashcards

1
Q

definition: endometriosis

A

chronic gynecologic disorder:

  • chronic pelvic pain
  • infertility
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2
Q

what are the pathogenic mechanisms of endometriosis?

A
  • retrograde menstruation
  • vascular lymphatic dissemination
  • coelomic metaplasia
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3
Q

definition: retrograde menstruation

A
  • direct implantation of endometrial cells
  • consistent with predilection for ovaries and pelvic peritoneum and found in abdominal or episiotomy scar
  • “Sampson theory”
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4
Q

definition: vascular lymphatic dissemination

A
  • distant sites of endometriosis can be explained by this - pleura, kidney
  • “Halban theory”
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5
Q

definition: coelomic metaplasia

A
  • multipotent cells in the peritoneal cavity
  • under certain conditions, these cells can develop into functional endometrial cells
  • “Meyer theory”
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6
Q

what are the risk factors for endometriosis?

A
  • early menarche (before 11)
  • shorter cycle interval
  • prolonged heavy bleeding
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7
Q

what are protective factors for endometriosis?

A
  • higher parity
  • increased duration of lactation
  • regular exercise
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8
Q

where is endometriosis usually found?

A
  • ovaries (most common)
  • pouch of douglas
  • round ligament
  • fallopian tubes
  • sigmoid tubes
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9
Q

what are the clinical manifestations of endometriosis?

A
  • progressive dysmenorrhea
  • deep dyspareunia
  • chronic pelvic pain
  • sacral back ache
  • dyschezia
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10
Q

what is a “chocolate cyst”?

A

endometrioma

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11
Q

when should endometriosis be suspected? what are differentials?

A

dysmenorrhea that does not respond to oral contraceptives or NSAIDs

  • chronic PID
  • pelvic adhesions
  • GI dysfunction
  • ovarian cyst
  • symptomatic uterine retroversion
  • interstitial cystitis
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12
Q

how is the definitive diagnosis for endometriosis made? what is observed?

A

histology obtained by biopsy

endometrial glands and stroma

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13
Q

what are the goals for endometriosis treatment?

A
  • reduction in pelvic pain
  • minimize surgical intervention
  • preserve fertility
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14
Q

what is the medical management of endometriosis? when is this indicated?

A

exogenous hormones to induce atrophy of the endometrial tissue

good for if patient wants to get pregnant in the future

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15
Q

what are the medical options for endometriosis treatment?

A
  • combined contraceptives with an NSAID
  • progesterone
  • danazol
  • GnRH
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16
Q

what is the mechanism of combined contraceptives with an NSAID for endometriosis?

A

induces decidual reaction in the functioning endometriotic tissue

17
Q

what is the mechanism of progesterone for endometriosis?

A

suppresses FSH / LH release and the resulting ovarian steroidogenesis

18
Q

what is the mechanism of danazol for endometriosis?

A

suppresses FSH / LH - significant side effects related to hypoestrogenic and androgenic properties which might not resolve

19
Q

what is the mechanism of GnRH agonists?

A

ultimately downregulate the pituitary - side effects less severe and reversible - hot flashes, night sweats, vaginal dryness

20
Q

what is the default development sex?

A

female

21
Q

in the absence of the SRY gene what happens to the mesonephric duct?

A

regresses

22
Q

the gonads arise from what embryological structure and germ layer?

A

intermediate mesoderm within the urogenital ridges of the embryo

23
Q

the genital ducts arise from what embryological structures?

A

paired mesonephric and paramesonephric ducts

24
Q

what embryological structures give rise to the male genital ducts?

A

mesonephric ducts

25
Q

what embryological structures give rise to the female genital ducts?

A

paramesonephric ducts

26
Q

the paramesonephric is also known as what?

A

mullerian duct

27
Q

the paramesonephric ducts develop into what structures in the female?

A

fallopian tubes
uterus
upper 1/3 of vagina

28
Q

the urogenital sinus develops into what structures in the female?

A

lower 2/3 vagina
bulbourethral glands
vestibule

29
Q

fallopian tubes
uterus
upper 1/3 of vagina

these develop from what embryological structure?

A

paramesonephric ducts

30
Q

lower 2/3 vagina
bulbourethral glands
vestibule

these develop from what embryological structure?

A

urogenital sinus

31
Q

how do mullerian anomalies develop?

A

incomplete fusion or incomplete resorption of the septum

32
Q

pathogenesis: septate uterus

A

incomplete resorption of uterine septum

33
Q

pathogenesis: bicornate uterus

A

incomplete fusion of mullerian ducts (two separate structures but one cervix)

34
Q

pathogenesis: uterine didelphys

A

complete failure of fusion of mullerian ducts (double uterus vagina, and cervix)

Year 2 OBGYN (33 decks)

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