Endometriosis Flashcards
Is there a familial association with endometriosis?
Yes
What, generally, are the major s/sx of endometriosis?
- Chronic pelvic pain
- Infertility
- Progressive dysmenorrhea
What is the retrograde menstruation theory on the pathogenesis of endometriosis?
Direct implantation of endometrial cells in inappropriate places
What is the vascular lymphatic dissemination theory of endometriosis?
Distant sites of endometriosis through spread through lymphatics
What is the coelomic theory of endometriosis?
Multipotential cells in the peritoneal cavity differentiate inappropriately, and respond to hormone changes
What are the three major risk factors for the development of endometriosis?
- Early menarche
- Shorter cycle interval
- Prolonged heavy bleeding
What are the three major protective factors for endometriosis?
- Higher parity
- Increased duration of lactation
- Regular exercise
Where does endometriosis usually occur?
- On both ovaries and fallopian tubes
- Round ligament
- Sigmoid colon
What is the pouch of douglas (posterior cul-de-sac)?
Area anterior to the rectum, and posterior to the uterus
Is deep or superficial dyspareunia more common with endometriosis?
Deep
True or false: the s/sx of endometriosis correlate well with extent of tissue
False
What is an endometrioma?
Endometriosis on the ovary
What is the only way to definitively diagnose endometriosis?
Look at it–scope or surgery
What is the classic presentation of endometriosis?
Pts with dysmenorrhea that does not respond to NSAIDs
What is the ddx of endometriosis?
- PID
- GI dysfunction
- Interstitial cystitis
True or false: pts with endometriosis usually have an normal pelvic exam
True
What is a diagnostic test to assess for endometriosis?
Trial of GnRH agonist like leuprolide
Will initially have increased s/sx, but will eventually subside with continued therapy
What is the role of imaging studies for endometriosis?
Not sensitive
What are the histological findings of endometriosis?
Glands in a field of inflammation
What are the three major goals of medical therapy for endometriosis?
- Reduction in pelvic pain
- Minimize surgical intervention
- Preserve fertility
What is expectant management of endometriosis?
-Wait it out to birth a child or when menopause comes (if older)
What is the medical management, generally, of endometriosis? Does this preserve fertility?
- Induction of atrophy of the endometrial tissue
- Will maintain fertility
What is the MOA of using NSAIDs + oral contraceptives to treat endometriosis?
Reduces inflammation and
What is the MOA of using progesterone in treating endometriosis?
Suppresses FSH/LH release and the resulting steroidogenesis
What is the MOA of danazol in the treatment of endometriosis?
Suppresses FSH and LH production
What is the MOA of using leuprolide in treating endometriosis?
GnRH agonism will ultimately downregulate the pituitary
What is the role of hormonal IUDs with endometriosis?
Will not change hormones, just uterus’s response
What are the surgical options for treating endometriosis?
- Limited cauterization of ectopic endometrial tissue
- Total hysterectomy or a bilateral oophorectomy
What fraction of women who had conservative surgical treatment for endometriosis will require surgery within 5 years?
1/3
What are the risks and benefits of a total hysterectomy for treating endometriosis?
Will prevent recurrence of endometriosis, but will send into menopause right meow
What is the gene on the Y chromosome that causes the development of the fetus into a male? What specifically does this cause?
SRY gene
Causes the mesonephric duct to form instead of regress
If the SRY gene is not present, what happens to the mesonephric ducts?
Regressed and replaced by the paramesonephric ducts
The gonads arise from what?
Intermediate mesoderm within the urogenital ridge
What do the genital ducts arise from?
Paired mesonephric, and paramesonephric ducts
The mesonephric duct gives rise to what?
Male genital duct
What paramesonephric ducts give rise to what?
Female genital ducts
What part of the female genitalia develops from the paramesonephric duct? (5)
- Upper 1/3 of vagina
- Cervix
- Uterus
- Fallopian tubes
- Ovary
What develops from the urogenital sinus? (3)
- Lower 2/3 of vagina
- Bulbourethral glands
- Vestibule
What, generally, are Mullerian anomalies?
Incomplete fusion or incomplete resorption of the septum
What causes a septated uterus, and what is the treatment?
incomplete resorption of the uterine septum. Needs to be surgically corrected
What cause a bicornuate uterus?
Incomplete fusion of the Mullerian ducts
What causes uterine didelphys?
Complete failure of fusion (double uterus, vagina, and cervix)
