Endometriosis

Question 1

What is endometriosis?

Answer 1

• The presence of endometrial-like tissue outside of the uterus
• Induces a chronic inflammatory reaction

Question 2

Where is endometriosis most commonly located?

Answer 2

• Within peritoneal cavity in the pelvis most commonly the uterosacral ligaments behind the uterus

Question 3

What is adenomyosis?

Answer 3

• Endometrial tissue within the myometrium of the uterus

Question 4

In adenomyosis how might you describe the feeling of the uterus on pelvic examination?

Answer 4

• Boggy and Enlarged

Question 5

Endometriosis is rarely diagnosed after menopause why is that?

Answer 5

• The endomerial-like tissue responds to estrogen like true-endometrium causing bleeding and symptoms.
• After menopause low levels of estrogen, resulting in improved symptoms
• Can present if taking HRT

Question 6

What are common presenting symptoms associated with endometriosis?

Answer 6

• Severe dysmenorrhea
• Chronic pelvic pain
• Dyschezia (pain on defication)
• Cyclical or perimenstrual symptoms
• Deep dyspareunia (endometrium in pouch of douglas)
• Ovulatory pain
• Chronic fatigue
• Infertility

Question 7

What investigations can be performed to investigate a patient with suspected endometriosis?

Answer 7

• Laparoscopy is currently the standard diagnostic method
• transvaginal U/S can detect gross endometriosis involving the ovaries and occasionally the rectum
• MRI can see endometriosis greater than 1cm in diameter in deep tissue

Question 8

Which gyne serum biomarker can be raised in endometriosis?

Answer 8

• Ca 125

- Not diagnostic, just know can affect results in a high risk patient for ovarian cancer

Question 9

What medical and surgical treatment options can be used in a patient with endometriosis?

Answer 9

• NSAIDS and simple analgesia
• Ovulation suppression (symptom relief only)
  
  • contraceptives
  • continuous progesterone therapy (medroxyprogesterone acetate)
  • GnRH analogues (second line)
• Endometrial ablation
• Histerectomy +/- Oophorectomy

Question 10

Cervical motion tenderness is most commonly seen in which two conditions?

Answer 10

• Ectopic pregnancy

- Pelvic infection (ie. PID)

Question 11

What are causes of acute pelvic pain?

a) Gyne
b) G.I.
c) Urinary tract

Answer 11

a) Ectopic, PID, miscarriage, ruptured ovarian cysts, ovarian torsion
b) Appendicitis, constipation, diverticular disease, IBS
c) UTI, Calculi

Question 12

What is the definition for chronic pelvic pain?

Answer 12

• Intermittent or constant pain in the lower abdomen or pelvis lasting at least 6 months
• Not occurring exclusively with menstruation, intercourse, or pregnancy

Question 13

True or False: The majority of ovarian cysts are problematic

Answer 13

• False
• Majority benign
• Pain may occur in the event of torsion, cyst rupture, or bleeding into the cyst