Endometriosis

Question 1

___ is a benign condition in which endometrial glands and stroma are present outside the uterine cavity and walls

Answer 1

Endometriosis

Question 2

It is Estimated that __-__% of women have some degree of endometriosis. It is found in ___ or more women with chronic pelvic pain.

Answer 2

5-15%

1/3

Question 3

The typical patient is in her ___(age), ____, and ___, but can present throughout the reproductive years.

Answer 3

30s
Nulliparous
infertile

Question 4

____ is the teory that endometrial fragments transported through fallopian tubes at time of menstruation and implant at intraabdominal sites

Answer 4

Retrograde menstruation (Sampson’s Theory)

Question 5

____ is the theory that there is a Metaplastic transformation of pelvic peritoneum

Answer 5

Müllerian (Coelomic) metapalasia theory (Meyer’s Theory)

Question 6

____ is the theory that substances released/shed from endometrium induce formation of endometriosis

Answer 6

Lymphatic spread (Halban’s Theory)

Question 7

where does endometriosis occur in the body?

Answer 7

BASICALLY ALL OF THE INNER GIRL PARTS 
Ovary (most common)
Cul-de-sac
Uterosacral ligaments
Broad ligament
Fallopian tubes
Round ligaments
Vagina
Rectosigmoid and bowel, appendix 
Urinary bladder and ureters

Question 8

how can you get rid of endometriosis surgically?

Answer 8

laparoscopy

Question 9

what is the classic triad for endometriosis?

Answer 9

dysmenorrhea
dyspareunia
dyschezia

Question 10

what other Sx may a woman with endometriosis experience?

Answer 10

Infertility
secondary dysmenorrhea
Premenstrual and postmenstrual spotting

Question 11

What PE findings may you find in a woman with Endometriosis ?

Answer 11

Cul-de-sac nodularity and tenderness
Uterosacral nodularity
Tender, fixed adnexal mass
Uterus fixed and retroverted

Question 12

What are a few DDx of endometriosis (FYI)

Answer 12

Chronic pelvic inflammatory disease
Recurrent acute salpingitis
Hemorrhagic corpus luteum
Benign or malignant ovarian neoplasm
Ectopic pregnancy
Non-gynecologic conditions (IBS, Interstitial Cystitis, MSK issues, psychogenic issues)

Question 13

___ is a sharp, firm, exquisitely tender “barb” (barbed wire) in uterosacral ligaments

Answer 13

Sine qua non

Question 14

What may you see on U/S in a woman with Endometriosis

Answer 14

Ultrasound – adnexal mass of complex echogenicity, internal echoes consistent with blood

Question 15

What is used for definitive dx of endometriosis?

Answer 15

Direct visualization (via laparotomy or laparoscopy)

Histologic and gross findings consistent with endometrial tissue

Question 16

____ can be used to dx endometriosis but is sucks… is isn’t specific or sensitive

Answer 16

Ca125

Question 17

A ____ occurs when endometrial tissue is in the ovaries.

Answer 17

endometrial cysts

Question 18

What are considerations you may include in the management of endometriosis? (FYI)

Answer 18

Severity of the symptoms
Extent of the disease
Desire for future fertility
Age of the patient
Threat to GI or urinary tract

Question 19

What is the 1st line tx for endometriosis?

Answer 19

NSAIDS
OCP’s
Progestins (iMedroxyprogesterone acetate—> DEPO)

Question 20

If 1st line tx fails what may you use next?

Answer 20

Laparoscopy (diagnose and treat the disease)

Question 21

What is considered 2nd line tx for endometriosis

Answer 21

Mirena IDU

GnRH agonist (creates a constant stream of GnRH, disrupts the pulsitile effect of GnRH)

High dose progestin (suppress gonadotropin relase)

Danazol (androgenic derivative that suppresses LS and FSH)

Question 22

Endometriomas > ___cm in diameter should be removed surgically

Answer 22

> 3cm

Question 23

what is the most definitive tx for endometriosis?

Answer 23

Hysterectomy

**Removal of ovaries has been traditional (now only take them if >40 y.o.)

Question 24

T/F: Staging of endometriosis is clearly associated with frequency and severity of pain sxs

Answer 24

F: Staging of endometriosis is NOT clearly associated with frequency and severity of pain sxs

Question 25

you can reduce the risk for endometriosis by minimizing _____ and suppression of _____ can

Answer 25

menstrual flow

ovarian cycling