Endometriosis Flashcards
___ is a benign condition in which endometrial glands and stroma are present outside the uterine cavity and walls
Endometriosis
It is Estimated that __-__% of women have some degree of endometriosis. It is found in ___ or more women with chronic pelvic pain.
5-15%
1/3
The typical patient is in her ___(age), ____, and ___, but can present throughout the reproductive years.
30s
Nulliparous
infertile
____ is the teory that endometrial fragments transported through fallopian tubes at time of menstruation and implant at intraabdominal sites
Retrograde menstruation (Sampson’s Theory)
____ is the theory that there is a Metaplastic transformation of pelvic peritoneum
Müllerian (Coelomic) metapalasia theory (Meyer’s Theory)
____ is the theory that substances released/shed from endometrium induce formation of endometriosis
Lymphatic spread (Halban’s Theory)
where does endometriosis occur in the body?
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
how can you get rid of endometriosis surgically?
laparoscopy
what is the classic triad for endometriosis?
dysmenorrhea
dyspareunia
dyschezia
what other Sx may a woman with endometriosis experience?
Infertility
secondary dysmenorrhea
Premenstrual and postmenstrual spotting
What PE findings may you find in a woman with Endometriosis ?
Cul-de-sac nodularity and tenderness
Uterosacral nodularity
Tender, fixed adnexal mass
Uterus fixed and retroverted
What are a few DDx of endometriosis (FYI)
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)
___ is a sharp, firm, exquisitely tender “barb” (barbed wire) in uterosacral ligaments
Sine qua non
What may you see on U/S in a woman with Endometriosis
Ultrasound – adnexal mass of complex echogenicity, internal echoes consistent with blood
What is used for definitive dx of endometriosis?
Direct visualization (via laparotomy or laparoscopy)
Histologic and gross findings consistent with endometrial tissue
____ can be used to dx endometriosis but is sucks… is isn’t specific or sensitive
Ca125
A ____ occurs when endometrial tissue is in the ovaries.
endometrial cysts
What are considerations you may include in the management of endometriosis? (FYI)
Severity of the symptoms Extent of the disease Desire for future fertility Age of the patient Threat to GI or urinary tract
What is the 1st line tx for endometriosis?
NSAIDS
OCP’s
Progestins (iMedroxyprogesterone acetate—> DEPO)
If 1st line tx fails what may you use next?
Laparoscopy (diagnose and treat the disease)
What is considered 2nd line tx for endometriosis
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)
Endometriomas > ___cm in diameter should be removed surgically
> 3cm
what is the most definitive tx for endometriosis?
Hysterectomy
**Removal of ovaries has been traditional (now only take them if >40 y.o.)
T/F: Staging of endometriosis is clearly associated with frequency and severity of pain sxs
F: Staging of endometriosis is NOT clearly associated with frequency and severity of pain sxs
