ENDOMETRIOSIS Flashcards
secondary CAUSES OF DYSMENORRHEA ?
- ENDOMETRIOSIS
- ADENOMYOSIS
- UTERINE FIBROID
- CHRONIC PELVIC INFECTION
- ENDOMETRIAL POLYP
What is the definition of endometriosis ?
It is inflammatory disorder charahcterized by the presence of ectopic endometrial tissue in the sites other than uterine mucosa .
Theories for the etiology of the endometroisis ?
- Sampson’t implantation theory [ Metastatic theory ]:
Retrograde of menstruation blood which contain endometrial cells pass to area other than uterus . - Meyer’s “Coelemic metaplasia “ theory : Adult cells from different sites in the body maybe induced to undergo differentiation to primitive origin before transforming into the endometrial cells .
- Vascular spread theory : the ectopic endometrial tissue can be spread through blood vessels or lymph node .
What are the most common sites for the endometriosis ?
- Ovary
- Pouch of dauglous
- Uterosacral ligament
- Rectovaginal septum
- Sigmoid colon
- Abdominal car
What are the process of the endometriosis that lead to its complications ?
- Dysmenorrhea : Normal cyclical bleeding —> Vasoconstrictor release —-> Myometrial ischemia —-> Dysmenorrhae .
- Infertility : A. Normal cyclical bleeding —-> Blood in ectopic sites —-> walls off the origin —> adhesion –> Tubal bloackage —–> Infertility
B. Blood in the pelvis ---> Increase the number of the macrophages ---> Attack the sperm and embryo ----> Infertility
- Endometrioma : Normal cyclical bleeding —> blood in ectopic sites —> walls off the organ .
What are the history that can elicit from the patient ?
- Age : 30-45 years old
- Infertility
- Outflow tract obstruction in adolecsent .
- Usually nalliparus / have had children long time prior the admission .
What are the Risk factors for endometriosis ?
- Uterine/ Gential tract outflow abnormality .
- Nulliparity & delayed child bearing
- Regular & short cycle interval
- Longer duration & heavy menstruation
- Exposure to toxic envirnometal
- Family history
What are the symptoms for endometriosis ?
- Some of them are Asymromatic .
- Dysmenorrhea
- Menorrhage
- Infertility
- Dysparunia
- Chronic pelvic pain
- Deep dyspareunia
- Abdominal pain
- premenstrual spotting
What are the findings that we can get in abdominal examination ?
Mass may be felt arising from the pelvis .
The mass is : 1. Tender 2.Non-mobile
What are the findings that we can find in pelvic examination
- Sometimes no finding.
- Pelvic tenderness with unilateral/bilateral adnexal mass & varying size
- Nodular feel of uteroscaral ligament & at pouch of daougles .
What are the investigations that we can do for endometriosis ?
- No Lab test that can help in diagnosis .
- Serum CA125 [ A. Useful as an indicator of frequency after treatment .
B. Normal level doesn not exclude out the endometriosis ]
3.Imaging [ A. Trans-vaginal ultrasound can detect endometriosis involve ovaries and rectal endometriosis.
B. USG , MRI , CT ---> can only detect adnexal mass / pelvic mass . ]
- Laparoscopy/ laparotomy : [ Visualization of endometrial deposits within the pelvis ]
What are the Complications of the Endometriosis :
- Infertility
- Chronic Pelvic Pain
- Genitourinary tract Involvement
- Lower GIT involvement
- Rapture of Cyst —–> Leading to acute abdominal pain
- Malignant change - It’s rare but usually happen in ovary .
- Risk of developing malignancies - Ovarian CA , Breast CA , Non-Hodgkin lymphoma
Overall Management for endometriosis ?
- Non-Pharmacological treatment : Avoid delay in child bearing.
2.Medical / Pharmacological treatment : A. NSAID
B. Hormone therapy [ Progesterone , GnRH agonist , contraception pills , Danazol , Gestrinone , Levonogestrel ]
- Surgical : A. Conservative surgery
B. Radical surgery
The aim of treatment :
To relive the pain , Restore the functional anatomy and Improve the infertility .
