Endometriosis Flashcards
What is it?
What do they form on ovaries?
What hormone is it driven by?
Endometrial tissue found outside the uterine cavity
Endometriomas or chocolate cysts - filled with brown fluid
Oestrogen so only really present in reproductive age
Where else can it also occur?
Pelvic peritoneum
Recto-vaginal pouch
Uterosacral ligament
Umbilicus
Why do you get blood in an organ or body cavity?
What could this lead to?
Why does endometriosis cause infertility? - 2 reasons
Endometrial tissue is hormone-sensitive so it bleeds during a period.
Inflammation causes the production of chemicals known as cytokines.
These cytokines can inhibit the sperm and egg cells, making fertilization more difficult.
Scarring and adhesions that occur with endometriosis can block the fallopian tubes or uterus, making it difficult for the sperm to meet the egg.
What is adenomyosis?
When endometrial cells exist and grow into the walls of the uterus.
Like endometriosis, the cells behave as they would normally act, and are affected each month with a woman’s period.
Presentation:
Pain:
- When is the pelvic pain cyclical?
- Why COULD it the pelvic pain begin to be constant?
- What could they have pain doing? - 3
- Where else may the pain be found?
Cyclical - with the menstrual cycle
Formation of adhesions from chronic inflammation
Dyspareunia - deep
Dysuria
Dyschezia - pain on defecation - may also have cyclical PR bleeding
Thigh pain
Presentation:
Menstrual and Fertility problems:
- What are the periods so painful?
- What may adenomyosis also cause in the menstrual cycle?
What is a rare lung and urine complication due to free blood?
Inflammation is due to bleeding into body cavities on top of normal period pain
Menorrhagia
Haematuria
Haermothorax
Examination:
What may be felt on abdo palpation?
What may be the position of the uterus be?
What may be felt on the uterosacral ligaments?
How would the uterus feel if the patient had adenomyosis?
Enlarged ovaries or adnexal masses
Retroverted uterus - lookup
Nodules
Large, boggy, tender uterus
Risk factors
Reproductive age
FH
Nulliparity - pregnancy makes symptoms better
Investigations:
What can a TVUS show? - 2
What surgery is used for definitive diag?
What can be done to look for more extensive disease, which wouldn’t be seen on TVUS?
Investigations for complications:
- Anaemia
- UTI
- Pregnancy
Ovarian endometriomas
Uterosacral ligament disease (nodules)
Laparoscopy + biopsy + medical photography
FBC - low Hb
Urine dip - MC+S
Beta-hCG
Management:
When conservative Rx is done?
Medical management:
- Type of analgesia used to relieve pain and why?
Hormonal Rx - to suppress ovulation and reduce dysmenorrhoea:
- What type of contraception can be used? Why is it used?
- What progestogens can be prescribed? Why are they used?
- What can be given to initiate temporary menopause for relief of symptoms?
NSAIDs - targets inflammation - Ibuprofen, mefenamic acid
Combined oral contraception - suppresses menstruation
Progesterone suppresses the lesions and stops them from growing:
- Levonogestrel IUS (Mirena)
- Desogestrel
- Norethisterone (higher, non-contraceptive dose)
- Depot
- Implant
GnRH analogue - leuprorelin IM 6 months
Management:
Surgical:
What can be done laparoscopically?
What is done if severe?
Excision of ablation of lesions via diathermy or laser
Hysteroscopy + BSO
{Ovaries need to be removed as they are the hormonal source}
Complications:
What may it cause obstruction to?
What could happen post-surgery?
What effects could it have on pregnancy?
GI
Ureters
Fallopian tubes - infertility
Adhesions
Ectopics
Miscarriages
