Endometriosis and Adenomyosis Flashcards
what is endometeriosis
benign BUT progressive condition where endometrial-like glands and stroma are present outside the uterus
is endometriosis considered to be ectopic
yes; the clumps of tissue respond to hormones just as if they were in the uterus
what is the cardinal feature of endometriosis
hemosiderin-laden macrophages
what are the 3 components of endometriosis
endometrial epithelium, glands, and stroma
what specific structures are endometriosis located in
on the peritoneum or surface of pelvic structres (ovaries, fallopina, outside of bowel, outside of bladder)
what are the three implant types
pigmented
non-pigmented
cryptic
how does a pigmented implant look like
anything that looks like blood (kind of like a volcano)
how does a non-pigmented implant look like
no blood hue so considered “inactive” endometriosis
BUT we treat it the same ways as a pigmented
how does a cryptic implant look like
lots of inflammation around it that it develops into a hole and endometriosis is inside there
what is an endometrioma
cyst that forms BENEATH the surface of ovary and is filled with CHOCOLATE-colored fluid
what are present in the cyst wall
endometrial glands and stroma
where are endometrioma found
broad ligament, fallopian tube, or pelvic sidewall
how does endometrioma attach to other sections
it ruptures and causes a rapid spread
is endometrioma staged
yup
what is the classic triad of symptoms for endometriosis
Dysmenorrhea
Dyspareunia
Dyschezia
what is endometrioma clinical presentation
- cyclic pelvic pain in association with menses - in the earlier stages
(ie. triad, name them, GO!) - infertility
- when endometrioma is treated, infertility decreases
what is the etiology of endometriosis
Unknown
endometriosis is associated iwth genital outflow tract obstruction in…
adolescents
Incidence of endometriosis:
10% ?
40%
80%
10%- general pop
40% - infertile females
80% - chronic pelvic pain (PID)
where is endometriosis most commonly found
surface of ovaries 60%
what other weird places are endometriosis found
- laparotomy scars, umbilicus, pelvic lymph nodes (30 %), nose.
- lung and brain (during autopsies)
what are the 5 theories of endometriosis development
- retrograde menstruation
- mullerian (coelomis) metaplsia
- lymphatic and vascular transport
- immunologic defects
- genetic predisposition
what is retrograde menstruation
endometrial implants are shed throught the tubes at menstraution and implant and grow in the pelvis
retrograde menstruation is supported by…
observing retrograde flow of blood at laparoscopy
retrograde menstr: increased likilihood in … or … in who age group
cervical stenosis or vaginal atresia/imperforate hymen in adolescents
what is the theory behind lymphatic and vascular transport
endometrial tissue is taken up into the lymphamtics and vascular systems draining the uterus and transported to various sites where they grow
-explaining how ppl get it metasized
what is the theory behind immunologic defect
specific defect in local CMI in women with endometriosis
- higher titers of Ab to endometrial antigens in these women
i dont know how to explain mullerian metaplasia
sorry
what are the signs for endometriosis
- tender, fixed adnexal mass
- retroverted uterus
- sharp, firm, tender, “barb” felt on utero-sacral ligament
what is the classic way to diagnose endometriosis
- laparoscopy** (which is done after BCP and NSAIDs dont work)
- histologic - hemosiderin-laden macrophages
is U/S reliable for endometriosis
nope
when is an U/S used
endometrioma
CA-125 is or isnt specific diganostic tool
NOT specific
-too many to list
what do you find in a laparoscopic finding
isolated implants, adnexal mass, cul-de-sac oblieration
what 2 things can an adnexal mass mean
- ovarian endometrioma
2. encapsulated adhesions
what is cul-de-sac oblieration
entire pelvis is rock solid - aggressive adnexal mass
how important is staging for endometriosis
VERY IMPORTANT!
-quanitify the severity thus guiding your treatment
the stage of endometriosis has a reverse correlation to … and a direct correlation to …
pain; infertility
- pain is more linked to the depth of infiltration then the severity of the disease
what are the 4 stages of endometriosis
Stage 1 Minimal disease 1-5 points
Stage 2 Mild disease 6-15 points
Stage 3 Moderate 16-40 points
Stage 4 Severe >40 points
what do the pts based on
related to type, location and amount of endometriosis present
what does treatment of endometriosis depend on
severity
age
future fertility
threat of impingement on surrounding organs
what are the 2 types of treatment available for endomet
surgical and medication
what are the 3 surgical types
resection
ablation -killling the tissue
hysterectomy - remove BOTH ovaries and tubes
what types of medcations are available
NSAIDS- continuous or episodic BCP - cyclic or continuous Prgestin - continuous Danocrine - continuous GnRH agonists
how long do you prescribe GnRH agonist for
6 months
medical treatment is effective for
pelvic pain
medical treatment is ineffective for
fertility
is endometriosis benign
yes BUT it can spread like cancer
what is adenomyosis
extension of endometrial glands and stroma into the uterine MUSCLES
adenomyosis aka …
endometriosis interna
at what age is adenomyosis mostly found
women in their 40’s
T/F pts with adenomyosis has associated endometriosis
True but only 15%
what is adenomyosis gross appearance
diffuse enlargement, thickened myometrium w/ glandular irregularties
-swiss cheese on u/s
how does adenomyosis look histologically
superficial extension of endometrium in the myometrium
what is the most common type of adenomyosis
diffuse, non-encapsulated
what is it called when its local, encapsulated
adenomyoma
-project into the uterine cavity
what can adenomyoma be mistaken for
submucous fibroid
what are the signs for adenomyosis
- uterus is SYMMETRICALLY enlarged
- soft, boggy (mostly) BUT it can be firm and asymmetrical
(-which is why it can get mistaken for fibroid uterus)
what are the symptoms for adenomyosis
menorrhagia, dysmenorrhea
BUT many are asymto
why menorrhgia for adeno
- Increased surface area of endometrial cavity
- Can interfere with the normal contractility of the uterine muscle leading to increased bleeding
why dymenorrhea for adeno
- The muscles start to clamp down
- More likely when glandular invasion exceeds 80% or more of the endometrium
how do you diagnose adenomyosis
- s/s,
- definitive ONLY after hysterectomy (histological)
- excessive bleeding that didnt repsond to hormonal treatments*
how do you treat adenomyosis
need to rule out endometrial cancer by doing a D&C or biopsy
BUT ONLY TREATMENT IS hysterectomy!
