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Reproductive Exam 2 > Endometriosis and Adenomyosis > Flashcards

Endometriosis and Adenomyosis Flashcards

1
Q

what is endometeriosis

A

benign BUT progressive condition where endometrial-like glands and stroma are present outside the uterus

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2
Q

is endometriosis considered to be ectopic

A

yes; the clumps of tissue respond to hormones just as if they were in the uterus

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3
Q

what is the cardinal feature of endometriosis

A

hemosiderin-laden macrophages

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4
Q

what are the 3 components of endometriosis

A

endometrial epithelium, glands, and stroma

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5
Q

what specific structures are endometriosis located in

A

on the peritoneum or surface of pelvic structres (ovaries, fallopina, outside of bowel, outside of bladder)

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6
Q

what are the three implant types

A

pigmented
non-pigmented
cryptic

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7
Q

how does a pigmented implant look like

A

anything that looks like blood (kind of like a volcano)

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8
Q

how does a non-pigmented implant look like

A

no blood hue so considered “inactive” endometriosis

BUT we treat it the same ways as a pigmented

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9
Q

how does a cryptic implant look like

A

lots of inflammation around it that it develops into a hole and endometriosis is inside there

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10
Q

what is an endometrioma

A

cyst that forms BENEATH the surface of ovary and is filled with CHOCOLATE-colored fluid

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11
Q

what are present in the cyst wall

A

endometrial glands and stroma

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12
Q

where are endometrioma found

A

broad ligament, fallopian tube, or pelvic sidewall

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13
Q

how does endometrioma attach to other sections

A

it ruptures and causes a rapid spread

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14
Q

is endometrioma staged

A

yup

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15
Q

what is the classic triad of symptoms for endometriosis

A

Dysmenorrhea
Dyspareunia
Dyschezia

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16
Q

what is endometrioma clinical presentation

A
  1. cyclic pelvic pain in association with menses - in the earlier stages
    (ie. triad, name them, GO!)
  2. infertility
    - when endometrioma is treated, infertility decreases
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17
Q

what is the etiology of endometriosis

A

Unknown

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18
Q

endometriosis is associated iwth genital outflow tract obstruction in…

A

adolescents

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19
Q

Incidence of endometriosis:
10% ?
40%
80%

A

10%- general pop
40% - infertile females
80% - chronic pelvic pain (PID)

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20
Q

where is endometriosis most commonly found

A

surface of ovaries 60%

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21
Q

what other weird places are endometriosis found

A
  • laparotomy scars, umbilicus, pelvic lymph nodes (30 %), nose.
  • lung and brain (during autopsies)
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22
Q

what are the 5 theories of endometriosis development

A
  1. retrograde menstruation
  2. mullerian (coelomis) metaplsia
  3. lymphatic and vascular transport
  4. immunologic defects
  5. genetic predisposition
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23
Q

what is retrograde menstruation

A

endometrial implants are shed throught the tubes at menstraution and implant and grow in the pelvis

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24
Q

retrograde menstruation is supported by…

A

observing retrograde flow of blood at laparoscopy

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25
Q

retrograde menstr: increased likilihood in … or … in who age group

A

cervical stenosis or vaginal atresia/imperforate hymen in adolescents

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26
Q

what is the theory behind lymphatic and vascular transport

A

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

27
Q

what is the theory behind immunologic defect

A

specific defect in local CMI in women with endometriosis

- higher titers of Ab to endometrial antigens in these women

28
Q

i dont know how to explain mullerian metaplasia

A

sorry

29
Q

what are the signs for endometriosis

A
  1. tender, fixed adnexal mass
  2. retroverted uterus
  3. sharp, firm, tender, “barb” felt on utero-sacral ligament
30
Q

what is the classic way to diagnose endometriosis

A
  • laparoscopy** (which is done after BCP and NSAIDs dont work)
  • histologic - hemosiderin-laden macrophages
31
Q

is U/S reliable for endometriosis

A

nope

32
Q

when is an U/S used

A

endometrioma

33
Q

CA-125 is or isnt specific diganostic tool

A

NOT specific

-too many to list

34
Q

what do you find in a laparoscopic finding

A

isolated implants, adnexal mass, cul-de-sac oblieration

35
Q

what 2 things can an adnexal mass mean

A
  1. ovarian endometrioma

2. encapsulated adhesions

36
Q

what is cul-de-sac oblieration

A

entire pelvis is rock solid - aggressive adnexal mass

37
Q

how important is staging for endometriosis

A

VERY IMPORTANT!

-quanitify the severity thus guiding your treatment

38
Q

the stage of endometriosis has a reverse correlation to … and a direct correlation to …

A

pain; infertility

- pain is more linked to the depth of infiltration then the severity of the disease

39
Q

what are the 4 stages of endometriosis

A

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

40
Q

what do the pts based on

A

related to type, location and amount of endometriosis present

41
Q

what does treatment of endometriosis depend on

A

severity
age
future fertility
threat of impingement on surrounding organs

42
Q

what are the 2 types of treatment available for endomet

A

surgical and medication

43
Q

what are the 3 surgical types

A

resection
ablation -killling the tissue
hysterectomy - remove BOTH ovaries and tubes

44
Q

what types of medcations are available

A 
NSAIDS- continuous or episodic
BCP - cyclic or continuous
Prgestin - continuous
Danocrine - continuous
GnRH agonists
45
Q

how long do you prescribe GnRH agonist for

A

6 months

46
Q

medical treatment is effective for

A

pelvic pain

47
Q

medical treatment is ineffective for

A

fertility

48
Q

is endometriosis benign

A

yes BUT it can spread like cancer

49
Q

what is adenomyosis

A

extension of endometrial glands and stroma into the uterine MUSCLES

50
Q

adenomyosis aka …

A

endometriosis interna

51
Q

at what age is adenomyosis mostly found

A

women in their 40’s

52
Q

T/F pts with adenomyosis has associated endometriosis

A

True but only 15%

53
Q

what is adenomyosis gross appearance

A

diffuse enlargement, thickened myometrium w/ glandular irregularties
-swiss cheese on u/s

54
Q

how does adenomyosis look histologically

A

superficial extension of endometrium in the myometrium

55
Q

what is the most common type of adenomyosis

A

diffuse, non-encapsulated

56
Q

what is it called when its local, encapsulated

A

adenomyoma

-project into the uterine cavity

57
Q

what can adenomyoma be mistaken for

A

submucous fibroid

58
Q

what are the signs for adenomyosis

A
  1. uterus is SYMMETRICALLY enlarged
  2. soft, boggy (mostly) BUT it can be firm and asymmetrical
    (-which is why it can get mistaken for fibroid uterus)
59
Q

what are the symptoms for adenomyosis

A

menorrhagia, dysmenorrhea

BUT many are asymto

60
Q

why menorrhgia for adeno

A
  • Increased surface area of endometrial cavity

- Can interfere with the normal contractility of the uterine muscle leading to increased bleeding

61
Q

why dymenorrhea for adeno

A
  • The muscles start to clamp down

- More likely when glandular invasion exceeds 80% or more of the endometrium

62
Q

how do you diagnose adenomyosis

A
  • s/s,
  • definitive ONLY after hysterectomy (histological)
  • excessive bleeding that didnt repsond to hormonal treatments*
63
Q

how do you treat adenomyosis

A

need to rule out endometrial cancer by doing a D&C or biopsy
BUT ONLY TREATMENT IS hysterectomy!

Reproductive Exam 2 (5 decks)

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