Endometriosis and Adenomyosis Flashcards
what is the diagnositic test of of choice for endometriosis?
laparoscopy
what does the tissue biospy of endometriosis show? (if anything, focus on the major two findings)
endometrial glands, hemosiderin-laden macrophages, and stroma (remember, endometrial glands and stroma should be found in the uterus and NOT outside)
what are the two most common sites of endometriosis?
ovary and pouch of douglas
what is the age range in which endometriosis is most common?
20s and 30s
t or f: endometriosis is common in multiparous women
FALSE; common in nulliparous women (THINK about this .. focus on estrogen relationship)
t or f: endometriosis is the most likely cause of infertility in women over the age of 30 without a hx of PID
TRUE
t or f: pelvic lymph nodes are a common site of endometriosis
TRUE
t or f: severity of symptoms correlates with quantity of ectopic endometrial tissue
FALSE: instead, it may correlate with the DEPTH of the ectopic tissue
t or f: the prolonged bleeding of endometriosis can cause scarring (adhesions)
TRUE (this is what may result in the chronic pelvic pain; the adhesions also with contribute to infertility)
t or f: with a positive family hx a pt may develop endometriosis at an earlier age than the family member
TRUE
what is the official term for pain with defecation?
dyschezia (how is this related to the deck? it may point towards implants on rectosigmoid
what is the most popular theory behind endometriosis?
retrograde menstruation
explain the theory of retrograde menstruation
endometrial tissue fragments are retrogradely transportred through the fallopian tubes and implant there or intra-abdominally w/ prediliction for ovaries
which theory of endometriosis explains its location outside of the pelvis?
vascular/lymphatic transport
t or f: endometrial glands and stroma can be implanted during clinician procedures (ex: c-section)
TRUE - called iatrogenic dissemination
what is the typical endometriosis uterus?
tender FIXED RETROflexed (with scarring POSTERIOR to uterus)
what is characteristic of the uterosacral ligaments with endometriosis?
nodular in nature or thickening and induration
women with endometriosis can develop a type of ovarian cyst called what?
endometrioma/chocolate cyst (these are tender, palpable, and freely mobile mplanted masses that occurs within the ovarian capsule and bleed)
t or f: endometrial tissue must be biopsied for definitive diagnosis of endometriosis
TRUE (remember, the gold std for diagnosis is lapratomy with biopsy proven hemodierin laden macrophages)
an endometrial implant red in color signifies what in terms of duration of time for the implant?
red - new
an endometrial implant brown in color signifies what in terms of duration of time for the implant?
brown - older
what color are the oldest implants? (which indicates scar tissue)
white
what is the maximum amount of time to be on estrogen suppression for treatment of endometriosis?
six months
t or f: often there is improvement with pregnancy with endometriosis symptoms
TRUE - secondary to tempory cessation of menses
t or f: the primary goal with medical treatment of endometriosis is to induce amenorrhea
TRUE
GnRH agonists (such as leuprolide) suppresses what hormone, inducing what state?
FSH; pseudomenopause - (remember, these should only be used for six months total as they are associated with osteoporosis
what is the definitive treatment of endometriosis?
TAH/BSO
englarged, globular, “boggy” uterus on physical exam is indicative of what?
adenomyosis
what is the major difference btwn endometriosis and adenomyosis?
ectopic endometrial tissue does NOT function like normal uterine tissue and is NONresponsive to hormones in the normal manner.
what is the definition of adenomyosis?
ectopic endometrial glands and strom found within the myometrium leading to SYMMETRICALLY ENLARGED AND GLOBULAR UTERUS
how can you differentiate btw adenomyosis and fibroids?
TVUS
t or f: adenomyosis is most common in nulliparous women
FALSE - rare!!!
t or f: adenomyosis pain is commonly cyclical
FALSE - commonly NON-cyclical
t or f: adenomyosis is typically associated with an assymetrically enlarged uterus
FALSE - symmetrical!!
what is the definitive treatment of adenomyosis?
hysterectomy
t or f: endometrial ablation will not improve adenomyosis symptoms
TRUE
what is proven medical therapy for adenomyosis?
none - no proven medical tx.
adenomyosis or endometriosis: typically found in older, multiparous women
adenomyosis
adenomyosis or endometriosis: the tissueis responsive to hormonal stimulation
endometriosis
adenomyosis or endometriosis: associated with cyclical pain
endometriosis
