Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Endometriosis and Adenomyosis > Flashcards

Endometriosis and Adenomyosis Flashcards

1
Q

What is endometriosis?

A

Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature. Tissue still responds to cyclical hormones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is chronic pelvic pain defined as?

A

Constant or intermittent pain in the lower abdomen or pelvis of a woman of at least 6 months duration and not associated with pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is thought to be the cause of endometriosis?

A

Not really known, but theories exist:

  • Retrograde menstruation?
  • Metaplasia of mesothelial cells?
  • Impaired immunity - failure to destroy retrograde menstrual cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are causes of chronic pelvic pain?

A
  • Endometriosis
  • Adenomyosis
  • Scar tissue and adhesions
  • IBS
  • Interstitial cystitis
  • Chronic PID
  • MSK - nerve entrapment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are common sites for endometriotic deposits to occur?

A

Ovaries

Pouch of douglas

Pelvic peritoneum

Uterosacral ligamnets

Bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are common symptoms of endometriosis

A
  • Severe dysmenorrhoea
    • ​+ premenstrual pain
  • Chronic pelvic pain
  • Deep dyspareunia (due to uterosacral ligaments)
  • Ovulation pain (pre menstrual pain)
  • Cyclical/perimenstrual symptoms
  • Chronic fatigue
  • Dyschezia
  • Cyclical rectal bleeding
  • Infertility/subfertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why can pain in endometriosis be cyclical responding to the menstrual cycle?

A

Endometrial tissue responding to hormonal changes in mesntrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why can pain be constant in endometriosis?

A

Due to adhesions that form due to chronic inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is dyschezia?

A

Difficulty defecating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What might you find on examination of someone with endometriosis?

A
  • Thickened pelvic ligaments
  • Blue nodules in posterior fornix
  • Fixed, immobile, retroverted uterus
  • Ovarian enlargement/adnexal masses
  • Adnexal tenderness/,ass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the classic sign seen in endometriosis on examination?

A

Fixed, retroverted uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are thought to be the mechanisms behind infertility in endometriosis?

A
  • Dyspareunia - reduced frequency of sex
  • Inactivation and phagocytosis of sperm by antibodies and macrophages
  • Fibrial damage, reduced tubal motility
  • Anovulation
  • LUF syndrome
  • Luteolysis caused by prostaglandin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigations would you consider doing in someone with suspected endometriosis?

A
  • Bloods - FBC (if menorrhagia)
  • Imaging - TVUSS, MRI Pelvis, Rectal USS
  • Other - Diagnostic laparoscopy GOLD STANDARD (1st line if significant symptoms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What might you see on TVUSS?

A
  • Ovarian endometrioma (homogeneous, low-level echoes)
  • Deep pelvic endometriosis such as uterosacral ligament involvement (hypoechoic linear thickening)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What might you see on diagnostic laparoscopy in someone with endometriosis?

A

Direct visualisation with biopsy-confirmed endometrial glands or stroma outside of uterine cavity - Chocolate cysts (can be >10cm in size), retroverted uterus, endometrioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How would you manage someone with endometriosis?

A

Determine if main problem is pain or subfertility, or both:

  • Medical -
    • COCP,
    • Oral progestogens,
    • Mirena IUS,
    • GNRH analogues eg Leuprorelin (induces a pseduomenopause due to low oestrogen levels)
    • HRT
      ​
  • Surgical
    • Excision of deposits from peritoneum/ovary
    • Diathermy / laser ablation of deposits,
    • Total ysterectomy AND salpingo-oophorectomy
17
Q

How does COCP help in endometriosis?

A

Suppress the hypothalamic-pituitary-ovarian axis and subsequent oestrogen/progesterone secretion, thereby inducing atrophy of ectopic implants.

18
Q

How do NSAIDS help in endometriosis?

A

There appears to be positive feedback between prostaglandin (PG) synthesis, aromatase activity, and oestrogen production, mediated by abnormally high COX-2 activity in the setting of endometriosis. Superficial, often atypical implants are active PG producer

19
Q

How do GnRH analogues help in endometriosis?

A

Rapidly induce a hypo-oestrogenic state by down-regulating the hypothalamic-pituitary-ovarian axis. An initial rise in gonadotrophins and oestrogen (flare) occurs after administration, but chronic exposure provides the desired response.

20
Q

How do oral progestogens help in endometriosis?

A

Progesterone induces development of the decidua and eventual atrophy of implants. Certain formulations also suppress the hypothalamic-pituitary-ovarian axis, resulting in decreased steroid hormone stimulation of implants.

21
Q

When is surgical management indicated in endometriosis?

A

When medical therapy has failed

22
Q

What are examples of GnRH analogues?

A

Leuprorelin

23
Q

How long should GnRH analogues be used for?

A

< 6 months - Prolonged exposure (>6 months) can lead to an irreversible decrease in BMD

24
Q

If someone had endometriosis and wanted a child but was suffering from infertility, what could you do to help them?

A
  • Controlled ovarian hyperstimulation - clomifene, aromatase inhibitors, FSH, GnRH analogues
  • IVF
  • Therapeutic laparoscopy
25
Q

What are the main complications of endometriosis?

A

Adhesion formation

26
Q

What age group does endometriosis tend to affect?

A

Women of reproductive age

27
Q

What is adenomyosis?

A

This is the presence of endometrial tissue deep within the myometrium - most common in multiparous women towards end of reproductive years

28
Q

What are features of adenomyosis?

A
  • Heavy painful periods
  • Abdominal pressure/bloating
  • Bulky, tender uterus - enlarged, boggy, tender uterus
29
Q

How would you investigate for adenomyosis?

A
  • Imaging - Pelvic USS
  • Other - laparoscopy, Hysteroscopy +/- biopsy (Histology of uterine muscle - obvs not endometrial biopsy)
30
Q

What might help in the management of adenomyosis?

A
  • NSAIDs
  • Mirena IUS
  • Uterine artery embolisation
  • Endometrial ablation

Often failed medical management/ablation and diagnosed on pathology of hysterectomy

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions