Endometriosis and Adenomyosis -Gambone Flashcards
What is Endometriosis? How is it diagnosed?
the presence of ectopic endodermal glands AND stroma
*histologic diagnosis
What is incidence? What is prevalence?
Incidence is number of new cases per unit of time, usually per year
Prevalence is the total number of people who have the disorder at any given time
What is the typical pt diagnosed with endometriosis?
30s, nulliparous and infertile
What is the retrograde menstruation theory of Sampson?
when you menstruate, some blood goes retrograde into the pelvic cavity
with genetic predisposition where macrophages cannot destroy these cells as well and uninterrupted menstruations, more likely to get endometrial cells where they don’t belong
likely pathogenesis
What do the different endometriosis lesions look like? Which type of lesions are responsible for the pain associated with endometriosis?
inactive: gray or bluish and represent “tattooing” of old disease
active: red and blood filled. contain the most prostaglandins
active lesions are responsible for pain (b/c most PGs)
What is an endometrioma of the ovary? What does it look like? Will it respond to medical therapy?
Ovarian cysts filled with thick, chocolate-colored fluid
represents aged, hemolyzed blood and desquamated endometrium
benign process but can cause a lot of inflammation, pain and adhesions if ruptured
> 3 cm will NOT respond to medical therapy –> need to be drained or removed
What is necessary for a diagnosis of ovarian endometrioma?
2 of the 4:
- endometrial epithelium
- endometrial glands
- endometrial stroma
- hemosiderin-laden macrophages
What are the signs and symptoms of endometriosis?
dysmenorrhea, dyspareunia (pain with sex), dyschezia (pain with defecating)
What is the mechanism behind pain in early endometriosis? Late endometriosis?
early: cyclic pain that starts 1-2 days before menses and is related to menstrual swelling
late: non-cyclic pain mediated by prostaglandins and cytokines
Is there a correlation between the stage of endometriosis (I–> IV) and the frequency and severity of pain?
NO!
What has to be ruled out when considering a diagnosis of endometriosis?
ectopic pregnancy*
What does endometriosis generally feel like on a pelvic exam? What is needed for a definitive diagnosis?
firm, tender nodule or “barb” felt of the uterosacral ligaments
laparoscopy is definitive
What is the most effective surgical management of endometriosis? What is the recurrence rate?
TAH-BSO with destruction of all peritoneal implants (total hysterectomy, bilateral salpingo ovarectomy)
appendectomy is recommended
recurrence rate is still 20%
When should you perform surgery on a pt with endometriosis? What is the concern with this procedure?
large endometriomas (>3 cm) should be removed
causes a decrease in the number of ovarial follicles –> be careful if still want to get pregnant
can give medical agents before surgery (GnRH agonist)
What are the medical treatments for endometriosis?
first line:
NSAIDS and OCs
second line:
Danazol (high SE–> adronergic), high-dose progestins and GnRH analogues
