Endometriosis depth - BMJ Flashcards
What are key symptoms that suggest a diagnosis of endometriosis?
Chronic pelvic pain, dysmenorrhea that becomes more severe and acyclic, painful intercourse (dyspareunia), and sub-fertility.
What might be found during a pelvic examination in a patient with endometriosis?
Uterosacral ligament nodularity, fixed retroverted uterus, visible endometriotic lesions on the vagina or cervix, and possible masses suggestive of endometriomas.
What are the primary diagnostic tools used to confirm endometriosis?
Transvaginal ultrasound for ovarian endometriomas and deep infiltrating endometriosis, MRI for complex cases, and diagnostic laparoscopy as the gold standard.
What are first-line treatments for managing endometriosis?
NSAIDs for pain management and hormonal treatments like oral contraceptives and progestogens to suppress endometrial growth.
What surgical options are available for the treatment of endometriosis?
Laparoscopic excision or ablation of lesions, ovarian cystectomy, and, in severe cases, hysterectomy may be considered.
How does endometriosis management change when fertility preservation is a priority?
Surgical treatments like laparoscopic excision are preferred; medical treatments should be considered carefully to avoid impacting fertility.
What is the pathophysiology underlying endometriosis?
Retrograde menstruation, immune system dysregulation, and the presence of endometrial-like cells outside the uterus lead to inflammatory responses and lesion formation. Endometriosis involves inflammatory processes with prostaglandins and cytokines, and ectopic endometrial tissues reacting to hormonal cycles.
What factors affect the prognosis of endometriosis?
Disease extent at diagnosis, effectiveness of initial treatment, and patient’s age and desire for fertility. Recurrence rates are variable depending on treatment modalities used.
What are the benefits and risks of endometriosis treatments?
Benefits include symptom relief and improved fertility. Risks include side effects like bone density loss from GnRH analogues and surgical complications.
How does histopathology help in diagnosing endometriosis?
Histopathology confirms the presence of endometrial tissues outside the uterus, aiding in diagnosis.
