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Published byMaximillian Dalton Modified over 7 years ago
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Endometriosis *Is the presence of endometrial glands and stroma outside the endometrial cavity and walls *Deposits proliferate during the menstrual cycle, brake down & bleed with menstruation, causing local inflammatory reaction *Fibrosis & distortion of the tissue affected with dense scarring. Benign
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Endometriosis Hormone dependant Responds to estrogen
Regress after menopause, oopherectomy and during pregnancy
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Endometriosis Etiology
Unknown Theories Retrograde menstruation Coelomic epithelium transformation Lymphatic and vascular spread Genetic and immunologic factors
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Endometriosis Epidemiology
Disease of reproductive age group Affect 5-15% of women Diagnosed in 20-30% of women investigated for infertility More in women whose first degree relative have the disease Often diagnosed incidentally
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Endometriosis High social class women in their thirties and infertile!
Can be diagnosed in any type of women and all age groups
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Endometriosis Sites More commonly in the dependant part of the pelvis
Ovaries 2/3 of women Broad ligament Peritoneal surface of Cul-de-sac and uterosacral ligaments Rectovaginal septum Rectosigmoid colon Distant and laparatomy scars
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Endometriosis Pathology
Gross Hemorrhagic vesicle Free Papule and later nodule Enclosed White nodules or flattened fibrotic scar Healed Ovarian endometrioma is an enclosed hemorrhagic cyst of variable sizes
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Endometriosis Histopathology
Active endometrial glands and stroma Blood filled cystic lesions Fibrosis with glands only no stroma Adhesion formation
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Endometriosis Symptoms
According to site No relation between extent of the disease and severity of the symptoms Often discovered incidentally
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Endometriosis Symptoms
Female reproductive tract Dysmenorrhea Lower abdominal and pelvic pain Dyspareunia Accident to endometriotic cyst Low back pain Infertility Menstrual irregularity !
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Endometriosis Symptoms
Urinary tract Cyclical haematuria / dysuria Ureteric obstruction Gastrointestinal tract Dyschezia Cyclical rectal bleeding Intestinal obstruction
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Endometriosis Symptoms
Surgical scar and umbilicus Cyclical pain and bleeding Lungs Cyclical haemoptysis Haemopneumothorax`
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Endometriosis Clinical findings
Often Negative Suggested by Thickening and nodularity of uterosacral L. Tenderness in POD Ovarian mass/ masses Fixed retroverted uterus Tender nodule in the cervix, umbilicus or scar
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Endometriosis Investigations
Ca 125 often elevated Ultrasonography for ovarian cyst MRI
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Endometriosis DD All causes of chronic pelvic pain Acute conditions
Ectopic pregnancy Acute PID Complicated ovarian cyst Acute appendicitis and other surgical emergencies
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Endometriosis Diagnosis
Direct visualization of the lesion Laparascopy Laparatomy Histopathology to confirm the diagnosis
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Endometriosis Treatment
Non-steroidal anti-inflammatory agents Induce Amenorrhea: Pseudopregnancy Induce Amenorrhea: Pseudomenopause Surgery
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Endometriosis Treatment
Pseudo-pregnancy Combined OCP continuous Cyclical ?? of limited value Side effect Synthetic progestogens: Medroxyprogesterone acetate and dydrogesterone high doses continuous Side effect Levonorgestrel-releasing system reduces dysmenorrhoea and regress POD implants
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Endometriosis Treatment
Pseudomenopause Danazol androgen derivative 6-9 months Gestrinone, androgen derivative Both drugs have androgenic side effects GnRH agonists Menopausal symptoms, Osteoporosis ? Add back therapy
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Endometriosis Treatment
Surgery Conservative Young patient, women seeking pregnancy, cysts >3cm in diameter Surgical excision, Laser Radical/Definitive surgery Hysterectomy and BSO
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Endometriosis Treatment
Certainty of diagnosis Severity of symptoms Extent of the disease Fertility Age Damage to other organs
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Endometriosis and Infertility
Ovarian function Tubal function Coital function Sperm function Early pregnancy failure
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Adenomyosis Endometrial glands deep within the myometrium
Unknown etiology Different type of patient and presentation
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Adenomyosis Multiparous women Late thirties or early forties
Sever spasmodic dysmenorrhea Menorrhagia Bulky uterus Diagnosis often histological on examination of hysterectomy sample
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Adenomyosis Treatment
Induce amenorrhea Symptoms recur once treatment is stopped Hysterectomy is the only definitive treatment
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