Endometriosis Flashcards Preview

B - Gynaecology > Endometriosis > Flashcards

Flashcards in Endometriosis Deck (59)
1

What is endometriosis?

A chronic oestrogen dependant condition characterised by the growth of endometrial tissue in sites other than the uterine cavity

2

What sites are most commonly involved in endometriosis?

- Pelvic cavity
- Uterosacral ligaments
- Pouch of Douglas
- Rectosigmoid colon
- Bladder or distal ureter

3

What other sites are more rarely involved in endometriosis?

- Umbilicus
- Scar sites
- Pleura
- Pericardium
- CNS

4

What is the prevalence of endometriosis?

Estimated to effect 10-15% of women of reproductive age

5

Why is it difficult to determine the prevalence of endometriosis?

- Because of diversity of symptoms and their severity
- Endometriosis may be asymptomatic

6

Who does endometriosis have a higher prevalence in?

Infertile women

7

What is the prevalence of endometriosis in infertile women?

25-40%

8

In what age group is endometriosis found in?

Almost exclusively in women of childbearing age

9

At what age does the diagnosis of endometriosis most commonly occur?

30’s

10

What are the risk factors for endometriosis?

- Early menarche
- Late menopause
- Delayed childbearing
- Short menstrual cycles
- Long duration of menstrual flow
- Obstruction to vaginal outflow
- Genetic factors

11

What can cause obstruction to vaginal outflow?

- Hydrocolpos
- Female genital mutilation
- Defects in uterus or Fallopian tubes

12

What indicates that there are genetic factors involved in endometriosis?

The risk of endometriosis in first-degree relatives with severe endometriosis is 6x that of relatives of unaffected women

13

What factors are protective against endometriosis?

- Multiparity
- Use of oral contraceptives

14

What are the main symptoms of endometriosis?

- Dysmenorrhoea
- Dyspareunia
- Cyclic or chronic pelvic pain
- Subfertility

15

What other symptoms may be present in endometriosis?

- Bloating
- Lethargy
- Constipation
- Low back pain

16

What are the less common symptoms of endometriosis?

- Cyclical rectal bleeding
- Menorrhagia
- Diarrhoea
- Haematuria

17

How does the clinical presentation of endometriosis vary?

Some women experience severe symptoms, whereas some women have no symptoms at all

18

What happens to the severity of symptoms of endometriosis with age?

Tends to increase

19

Can endometriosis be asymptomatic?

Yes

20

How might endometriosis be detected if the patient is asymptomatic?

Diagnosed incidentally or during investigations for infertility

21

What proportion of women with infertility have endometriosis?

1/3

22

What % of women with endometriosis are infertile?

40%

23

How does endometriosis cause infertility?

Exact mechanism is unknown, but possible mechanisms include;
- Anatomical distortions and adhesions
- Release of factors from endometriotic cysts which are detrimental to gametes or embryos

24

What is often found on examination in endometriosis?

Examination is normal

25

What findings, if any, might there be on examination in endometriosis?

- Posterior fornix or adnexal tenderness
- Palpable nodules in the posterior fornix or adnexal masses
- Bluish haemorrhagic nodules visible in posterior fornix

26

What are the differential diagnoses of endometriosis?

- Pelvic inflammatory disease
- Ectopic pregnancy
- Torsion of ovarian cyst
- Appendicitis
- Primary dysmenorrhoea
- Irritable bowel syndrome
- Uterine fibroids
- Urinary tract infection

27

What is the gold standard for investigation for most forms of endometriosis?

Laparoscopy

28

What is the problem with laparoscopy in the diagnosis of endometriosis?

Invasive with small risk of major complications

29

Give a complication of laparoscopy

Bowel perforation

30

What other investigations may be performed in endometriosis?

- MRI scan
- Transvaginal ultrasound

31

When might MRI scan be useful in endometriosis?

In non-invasive diagnosis, especially for sub-peritoneal deposits

32

Why do investigations need to be done in an acute setting of endometriosis?

To exclude important differentials

33

What investigations are performed to rule out differentials in acute endometriosis?

- Blood tests
- Urinalysis
- Cervical swabs
- ß-hCG

34

Is there a cure for endometriosis?

No

35

What are the types of intervention for endometriosis?

- Treatment of pain
- Treatment of endometriosis-associated infertility

36

What will abate the process of endometriosis in many women?

Menopause - natural or surgical

37

What is the goal of management of endometriosis in women in reproductive years?

- Provide pain relief
- Restrict progression of the process
- Restore or preserve fertility where needed

38

In what % of patients does medical treatment reduce the symptoms of endometriosis?

80-90%

39

Which of the treatment options for endometriosis have been shown to reduce the recurrence of symptoms once treatment has stopped?

None of them

40

What might the management of endometriosis involve?

- Suppression of ovarian function for at least 6 months
- Surgical options
- Pain management
- Fertility management

41

What is the basis for most medical treatment of endometriosis?

Suppression of ovarian function

42

What are the options for the suppression of ovarian function?

- COCP
- Medroxyprogesterone acetate
- GnRH agonist

43

Does hormonal treatment improve fertility in endometriosis?

No

44

What are the surgical options for the management of endometriosis?

- Laparoscopy
- Stripping of endometriomatas
- Hysterectomy with salpingo-oophrectomy

45

What management can be performed for endometriosis at the time of diagnostic laparoscopy?

Laparoscopic excision or ablation

46

What are the main conservative surgical techniques for endometriosis performed by laparoscopy?

- Thermal or laser ablation
- Excision
- Ovarian cystectomy
- Denervation procedures

47

What are endometriomatas?

Large cysts or endometriosis

48

What is hysterectomy with salpingo-oophrectomy reserved for in endometriosis/

Last resort

49

What is the general principle for the management of pain in endometriosis?

Create a pseudo-pregnancy or pseudo-menopause

50

How is a pseudo-pregnancy/menopause achieved in endometriosis?

Suppression of ovarian function

51

What analgesics are commonly used for reducing pain in endometriosis?

NSAIDs, e.g. naproxen, or paracetamol with or without codeine

52

Is medical or surgical management more effective for addressing infertility associated with endometriosis?

Surgery

53

What form of surgical management is effective for addressing infertility associated with endometriosis?

Attempts to remove endometrial tissue and preserve the ovaries without damaging normal tissue

54

What is an appropriate treatment for infertility related to endometriosis?

IVF

55

When in particular is IVF an appropriate treatment for infertility associated with endometriosis?

If there are co-existing causes of infertility and/or other treatments have failed

56

What are the complications of endometriosis?

- Fertility problems
- Adhesions
- Ovarian cysts
- Increased risk of ovarian cancer

57

How can moderate-to-severe endometriosis lead to infertility?

Can cause tubal damage leading to infertility

58

What are lesser degrees of endometriosis associated with, with regard to fertility?

Sub-fertility and increased risk of ectopic pregnancy, even in absence of obvious tubal damage

59

What can adhesions lead to in endometriosis?

Bowel and ureter obstruction