Endometriosis - PDF

ENDOMETRIOSIS DEFINITION Presence of functioning endometrium(glands and stroma) in sites other than uterine mucosa is called endometriosis. RISK FACTORS- first degree relatives 6 times risk to have endometriosis Early menstruation (before age 11) Shorter menstrual periods (less than 27...

ENDOMETRIOSIS DEFINITION Presence of functioning endometrium(glands and stroma) in sites other than uterine mucosa is called endometriosis. RISK FACTORS- first degree relatives 6 times risk to have endometriosis Early menstruation (before age 11) Shorter menstrual periods (less than 27 days on average) Heavy menstrual periods lasting more than seven days Nulliparity obstruction of menstrual flow(mullerian anomalies) Pathogenesis the exact cause of endometriosis remain unknown. Many theories has been presented to better understand and explains its development. Sampon's theory- proposed by John.A.Sampson. Also known as Retrograde menstruation According to this theory, there is retrograde flow of menstrual blood through the uterine tubes during menstruation. The endometrial fragments get implanted in the peritoneal surface of pelvic organs.This theory explains only pelvic endometriosis, it fails to explain the endometriosis at distant sites  Meyer and Ivanoff Theory- Also known as Coelomic Metaplasia. Chronic irritation of pelvic peritoneum by the menstrual blood may cause coelomic metaplasia which results in endometriosis.This theory can explain endometriosis of the abdominal viscera, the retrovaginal septum and the umbilicus. Halban's Theory- Also known as Lymphatic Theory.It may be possible for normal endometrium to metastasise the pelvic lymph nodes through the draining lymphatic channels of uterus.  Vascular theory- It can explain endometriosis at distant sites as lungs, arms or thighs. Direct Implantation- According to this theory, endometrial or decidual tissues start to grow in susceptible individual when implanted in the new sites.Such sites are the abdominal scar following hysterectomy, caesarean section, tubectomy, myomectomy.This theory explains endometriosis at episiotomy scar, vaginal or cervical site but fails to clarify endometriosis at sites other than mentioned. CLINICAL MANIFESTATIONS DYSPAREUNIA DYSURIA CHRONIC PELVIC PAIN DYSMENORRHEA(50%) ABNORMAL MENSTRUATION INFERTILITY PHYSICAL EXAMINATION Abdominal examination-may not reveal any abnormality A mass may be felt in lower abdomen arising from pelvis chocolate cysts or tubo ovarian mass due to endometriotis lesions Pelvic examination-bimanual exam reveals nothing positive findings are-pelvic tenderness,nodules in pouch of douglas,bilateral adnexal mass,nodules in pouch of douglas Specula examination reveals bluish spots at posterior fornix Diagnostic tests initial investigations-TVS Best investigation -laparoscopy Gold standard-laparoscopy serum Ca-125 marker (non specific)seen in severe endometriosis Treatment Medical management NSAIDS -1st line of mild dysmenorrhea OCT-3 Months continously progestrone-DMPA,MPA,NETA aromatase inhibitor Danazol not commonly used  Surgical failed medical management infertility and severe dysmenorrhea Conservative management consist of excision of endometrium, adhesions,restoration of pelvic anatomy as possible,and resection of endometriomas. --endometriotic cystectomy if size more than 5cm --fulguaration : ablation of endometriotic deposits --LUNA: Laporoscopic uterosacral nerve ablation --hysterectomy+BSO- In patients who dont wish to conceive or completed family. ,