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ENDOMETRIOSIS

Notes

Definition the proliferation and functioning of endometrial tissue outside of the uterine cavity incidence: 15-30% of all premenopausal women mean age at presentation: 25-30 years

Etiology unknown theories • retrograde menstruation theory of Sampson • Mullerian metaplasia theory of Meyer • endometriosis results from the metaplastic transformation of peritoneal mesothelium under the influence of certain unidentified stimuli • lymphatic spread theory of Halban • surgical “transplantation” • deficiency of immune surveillance

Predisposing Factors nulliparity age > 25 years family history obstructive anomalies of genital tract

Sites of Occurrence ovaries • most common location • 60% of patients have ovarian involvement broad ligament peritoneal surface of the cul-de-sac (uterosacral ligaments) rectosigmoid colon appendix

S y m p t o m s t h e r e m a y b e l i t t l e c o r r e l a t i o n b e t w e e n t h e e x t e n t o f d i s e a s e a n d s y m p t o m a t o l o g y p e l v i c p a i n d u e t o s w e l l i n g a n d b l e e d i n g o f e c t o p i c e n d o m e t r i u m u n i l a t e r a l i f d u e t o e n d o m e t r i o m a d y s m e n o r r h e a ( s e c o n d a r y ) w o r s e n s w i t h a g e s u p r a p u b i c a n d b a c k p a i n o f t e n p r e c e d e m e n s t r u a l f l o w ( 2 4 - 4 8 h o u r s ) a n d c o n t i n u e t h r o u g h o u t a n d a f t e r f l o w i n f e r t i l i t y 3 0 - 4 0 % o f p a t i e n t s w i t h e n d o m e t r i o s i s w i l l b e i n f e r t i l e 1 5 - 3 0 % o f t h o s e w h o a r e i n f e r t i l e w i l l h a v e e n d o m e t r i o s i s d y s p a r e u n i a o n d e e p p e n e t r a t i o n p r e m e n s t r u a l a n d p o s t m e n s t r u a l s p o t t i n g b l a d d e r s y m p t o m s f r e q u e n c y , d y s u r i a , h e m a t u r i a b o w e l s y m p t o m s d i r e c t a n d i n d i r e c t i n v o l v e m e n t • diarrhea, constipation, pain and hematochezia

D i a g n o s i s t r u l y a s u r g i c a l d i a g n o s i s h i s t o r y c y c l i c s y m p t o m s - p e l v i c p a i n , d y s m e n o r r h e a , d y s c h e z i a p h y s i c a l e x a m i n a t i o n t e n d e r n o d u l a r i t y o f u t e r i n e l i g a m e n t s a n d c u l - d e - s a c f i x e d r e t r o v e r s i o n o f u t e r u s f i r m , f i x e d a d n e x a l m a s s ( e n d o m e t r i o m a ) l a p a r o s c o p y ( s e e C o l o u r A t l a s D 1 , D 2 ) d a r k b l u e o r b r o w n i s h - b l a c k i m p l a n t s ( m u l b e r r y s p o t s ) o n t h e u t e r o s a c r a l l i g a m e n t s , c u l - d e - s a c , o r a n y w h e r e i n t h e p e l v i s c h o c o l a t e c y s t s i n t h e o v a r i e s ( e n d o m e t r i o m a ) p o w d e r - b u r n l e s i o n s e a r l y w h i t e l e s i o n s a n d b l e b s

Gynecology 20

MCCQE 2000 Review Notes and Lecture Series

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