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57 Cards in this Set

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Objectives for endometriosis:

- define endometriosis
- common differentials
- diagnostic modalities
- hormonal v surgery tx
Objectives Fibroid:
- define leiomyomata
- common differentiral dx
- diagnostic modalities
- hormonal v surgery tx
What is Endometriosis?****
Misplaced uterine tissue

- glands and stroma
What is endosalpingiosis?****
Misplacement of endometrial tissue

glands only!
If we have endometriosis what do we call it?
Ovaries – endometrioma (chocolate cyst)

***Chocolate syrup
What do we call endometriosis in the the myometrium?
Myometrium – adenomyosis*****

glands grow into the wall of the uterus

big
swollen
tender
Where is a place in the thorax where endometriosis may appear but in real life never seen
Lung – pneumothorax Bowel
What is common symptoms of endometriosis?
pain with sex
On physical exam what is the BUZZWORD***EXAM

for endometriosis?
Powderburn lesions
What are symptoms on presentation for endometriosis?
Dysmenorrhea
Menorrhagia
Dyspareunia
Chronic Pelvic Pain
Infertility
Incidental finding on laparoscopy
What is dysmenorrhea?
pain w/ periods
What is menorrhagia?
excess amount of bleeding
What is Dyspareunia?
pain with sex
Does the # of symptoms tell you the amount of disease for endometriosis
Amount of disease does not necessarily correlate with symptoms
Will a women be infertile if she has endometriosis?
Endometriosis does not necessarily mean infertility
What are the 3 pathogenesis theories for endometriosis?
Lymphatic or hematogenous
Retrograde flow
Hereditary / embryologic
What are 3 clinical findings for endometriosis?
Uterosacral nodularity
Cervical motion tenderness
Boggy uterus
What are the 2 ways to diagnose endometriosis?
Laparoscopic proven with or without biopsies

Response to Depo lupron
What is Depo lupron?
GnRH agonist!
down regulates GnRH receptor
decreases estrogen levels

aka Medical hysterectomy
How long do you use depo lupron and what side effect do you look for?
6 months limit – osteoporosis
How can depo lupron be used as an adjunct in infertility cases?
Can help quiet the inflammation as an adjunct in infertility cases
What are treatment options for endometriosis?
- Laser ablation of visible disease

- LUNA – laparoscopic uterosacral nerve ablation

-Appendectomy if needed

-Follow with Depo lupron, Depo
- Provera or oral contraceptives; NSAID’s

-Goal of medical management – anovulation

Laparoscopy – 2 year improvement with slow return

Presacral neurectomy

Total hysterectomy with bilateral salpingoophorectomy – cures
What is goal of medical management for treatement of endometriosis?
anovulation

anovulatory cycle is a menstrual cycle during which the ovaries do not release an oocyte. Therefore, ovulation does not take place.
What is the only CURE for endometriosis?
Total hysterectomy with bilateral salpingoophorectomy – cures*****EXAM


just a hysterectomy is NOT enough
After you remove the endometriosis tissue what can you give the women?
*******Consider estrogen – will not stimulate regrowth
You have a women with HEAVY PERIODS
CRAMPS
DYSPAREUNIA (refuses sex......say what)
+ uterosacral tenderness with nodularity
boggy retroverted uterus
+CMT reproducing pain
left adnexal 4 cm tender mass
US- left ovarian cyst
What is the assessment?
Assessment:

Dysparenia
Dysmenorrhea
Menorrhagia
Complex ovarian cyst
Likely endometriosis*****
EXAM****

WHAT IS THE MOST COMMON FEMALE TUMOR?
fibroids
This is a smooth muscle tumors of fibroids?
Leiomyomata
Are most leiomyomata's benign or malignant?
benign
How do Fibroid leiomyomata's present?
Bleeding
and
pain
What race are leiomyomata common in?
black women
Where do leiomyomata occur?
can occur anywhere in the pelvis
Where do uterine fibroid occur:
intraligamentary
outside the uterus near ligaments
Where do uterine fibroid occur:
Protruding submucosal
In the submucosal of the uterus
Where do uterine fibroid occur:
submucosal
In the submucosa of the uterus
Where do uterine fibroid occur:
subserosal
How do MOST fibroids present?
Pain – usually dysmenorrhea
What are other symptoms of fibroids?
Back pain
Pelvic fullness
Urinary frequency
Heavy menses
Sometimes intermenstrual bleeding
How do we diagnose fibroids?
Pelvic mass on bimanual exam

Pelvic ultrasound

Incidental finding at laparoscopy or c – section
What is a sessile fibroid?
Flat
What is pedunclulated fibroid?
Mushroom like
how can pregnancy affect fibroids?
High estrogen causes growth

Shrink spontaneously
What are treatment options for fibroids?
Myomectomy

Uterine artery embolization

Hysterectomy

Depo lupron - decrease estrogen which causes firboid to grow
What is a myomectomy?
Used as an adjunct to infertility or recurrent miscarriages
If you have a fibroid in the myometrium of the uterus how can you remove this?
Myomectomy

Hysteroscopic resection – submucosal
What if you have a transmural fibroid, how would you treat this?
Myomectomy

treat like a classical c-section…15% uterine rupture if labored…labor is contraindicated
What is another way to decrease growth of a fibroid?
Uterine artery embolization

minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels by purposely introducing emboli.
What is uterine artery embolization?
Plugs

Causes infarction of the uterus

Collateral blood flow

unclear long term results-depends on size and location
What women would you NEVER do uterine artery embolization
In a women who wants to become pregnant
ON EXAM******

What is the most common cause of Hysterectomy?
F*&king
FIBROID
How are hysterectomys most commonly done?
abdominally
What is a great drug for fibroids?
Depo Lupron

Estrogen feeds fibroids, causes growth
Shrinks fibroids
How long does it take for optimal shrinkage of a fibroid with depo lupron?
Optimal shrinkage occurs after 3 months of treatment
What happens after you stop depo lupron for fibroid treatment?
Not a long term treatment option – rapid regrowth after stopping
ON EXAM*****

How long do you treat endometriosis with depo lupron?
6 months
ON EXAM*****

How long do you treat fibroids with depo lupron?
3 months
What is the tx for fibroids?
*****EXAM
Hysterectomy - uterus only
What is the tx for Endometriosis?
*****EXAM
Hysterectomy + Ovaries

Uterus + Ovaries must go!