Endometriosis ( from endo “inside”, and metra , “womb”) is a common medical condition in women in which endometrial cells are deposited in the areas outside the uterine cavity .the uterine cavity is lined by endometrial cells, which are under the influence of female hormones. Endometial cells deposited in the areas outside the uterus (endometriosis) continue to be influenced by these hormonal changes and respond similarly as do these cells found inside.
Endometriosis is a chronic disease that affects between 5% to 15% of women of reproductive age. It is a benign lesions with cells similar to those lining the uterus. Often, extensive endometriosis causes a few symptoms, whereas an isolated lesion may produce severe symptoms.
implantation theory – menstrual flow regurgitates through the fallopian tubes and deposit particle of viable endometrial tissue outside the uterus cavity spread then occurs via metaplasia (endometrial tissue reproducing itself)
Vascular and lymphatic dissemination theory – spread of endometrial glands occurs through the lymphatic and vascular system to location outside the uterus .
Although the abnormally located tissue is usually confined to the pelvic cavity, it may occur in the other areas. The most frequent sites are the ovary and dependent portion of the pelvic peritoneum. rarely, tissue may be found outside the pelvis, such as in surgical scars, lungs, and extremities.
Regardless of the site, this misplaced endometrial tissue responds to hormonal stimulation and bleeds, producing a variety of manifestation. Scarring and inflammation occurs at sites of endometriosis. Repeated episodes of inter-peritoneal bleeding (from hormonal stimulation of the endometrial tissue) cause adhesions. Eventually, one peritoneal surface may become fixed to another.
It appears that prostaglandin synthesis at the time of menstruation produces strong myomertrial contractions. The severe muscle spasms constrict blood vessels supplying the uterus, causing ischemia and pain. The excess prostaglandin in smooth muscle also help explain the presence of GI manifestation, such as nausea and vomiting and diarrhea or headache.
*Premenstrual dysphoric disorder (PMDD) a is identified by a variety of physical and emotional symptoms that occur during the last week of the luteal phase of the menstrual cycle and that remit within a few days after the onset of the follicular phase. In most women, these symptoms occur in the week before, and remit within a few days after, the onset of menses. The disorder has also been reported in non menstruating women who have had a hysterectomy but who retain ovarian function. The diagnosis is given only when the symptoms are sufficiently severe to cause marked impairment in social or occupational functioning and have occurred during a majority of menstrual cycles in the past year
*PMDD is a severe form of a common problem called premenstrual syndrome, or PMS. About 75 percent of women of childbearing age have some PMS problems. About 2 to 10 percent of women in this age group have PMDD
Decreased interest in usual activities (e.g., work, school, friends, hobbies)
Marked change in appetite, overeating, or specific food cravings
Hypersomnia or insomnia
Altered sexual drive
Suicidal ideations or attempts
The symptoms of PMDD are: • Sadness and crying • Feeling nervous, anxious, and irritable • Strong cravings for certain foods • Problems paying attention and concentrating • Physical problems such as breast tenderness, headaches, joint or muscle pain and swelling or bloating • Trouble sleeping
-is an abnormal passage that connects the vagina to other organs, such as the bladder or rectum, resulting in leakage of urine or feces into the vagina. A vagina fistula could also be described as a hole in the vagina that allows stool or urine to pass through the vagina .
Vaginal Fistulas include:
Vesicovaginal fistula –also called bladder fistulas, occur between the vagina and urinary bladder. This is the common type of vaginal fistula.
Ureterovaginal fistula –ureter fistulas, occur between the vagina and distal ureter (ureters are ducts that carry urine from the kidney to the bladder).
Urethrovaginal fistula - urethra fistulas, occur between the vagina and urethra ( tube that carries urine out the body).
Rectovaginal fistula -rectum fistulas, occur between the vagina and the rectum.
All the above vaginal fistulas cause some similar symptoms such as:
1. Urine or flatus and feces leak into the vagina.
2. Excoriation and irritation of the vaginal and vulvar tissues occur.
3. Severe infection may result from this irritation.
4. Psychologically distressing problems which women face. ex. Patients with those disorders frequently become social recluses, causing great disruption to their family relationships and other social activities. So, they often fail to consult a physician until the problem has become severe, and even then they are reluctant to discuss it.
Prolapsed or descent of the uterus occurs in three stages:
First degree- uterus descends into the vaginal canal and the cervix reaches but does not go through the introitus.
Second degree- body of the uterus is still within the vagina, but the cervix protrudes through the introitus.
3.Third degree- (also called “procidentia” or “complete prolapse”)- the entire uterus and the cervix protrude through the introitus with inversion of the vaginal canal.
Uterine prolapsed varies in severity. In mild uterine prolapsed can experience no signs and symptoms or you could have moderate to severe uterine prolapsed. If that’s the case, you may experience the ff.
sensation of heaviness or pulling in your pelvis
tissue protruding from your vagina
urinary difficulties, such as urine leakage or urge incontinence
trouble having a bowel movement
low back pain
feeling as if you’re sitting on a small ball or as if something is falling out of your vagina
symptoms that are less bothersome in the morning and worsen as the day goes on
Electrical stimulation – a device which delivers small electrical currents is applied to targeted muscles within the vagina or on the pelvic floor. The current causes muscles to contract, which strengthens them.
Vaginal hysterectomy with anterior and posterior colporraphy (repair of vagina and underlying fascia)
The nurse must encourage pregnant patients to seek qualified obstetric care.
Teaching patients after delivery to alternately tense and relax their gluteal muscles and the muscles of the pelvic floor.
Maintain a healthy weight. By keeping or getting your weight control, you may decrease your risk of uterine prolapse.
Practice Kegel exercises. Because of pregnancy or childbirth can weaken pelvic floor muscles and connective tissue, your doctor may recommend Kegel exercises- special exercises in which you repeatedly squeeze and relax the muscles of your pelvic floor.
The term rectum refers to the 12-15 cm. of the large intestine. The rectum is located just above the anal canal. Normally, the rectums securely attached to the pelvis with the help of ligaments and muscles. This attachment to the body also weakens. This causes the rectum to prolapsed, meaning its splits or falls out of place. Occasionally, large hemorrhoids (large, swollen veins inside the rectum) may predispose the rectum to prolapsed.
By the time a person with toxic shock syndrome (TSS) sees a health professional, immediate medical treatment is usually necessary. Because TSS can progress rapidly and cause life-threatening complications, treatment almost always takes place in a hospital where a person's condition can be closely monitored. Treatment for shock or organ failure is usually necessary before any test results are available. Admission to the intensive care unit (ICU) is usually needed when a person shows signs of shock or has problems breathing (respiratory failure).
Toxic shock syndrome ( TSS ) is a very rare but potentially fatal illness caused by a bacterial toxin . Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative-positive bacteria include Staphylococcus aureus and Streptococcus pyogenes . Streptococcal TSS is sometimes referred to as Toxic shock-like syndrome ( TSLS ).
TSS can occur via the skin (e.g., cuts, surgery, burns),
vagina, (prolonged tampon exposure), or pharynx .
Toxic shock syndrome is the rare result of infection by Streptococcus pyogenes (group A strep) or Staphylococcus aureus (staph) bacteria. These bacteria make toxins that cause TSS. These bacteria are common but usually don't cause problems. They can cause infections of the throat or skin that are easy to treat, such as strep throat or impetigo . In rare cases, the toxins enter the bloodstream and cause a severe immune reaction in people whose bodies can't fight these toxins.
Because it progresses so quickly, toxic shock syndrome is usually diagnosed and treated based on symptoms and signs of infection without waiting for laboratory results. Additional blood and tissue tests can help identify the type of bacterium causing the infection.
*intravenous fluid replacement
Treatment for strep or staph toxic shock syndrome includes:
Removal of the source of the infection . If a woman is using a tampon, diaphragm, or contraceptive sponge, it is removed immediately. Infected wounds are usually drained and cleaned to rid the area of bacteria. remove dead or severely infected tissue. This is called surgical debridement.
Intravenous immunoglobulin (IVIG) can be used when toxic shock syndrome is severe or does not improve with antibiotics
Treatment of complications of the illness , including low blood pressure, shock, and organ failure. The specific treatment depends on what problems have developed. Large amounts of intravenous (IV) fluids are typically used to replace fluids lost from vomiting, diarrhea, and fever and to avoid complications of low blood pressure and shock.
Antibiotics to kill the bacteria that are producing the toxins causing TSS.
Clindamycin Other medicines, such as cloxacillin or cefazolin.
Shock , causing decreased blood and oxygen circulation to the vital organs.
Acute respiratory distress syndrome (ARDS). Lung function decreases, breathing becomes difficult, and blood oxygen levels drop.
Disseminated intravascular coagulation (DIC). This condition causes the clotting factors in the blood to become too active. Many blood clots may form throughout the body, which uses up the clotting factors. This can cause excessive bleeding.
Kidney failure, also called end-stage renal disease. Failure happens when kidney damage is so severe that treatment with dialysis or a kidney transplant is needed to prevent death.
These people lack specific antibodies against the toxins of strep or staph.
People with immune system problems, such as diabetes , cancer, or autoimmune diseases , are also at higher risk for toxic shock syndrome because they are also more likely to lack the specific immune system response needed to fight the toxins.
Risk factors for menstrual TSS
The prolonged use of a tampon, especially the super absorbent type, increases a woman's risk for menstrual TSS. If you have had menstrual TSS in the past, you have an increased risk of developing it again .
Routine complete blood count (CBC) of red and white blood cells, platelets, and other basic qualities of your blood.
Cultures of blood and other body fluids and tissues for signs of strep or staph bacteria . For menstrual TSS, a vaginal fluid sample is tested. For nonmenstrual TSS, a swab or sample of a suspected wound, lesion, or other affected area is tested. Blood cultures do not usually detect staph TSS when it is present, but strep can be identified in a sample of blood or cerebrospinal fluid (CSF) or by a tissue biopsy . Cultures from the throat, the vagina , or a sputum sample may also show the bacteria.
Chest X-ray, to look for signs of damage to the lungs ( respiratory distress syndrome ).
Tests to rule out other infections that can cause symptoms similar to those of TSS, such as an infection of the blood ( sepsis ), a tick-borne bacterial infection ( Rocky Mountain spotted fever ), a bacterial infection caused by contact with the urine of infected animals ( leptospirosis ), or typhoid fever
Elimination of the source of the infection
Administration of fluids, vasopressin, and antibiotic agent