2. One of the most mysterious and facinating
gynaecological disorder
By definition endometriosis is the occurance of
ectopic endometrial tissues outside the cavity
of uterus which contain endometrial stroma
which is capable of responding to the varying
degree to cyclical hormonal stimulation
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3. AETIOLOGY
Disease of child bearing period
Changing social paterns
Late marriage
Limitation of family size
Seen in affluent class
Genetic suceptabilty
Familial tendency
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4. THEORIES
Implantaion theory
Reflux of menstrual endometriam through fallopian
tubules
Reserch on rhesus monkeys confirmed it
Coelomic metaplasia theory
Rests of embryonic mesothelium
Metasttic theory
Embolisation of menstrual fragments
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5. Histogenesis by induction
Some chemical substances present had been
considerd to be the important cause
Homonal influence
Oestrogen is considerd
Pregnancy tends to decrease due to increased
progestrone level
Rarely seen before puberty
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7. SITES OF ENDOMETRIOSIS
Ovaries
Cul-de-sac- uterosacral ligament
Peritoneum overlying the bladder
Sigmoid colon
Back of uterus
Intestinal coils
Appendix
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8. PATHOLOGY
Area appears dark red,bluish and blackish
cystic area
Scarring around the lesion giving a puckering
look
Non pigmented areas or yellowish whitish thick
plaque
Powder burnt areas
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9. CHOCLATE CYSTS OF OVARIES
Most important manifestation of endometriosis
Obivious thickening of tunica albugenia
Vascular red adhesions are well marked on
undersurface of the ovary
Inner surface of cyst wall is vascular and
contain areas of dark brown tissue
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10. HISTOLOGICL APPEARANCE
Lining epithelium is usually columnar
Tendency for formation of papillae
A zone of tissue containing large cells with
brown cytoplasm,polyhedral in shape
resembling leutin –this pseudoxanthoma cells
are probably large macrophages or scavenger
cells
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11. CLASSIFICATION –AMERICAN FERTILITY
SOCIETY
Based on size and location of endometrial
lesion
Minimal –small spot seen at laprotomy but no
clinical symptom
Mild-scatterd fresh superficial lesions No
scarring or retraction.no adenexal adhesions
Moderate –ovaries ar involved with scarring
and retraction,more than 2cm in size minimal
peritubal and ovarian adhesions
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12. Severe –ovaries are involved with size of
endometriosis exceeding 2cm
Dence peritubal and periovarian adhesions
restricting the mobility
Uterosacral ligaments are thickened
Evidence of involvement of bowel and urinary
tract
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13. CLINICAL FEATURES
Dysmenorrhoea
Most common symptom
Pain begining before the onset of menstruation
,builds up continously until the flow begining and
gradually declines there after
Backache is the most common complaint
Sometime there may be radiating pain along the
sacral nerve
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14. Abdominal pain
Lower abdominal pain of varying intensity
1. Dyspareunia
movements of cervix elicit tenderness
Infertilty
40%
Menstrual symptoms
Menorrhagia is common
Irregular bleeding may also occur
Polymenorrhea is noted in ovarian involvement
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15. Chronic pelvic pain –prostaglandin E2 is the
cause of this pain
Urological symptoms-frequency dysuria rarely
haematuria
Hydronephrosis
Bowel symptoms –painful defecation,diarrhoea
and melena around menstruation,some times
constipation
Painfull abdominal mass-stimulating peritonits
appendicitis and ectopic pregnancy
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16. PHYSICAL FINDINGS
Abdominal examination –cystic swolling
Swolling is fixed and may be slighty tender
Speculam examination-bluish or blackish
puckerd spots in posterior fornix,spots which is
tender to touch
Vaginal examination-tender fixed retroverted
uterus
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18. INVESTIGATIONS
Laproscopy
CA 125 ,glycoprotien and cell surface antigen is
raised to 35u/l in 80% of cases
Ultrasound and MRI
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19. PROPHYLAXIS
Low dose of oral contaracepive pills
Tubal patency test is to be avoided in
immediate intermenstrual phase
Operation of the genital tract should be
sheduled in premenstrual period
Hystrectomy and classical caesarean section is
to be avoided
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20. TREATMENT
Oral contraceptive
Oral progestrone
Minimal invasive surgery
Done using laproscopy
Aspiration of fluid in the culde sac
Destruction of endometriotic implants by
diathermy,cauterization or vapourisation
Large lesions and choclate cyst can be exised
Laproscopic breaking of the adhesions –relives
dysmenorrhoea
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