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Endometriosis

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obstetrics & gynecology,

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Endometriosis

  1. 1. Endometriosis Samman Khurshid M.B.B.S.(Final Year)
  2. 2. Definition  Endometriosis is the presence of tissue similar to normal endometrium, in structure and function, at sights other than the lining of the uterine cavity.
  3. 3. Incidence  10 – 20% of the Laparotomies.
  4. 4. Etiology and Pathogenesis  Implantation Theory  Coelomic Metaplasia Theory  Lymphatic or Haematogenous Dissemination
  5. 5. Predisposing factors  Age  Race  Socioeconomic status  Infertility  Parity  Genetic  Auto immune
  6. 6. Site of Endometriosis  Ovaries - Commonest  Pelvic peritoneum  Uterovesical pouch  Retroviginal septum  Fallopian tubes  Others
  7. 7. Pathology Gross features  Spots  Cysts(chocolate)  Peritonitis  Fibrosis – Adhesion  Strictures – Obstruction Microscopic features  Endometrial glands  Endometrial stroma
  8. 8. Symptoms  Asymptomatic  Dysmenorrhea  Dyspareunia  Abdominal & Pelvic pain  Menorrhagia  Infertility  Others
  9. 9. Signs  No clinical signs  Cyst or nodular masses  Retroverted Uterus  Tenderness  Bluish nodule
  10. 10. Diagnosis  Examination under anesthesia  Laparoscopy  Laparotomy  Non invasive methods  Ultrasonography.  CT-scan/MRI.  CA-125.
  11. 11. Differential Diagnosis  Chronic pelvic inflammatory disease  Hemorrhage in corpus luteum  Myomas  Malignant disease of ovary  Ca Cervix and Vagina  Adenomyosis  Carcinoma of colon or rectum  Acute abdomen
  12. 12. Treatment  Expectant treatment  Medical(Hormones)  Surgery  Combination of medical and surgical treatment  Assisted reproductive technique
  13. 13. Cont.….  Expectant Treatment  Medical Treatment 1. Pseudo pregnancy treatment  Combination of Estrogen and Progestogen  Progestogens only 2. Pseudo menopause treatment  Danazol  Gestrinone  GnRH analogues or antagonists
  14. 14. Complications  Recurrence of Endometriosis  Malignant Change in Endometriosis
  15. 15. Thanks….

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