what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Endometriosis still an enigmatic disease dr. sharda jainLifecare Centre
ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE : Introduction DR. SHARDA JAIN DR. JYOTI AGARWAL
DR. JYOTI BHASKER
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
ENDOMETRIOSIS: THE BITTER TRUTH
Endometriosis An Enigmatic Disease, DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyo...Lifecare Centre
ENDOMETRIOSIS STILL AN ENIGMATIC DISEASE
Endometriosis: The Pain That Keeps on Giving
“Endometriosis remains a riddle wrapped in a mystery inside an enigma”
Endometriosis occurs when tissues that
usually grow inside uterus instead grow on the outside. These tissues
often grow on the surfaces of organs in the pelvis or abdomen, where they are
not supposed to grow.
View a diagram that shows where
endometriosis might grow.
Endometriosis is one of the most common
gynecological diseases, affecting more than 5.5 million women in North
America. An estimated 2 percent to 10 percent of women of reproductive
age have endometriosis.
International Journal of Pharmaceutical Science Invention (IJPSI) inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Evidence linked treatment for endometriosis-associated infertilityApollo Hospitals
Endometriosis is conventionally defined as the presence of
tissue lesions or nodules that are histologically similar to
the endometrium, but are present at sites outside the uterus.It is a chronic, often recurring disease of complex and unclear aetiology. Endometriosis is a highly variable condition in terms of age and mode of presentation, range of symptoms, anatomical sites, response to treatment and likelihood of recurrence.
Case Report:Massive Ovarian Cyst in a Adolescent GirlTana Kiak
For benign tumours adhesion prevention strategies should be used. Surgical intervention should as much as possible be directed towards preservation of ovarian tissue. There is scarcity of published literature on this subject.
We need bigger studies to address the issue of how much fertility preservation is safely possible.Irrespective of indication for surgery, it is always preferable to attempt conservative, fertility sparing surgery in adolescents.
Polycystic ovary syndrome (PCOS) is of clinical and public health importance as it is very common in today’s era affecting women of reproductive age group. It has significant and diverse clinical implications including reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, adverse cardiovascular risk profiles) and psychological features (increased anxiety, depression and worsened quality of life).
Another commonest ovarian disorder is ovarian cyst. The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance.
In a regular Homoeopathic OPD the physician today encounter these two cases frequently. Most of the patients visiting with these disorders opt for Homoeopathy as an alternative treatment option to revert surgical procedures, or after failed hormonal therapies.
Homoeopathic management should focus on education, addressing psychological factors and strongly emphasizing healthy lifestyle with targeted medical therapy as required.
The present article discusses on various aspects of these ovarian disorders. Cases of Ovarian disorders which were successfully treated with homoeopathic medicines by the author are reported here.
Dr. Smita Brahmachari
M.O., Dept. of AYUSH, Govt. of NCT Delhi.
Presentation Topic: Endometriosis. Discuss in detail the endometriosis . What is it? What is the etiology, clinical features, how can you diagnose and what is it's treatment as well as management. You'll find everything in this presentation along with pictures and illustrations.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. DR. SHASHWAT JANI
M.S. ( GYNEC )
DIPLOMA IN ENDOSCOPY.
Assistant Professor, dept. of obs – gyn,
Smt. N.h.l. municipal medical college ,
Sheth v.s. general hospital
Ahmedabad, gujarat , india..
MOB : +91 99099 44160.
E-mail : drshashwatjani@gmail.com
drshashwatjani@gmail.com 1
2. INTRODUCTION OF ENDOMETRIOSIS
SITES
AETIOLOGY
THEORIES FOR ENDOMETRIOSIS
CLINICAL FEATURES
CLASSIFIC ATION OF ENDOMETRIOSIS
PATHO-PHYSIOLOGY
DIAGNOSIS OF ENDOMETRIOSIS
MANAGEMENT
drshashwatjani@gmail.com 2
4. Endometriosis initially described by Von Rokitansky in 1860
Endometriosis is a clinical and pathological entity.
It is characterized by the presence of tissue resembling
functional endometrial glands and stroma outside the uterine
cavity.
It is not a neoplastic condition, but malignant transformation
is possible.
drshashwatjani@gmail.com 4
5. ABDOMINAL
Most common site - OVARY (44% involved)
Pouch of Douglas
Uterosacral ligament
Broad ligament
Rectovaginal septum
Pelvic lymph node
Rare sites - Gut, Appendix, Ureter, Urinary Bladder
drshashwatjani@gmail.com 5
9. AGE - 30-40 years(most common) - between the menarche
and menopause.
FAMILY HISTORY -7 times greater if a 1st degree relative
affected by endometriosis.
New study- Early menarche
Late marriage
SOCIAL AND ECONOMIC FACTORS- more common in
highly civilized communities.
PARITY- 50-70 % affected women are childless.
drshashwatjani@gmail.com 9
11. John Sampson first postulated that endometriosis arose
from retrograde flow of fragments of endometrial tissue
through the oviducts and into the peritoneal cavity.
Epidemiologic data suggests that women who menstruate
more frequently, more heavily, or for a longer duration
have increased chance of disease development.
There is retrograde flow of menstrual blood through the
uterine tube during menstruation. The endometrial
fragments get implanted in the peritoneal surface of pelvic
organs( Sites– ovaries, uterosacral ligament)
Anomalies of the Mullerian tract, increased occurrence of
endometriosis and stenosis of external cervical os.
drshashwatjani@gmail.com 11
13. In this theory, the germinal epithelia of the ovary,
endometrium and peritoneum all originate from the same
totipotential coelomic epithelium.
In coelomic Metaplasia, these totipotential coelomic cell are
transformed by repeated exposure to hormonal or infection
stimuli.
Development of endometriotic lesions in unusual locations.
Prolonged treatment with estrogen.
drshashwatjani@gmail.com 13
14. Endometrial cell can be transported to extrauterine sites by
blood vessels or the lymphatic system or by contamination of
the pelvis or abdominal wall incision, if the uterine cavity is
surgically entered.
drshashwatjani@gmail.com 14
15. In cellular immunity, can facilitate the successful
implantation of translocated endometrial cells.
In endometriosis lymphocytes decreased cytotoxic
response to endometrial cell may be due to defect in
natural killer cell activity, such as a decreased lytic effect
toward stroma that allow ectopic development of
endometrial fragments.
There may be increased resistance of endometrium in
women with endometriosis to natural killer cytotoxicity.
drshashwatjani@gmail.com 15
16. Endometriosis is an estrogen-dependent condition.
Estradiol concentration greater than 60pg/ml is necessary for
proliferation of endometrial lesions.
Estrogen & Progesterone receptors are found in much lower
concentrations in endometriotic tissue than in normal
endometrial tissue,
Growth factors can originate from the peritoneal
environment to stimulate endometrial development.
Platelet derived growth factor, macrophage secretory
products enhance endometrial stromal cell proliferation.
drshashwatjani@gmail.com 16
17. Increased concentration of macrophages derived growth
factors including vascular endothelial growth factor.
Molecular alterations in steroidogenic enzyme function have
been implicated in the pathogenesis of endometriosis.
Menstrual effluent contains factors that induce alterations in
the peritoneal mesothelium, facilitating adhesions of
endometrial cells.
drshashwatjani@gmail.com 17
19. Most common symptom
Pain starts a few days prior to menstruation, gets worse
during menstruation( secondary dysmenorrhoea)
Pain due to Increased secretion of PGF2α, Thromboxane β2
from endometriotic tissue.
Abnormal Menstruation
Menorrhagia is a predominant abnormality.
Polymennorhoea, premenstrual spotting also occur.
drshashwatjani@gmail.com 19
20. It is usually deep, due to stretching of the structures of the
Pouch of Douglas or direct contact tenderness found in
endometriosis of rectovaginal septum or Pouch of Douglas and
with fixed retroverted uterus.
Abdominal pain
lower abdominal pain or backache
May be due to inflammation in peritoneal implants due to
cystic bleeding
Irritation or invasion of nerve
Action of inflammatory cytokines released by the
macrophages.
drshashwatjani@gmail.com 20
21. Infertility
Mechanical interference---
1. Pelvic adhesions
2. Chronic salpingitis
3. Impaired oocyte pickup
4. Altered tubal motility
5. Distortion of tubo-ovarian relations
Alteration in peritoneal fluid
1. Increased concentration of prostaglandins
2. Increased number of macrophages
3. Increased production of cytokines
4. Phagocytosis of sperms
Abnormal Systemic Immune system
1. Increased cell-mediated gametes injury
2. Increased prevalence of autoantibodies
Hormonal or ovulatory dysfuntion
1. Defective folliculogenesis
2. Luteinized unruptured follicle syndrome
3. Hyperprolactinemia
4. Luteal phase deficiency
5. Implantation failure drshashwatjani@gmail.com 21
22. General conditions- Fair
Pallor + due to Menorrhagia
Pulse, B. P. –Normal
CVS/ RS – Normal
P/A- Mass felt in lower abdomen arising from the pelvis
Enlarged chocolate cyst or tuboovarian mass,
due to endometriotic adhesions.
The mass is tender with restricted mobility.
L/E-See Vulva and other structures
P/S- See cervix, vagina for any deposits, discharge or
growth.
drshashwatjani@gmail.com 22
23. o Tender uterosacral ligament
o Cul-de-sac nodularity found
o Induration of the rectovaginal septum
o Fixed retroversion of the uterus
o Adnexal masses and generalized or localized pelvic
tenderness present
o Uterosacral nodules may be found
drshashwatjani@gmail.com 23
26. ASRM staging has poor correlation with
pregnancy rate.
In 2009 new staging system was proposed called
Endometriosis Fertility Index.
EFI is numerical measure of functional anatomy
based on assessment of tubes, fimbriae and
ovaries.
EFI score 0 to 10
(0 – poorest and 10 – the best prognosis).
drshashwatjani@gmail.com 26
27. Diagnosis made by Clinical Presentation
Clinical Examination
Clinical examination- In many women with endometriosis no
abnormality is detected during the clinical examination.
The clinical examination may have false-negative results.
So, the diagnosis of endometriosis should be confirmed by
biopsy of suspicious lesions or by laparoscopy.
drshashwatjani@gmail.com 27
28. Transvaginal or Transrectal ultrasonography is an important
diagnostic tool in the assessment of ovarian endometriotic
cysts, adnexal masses.
( Sensitivity-97% and Specificity-96% )
Other imaging techniques are- CT/ MRI
Can be used to provide additional and confirmatory
information but they cannot be used for primary diagnosis.
drshashwatjani@gmail.com 28
29. Cancer Antigen-125, a high molecular weight glycoprotein
expressed on the cell surface of some derivatives of embryonic
coelomic epithelium.
It is elevated towards the end of the luteal phase and during
menstruation.
In many other conditions elevated CA-125 concentration like
PID, adenomyosis, uterine leiomyoma, menstruation,
pregnancy, epithelial ovarian cancer, pancreatitis, chronic liver
disease.
drshashwatjani@gmail.com 29
30. 80% of women with pelvic pain and endometriois had a CA-
125 titre greater than 16 U/ml
6% of patients with pelvic pain and without endometriosis
had an increased CA-125.
The result of most studies suggest that CA-125 is not
sufficiently sensitive to identify lesser stages of
endometriosis.
CA-125 is not reliable as a screening test.
drshashwatjani@gmail.com 30
31. drshashwatjani@gmail.com 31
Diagnostic Laparoscopy is the gold standard
investigation for Endometriosis.
In laparoscopy examination, we classify the extent and severity of
disease.
In laparoscopy evaluation, a double puncture technique is essential.
The forceps placed through the lower abdomen sheath permits
mobilization of the tube and ovaries.
Inspect the lateral side wall, all ovarian surface, both sides of the broad
ligament, the bladder, bowel serosa, inferior aspect of cul-de-sac,
evaluation of the uterosacral ligaments and rectal serosa.
To avoid under diagnosis it should not be performed during or within 3
months of hormonal therapy.
33. Typical “powder-burn or “gunshot” lesions on the serosal
surface of the peritoneum. These lesions are black, blue or
dark brown, nodules or small cysts containing old
hemorrhage surrounded by variable degree of fibrosis.
White lesions are predominantly fibromuscular. Scarring
with scattered glandular and stromal elements.
Brown lesions are mainly haemosiderin deposits. Peritoneal
defect and subovarian adhesions contain endometriosis in
40% -70%.
drshashwatjani@gmail.com 33
35. For ovarian endometriosis- Large ovarian endometriotic cysts
are usually located on the anterior surface of the ovary and
associated with retraction, pigmentation and adhesions to the
posterior peritoneum. Size smaller than 12 cm in diameter for
diagnosis.
Ovarian endometriotic cyst contain a thick, viscous dark
brown fluid.(Chocolate fluid)
Chocolate cysts– sometimes it is confused with
hemorrhagic corpus luteum cysts and
neoplastic cysts. Biopsy must be done.
drshashwatjani@gmail.com 35
39. Progestogens suppress ovarian steroidogenesis and promote
endometrial glandular atrophy, apoptosis and extensive
decidual transformation to the stroma.
Progestogens oppose the growth-promoting effect of estrogens
on the endometrial tissue by altering the clearance of the
nuclear estrogen, receptor and inducing 17 β hydroxysteroid
dehydrogenase which convert estradiol to the weaker estrone.
They- prevent reflux menstruation
- prevent implantation and growth
of regurgitated endometrium.
- Progestogens have anti-inflammatory effect.
Side effects weight gain, edema, irritability.
drshashwatjani@gmail.com 39
40. Danazol is a synthetic derivative of 17α-ethinyl
testosterone that was introduced into clinical practice
by Greenblatt in 1971.
The pharmacologic action of Danazol is complex,
directly inhibiting GnRH secretion. Midcycle LH surge
is ablated although basal gonadotropin concentrations
are maintained.
Direct inhibitions of steroidogenesis, increased
metabolic clearance of estradiol and progesterone.
Side effects- Weight gain, muscle cramps, increase
breast size, vasomotor symptoms.
drshashwatjani@gmail.com 40
41. GnRH agonists bind to pituitary GnRH receptors and
stimulate LH and FSH synthesis and release.
Agonists have much longer biologic half-life(3-8 hours) and
GnRH have(3-5 mint) continuous exposure of GnRH
receptors to GnRH agonist activity.
Ovarian steroid production is suppressed.
Side effects- Hypoestrogenism, hot flushes,
vaginal dryness, osteoporosis
drshashwatjani@gmail.com 41
42. This drug act by interrupting local estrogen
formation
With in the endometriosis implant themselves they
also inhibit estrogen production in the ovary,brain
and other source.
Side effect : Bone loss,development of multiple
follicles cyst at ovulation.
drshashwatjani@gmail.com 42
43. When medical measures fail surgical intervention is needed.
In most women with endometriosis, preservation of
reproductive function is most important.
The goal of surgery is to excise all visible endometriotic
lesions and associated adhesions like peritoneal lesions,
ovarian cysts, deep rectovaginal endometriosis and restore
normal anatomy.
Laparotomy should be reserved for patients with advanced
stage disease, who cannot undergo a laparoscopic procedure
and for those in whom fertility conservation is not necessary.
drshashwatjani@gmail.com 43
45. Conservative resection of disease by Laparotomy is most
valuable in case of extensive dense pelvic adhesions or
endometriomas greater than 5 cm in diameter.
Deep involvement of the rectovaginal septum with fibrotic
extension into perirectal fossa. Invasion of the bowel
muscular and endometriotic infiltration in the region of
uterine vessels and ureter. Are generally best approched
through the open abdomen.
Peritoneum – Small lesions of superficial peritoneal
endometriosis less than 5 mm in diameter are easily treated
with laser or bipolar coagulation or constant stream of
irrigation.
drshashwatjani@gmail.com 45
46. DIE CLASSIFICATION OPERATIVE PROCEDURE
(A) Anterior DIE
A1 : Bladder Laparoscopy partial cystectomy
(P) Posterior DIE
P1 : Uterosacral Laparoscopic resection of ligament
uterosacral ligament
P2 : Vagina Laparoscopic assisted vaginal
resection of DIE infiltrating
the posterior fornix.
P3 : Intestine
w/o vaginal infiltration ---- Intestinal resection
by laparoscopy or by Laparotomy
with vaginal infiltration ---- Laparoscopically assisted vaginal
intestinal resection or by Laparotomy
Multiple intestinal location ---- Intestinal resection by Laparotomydrshashwatjani@gmail.com 46
47. Surgical treatment of endometriosis less than 4-5 cm in
diameter.
Technique is initiated by longitudinally incising the cortex
overlying the cyst after achieving full mobilization of the
ovary.
Incision is made along the inferior pole on the opposite side
to the hilus to preserve the opposite side of ovarian tissue to
the fimbria.
The cyst contents are immediately drained with suction
cannula and cavity is irrigated and inspected for papillary
structure.
Very small endometriosis less than 1-2 cm in size may be
effectively treated by electro coagulation of the mucosal
lining.
drshashwatjani@gmail.com 47
49. Also called uterine endometriosis, in which islands of
endometrium are found in the wall of the uterus.
Observed commonly in elderly women.
Often coexists with uterine fibromyomas, pelvic
endometriosis, endometrial carcinoma.
Gross- Uterus appears symmetrically enlarged.
Histology- Islands of endometrial glands surrounded by
stroma.
C/F- Menorrhagia, progressively increasing
dysmenorrhoea, pelvic discomfort, backache,
dyspareunia.
drshashwatjani@gmail.com 49
50. C/E- Symmetrical enlargement of uterus, tender uterus.
Treatment- Diagnostic Hysteroscopy combined with
curettage.
Elderly- Total hysterectomy
-NSAID’s
-Hormonal therapy.
Drugs- Danazol, GnRH.
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