This document provides information on endometriosis including:
- Definition, incidence, stages, and common sites of endometriosis implants. The most common sites are the ovaries, posterior and anterior cul-de-sac.
- Theories on the pathophysiology of endometriosis including retrograde menstruation, coelomic metaplasia, oxidative stress and inflammation, immune dysfunction, stem cells, and altered endometrial cell fate.
- Risk factors which increase likelihood of developing endometriosis include family history, nulliparity, early menarche, hormones, obesity, and uterine retroversion.
- Key aspects of evaluating a patient with endometriosis including
This document discusses endometriosis, which is a condition where cells similar to the endometrium grow outside the uterus, most often on the ovaries and surrounding tissues. It affects 6-10% of women and can cause pain, infertility, and other issues. The cause is unknown but theories include retrograde menstruation and genetic factors. Diagnosis involves a medical history, physical exam, ultrasound, and laparoscopy. Treatment options include pain medications, hormonal therapy to suppress menstruation, and surgery to remove lesions and restore anatomy. Left untreated, it can progress in severity over time.
This document discusses endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries and pelvic peritoneum. It causes pain and can lead to infertility. Adenomyosis involves the growth of endometrial tissue into the uterine muscle. Both can cause heavy periods and pain. Treatment involves medication, surgery, or hysterectomy depending on symptoms and desire for future fertility.
Endometriosis is a condition where endometrial tissue grows outside the uterus, commonly found in the ovaries, fallopian tubes, and other pelvic organs. Common symptoms include severe menstrual cramps, pelvic pain, heavy periods, pain with sex, and infertility in 30-40% of cases. The only way to definitively diagnose endometriosis is through a surgical laparoscopy. Treatment options include hormonal therapies like birth control pills, GnRH agonists, or surgery to remove endometrial growths, with hysterectomy being used in more severe cases.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, often attaching to other organs. It is a common disease among women of childbearing age that causes pain and sometimes infertility. While its exact causes are unknown, endometriosis is thought to be due to retrograde menstruation or genetic/immune factors. It has no cure and is diagnosed through laparoscopy, though various hormone treatments, surgery, pregnancy, and alternative therapies can help manage symptoms. Endometriosis can range from minimal to severe depending on the extent and location of tissue growth outside the uterus.
This document provides a review of diagnostic problems and unusual features in the pathology of endometriosis. It discusses how alterations to the typical glandular and stromal components, as well as other findings like cytologic atypia, hyperplasia, and tumor-like growths can complicate diagnosis. It also describes unusual locations for endometriosis and reactive changes that can occur nearby, as well as how recognizing endometriosis is important for explaining other pathological findings and distinguishing primary from metastatic tumors. The goal is to increase awareness of diagnostic pitfalls to avoid under-diagnosis or misdiagnosis of this common disease.
Endometriosis is a medical condition where endometrial tissue grows outside the uterus, commonly in the ovaries, fallopian tubes, and pelvic lining. It affects 6-10% of women and causes pain, irregular bleeding, and infertility. The exact cause is unknown but theories include retrograde menstruation, genetic factors, and environmental toxins. Diagnosis involves a medical history, physical exam, ultrasound, MRI, and laparoscopy to visualize lesions. Stages range from minimal to severe based on location, size, and depth of implants. Treatment focuses on pain management and hormone therapy to suppress menstruation. Differential diagnoses include pelvic inflammatory disease, ovarian cysts, and uterine fibroids.
Endometriosis and adenomyosis are common gynecological conditions where endometrial tissue grows outside or inside the uterus respectively. Endometriosis occurs when endometrial tissue implants itself in areas like the ovaries or pelvic wall, causing pain and infertility. Adenomyosis involves the growth of endometrial tissue deep in the uterine wall. Both are estrogen-dependent and resolve after menopause. Treatment options include medication to induce amenorrhea and reduce symptoms, or surgery for severe cases or women who have completed childbearing. Hysterectomy provides the only cure for adenomyosis.
This document provides information on endometriosis including its definition, incidence, pathophysiology, risk factors, symptoms, diagnosis, and treatment options. Some key points:
- Endometriosis is a condition where endometrial tissue grows outside the uterus, most commonly on the ovaries, pelvic peritoneum, and ligaments. Its cause is unknown but theories include retrograde menstruation and immune/genetic factors.
- It has a prevalence of 10% in women between menarche and menopause. Symptoms include pelvic pain, dysmenorrhea, and infertility.
- Diagnosis involves physical exam, ultrasound, and laparoscopy. Treatment options include pain management
This document discusses endometriosis, which is a condition where cells similar to the endometrium grow outside the uterus, most often on the ovaries and surrounding tissues. It affects 6-10% of women and can cause pain, infertility, and other issues. The cause is unknown but theories include retrograde menstruation and genetic factors. Diagnosis involves a medical history, physical exam, ultrasound, and laparoscopy. Treatment options include pain medications, hormonal therapy to suppress menstruation, and surgery to remove lesions and restore anatomy. Left untreated, it can progress in severity over time.
This document discusses endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries and pelvic peritoneum. It causes pain and can lead to infertility. Adenomyosis involves the growth of endometrial tissue into the uterine muscle. Both can cause heavy periods and pain. Treatment involves medication, surgery, or hysterectomy depending on symptoms and desire for future fertility.
Endometriosis is a condition where endometrial tissue grows outside the uterus, commonly found in the ovaries, fallopian tubes, and other pelvic organs. Common symptoms include severe menstrual cramps, pelvic pain, heavy periods, pain with sex, and infertility in 30-40% of cases. The only way to definitively diagnose endometriosis is through a surgical laparoscopy. Treatment options include hormonal therapies like birth control pills, GnRH agonists, or surgery to remove endometrial growths, with hysterectomy being used in more severe cases.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, often attaching to other organs. It is a common disease among women of childbearing age that causes pain and sometimes infertility. While its exact causes are unknown, endometriosis is thought to be due to retrograde menstruation or genetic/immune factors. It has no cure and is diagnosed through laparoscopy, though various hormone treatments, surgery, pregnancy, and alternative therapies can help manage symptoms. Endometriosis can range from minimal to severe depending on the extent and location of tissue growth outside the uterus.
This document provides a review of diagnostic problems and unusual features in the pathology of endometriosis. It discusses how alterations to the typical glandular and stromal components, as well as other findings like cytologic atypia, hyperplasia, and tumor-like growths can complicate diagnosis. It also describes unusual locations for endometriosis and reactive changes that can occur nearby, as well as how recognizing endometriosis is important for explaining other pathological findings and distinguishing primary from metastatic tumors. The goal is to increase awareness of diagnostic pitfalls to avoid under-diagnosis or misdiagnosis of this common disease.
Endometriosis is a medical condition where endometrial tissue grows outside the uterus, commonly in the ovaries, fallopian tubes, and pelvic lining. It affects 6-10% of women and causes pain, irregular bleeding, and infertility. The exact cause is unknown but theories include retrograde menstruation, genetic factors, and environmental toxins. Diagnosis involves a medical history, physical exam, ultrasound, MRI, and laparoscopy to visualize lesions. Stages range from minimal to severe based on location, size, and depth of implants. Treatment focuses on pain management and hormone therapy to suppress menstruation. Differential diagnoses include pelvic inflammatory disease, ovarian cysts, and uterine fibroids.
Endometriosis and adenomyosis are common gynecological conditions where endometrial tissue grows outside or inside the uterus respectively. Endometriosis occurs when endometrial tissue implants itself in areas like the ovaries or pelvic wall, causing pain and infertility. Adenomyosis involves the growth of endometrial tissue deep in the uterine wall. Both are estrogen-dependent and resolve after menopause. Treatment options include medication to induce amenorrhea and reduce symptoms, or surgery for severe cases or women who have completed childbearing. Hysterectomy provides the only cure for adenomyosis.
This document provides information on endometriosis including its definition, incidence, pathophysiology, risk factors, symptoms, diagnosis, and treatment options. Some key points:
- Endometriosis is a condition where endometrial tissue grows outside the uterus, most commonly on the ovaries, pelvic peritoneum, and ligaments. Its cause is unknown but theories include retrograde menstruation and immune/genetic factors.
- It has a prevalence of 10% in women between menarche and menopause. Symptoms include pelvic pain, dysmenorrhea, and infertility.
- Diagnosis involves physical exam, ultrasound, and laparoscopy. Treatment options include pain management
Endometriosis is a common benign gynecological condition defined by the presence of endometrial glands and stroma outside the uterus. It has a prevalence of 8-10% in reproductive aged women. Risk factors include early menarche, heavy periods, delayed childbirth, nulliparity, and family history. The exact cause is unknown but theories include retrograde menstruation implanting cells, coelomic metaplasia, and lymphatic/vascular spread. Common sites of lesions are the ovaries, pouch of Douglas, and uterosacral ligaments. Treatment involves laparoscopy for diagnosis and staging, with medical management using hormonal therapies or surgery for deep infiltrating disease.
Endometriosis is a condition where endometrial tissue grows outside the uterus, most commonly on the ovaries, pelvic peritoneum, fallopian tubes, and intestines. This ectopic tissue can cause severe pain, especially during menstruation. Symptoms include severe menstrual cramps, pain during or after sex, chronic pelvic pain, painful bowel movements or urination, and infertility. Diagnosis is made when biopsy of the ectopic tissue shows endometrial glands and stroma. Treatment options include hormonal medications like birth control pills or progestins to suppress menstruation, as well as surgery to remove the endometrial growths.
This document discusses endometriosis, a condition where endometrial tissue grows outside the uterus. It causes pain and infertility. The document covers the pathogenesis, risk factors, classification into superficial, ovarian, and deep infiltrating types based on location and severity. Symptoms include painful periods and sex. Diagnosis involves physical exam, ultrasound, MRI and laparoscopy. Staging uses the ASRM system from minimal to severe based on extent of disease and adhesions. Treatment aims to control symptoms and improve fertility.
This document discusses adenomyosis, including its definition, pathogenesis, clinical presentation, diagnostic modalities, and treatment options. Adenomyosis is defined as the benign invasion of endometrial glands and stroma into the myometrium. It most commonly presents in women aged 30-45 with symptoms like dysmenorrhea, heavy menstrual bleeding, and dyspareunia. Diagnosis can be made using ultrasound, MRI, or biopsy. Treatment involves conservative management, medical therapy like progestins or GnRH agonists, or surgical options such as hysterectomy or uterine-sparing procedures.
This document provides information on endometriosis from Dr. Shashwat Jani, including:
- Definitions and descriptions of endometriosis, including common sites of lesions.
- Theories on the causes and pathophysiology of endometriosis such as retrograde menstruation and coelomic metaplasia.
- Clinical features like pelvic pain and infertility.
- Diagnostic methods including clinical exam, imaging, biomarkers, and laparoscopy - the gold standard.
- Staging and treatment approaches are also briefly covered.
This power point describes in nut shell hte definition, etiopathogenesis, clinical features, gross , histological and MRI findings in adenomyosis and its management
gyanaecology.endometriosis and adenomyosis.(dr.salama)student
The document summarizes endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries, uterine ligaments and pelvis. It causes pain and infertility. Adenomyosis involves endometrial tissue in the uterine wall. Both can be diagnosed by laparoscopy and treated through drugs or surgery, with hysterectomy providing definitive treatment for severe adenomyosis.
Uterine polyps and fibroids are common benign uterine tumors. Uterine polyps can be endometrial, fibroid, adenomyomatous, or placental in origin. They typically present with menorrhagia, metrorrhagia, or postmenopausal bleeding. Diagnosis is usually made by ultrasound, and polyps can be removed by D&C or hysteroscopy. Fibroids are the most common benign tumors in women. They are estrogen dependent and present with heavy menstrual bleeding, infertility, pain, or an abdominal mass. Treatment involves medical therapy, myomectomy or hysterectomy depending on symptoms. Adenomyosis involves endometrial tissue within the myometrial
The document provides an overview of endometriosis, including its introduction, epidemiology, risk factors, sites, theories of pathogenesis, clinical features, types, and impact on fertility. It describes endometriosis as the presence of endometrial tissue outside the uterus, most commonly involving the ovaries, pelvic peritoneum, and deep infiltrating sites. Retrograde menstruation and coelomic metaplasia are discussed as theories for how it develops. Clinical features include pelvic pain and infertility.
Uterine leiomyomas, or fibroids, are benign smooth muscle tumors that arise from the uterus. They are very common, affecting approximately 25% of women. Symptoms vary depending on the size and location of the fibroids but can include heavy menstrual bleeding, pelvic pain and pressure, and pregnancy complications. Treatment options include observation for small asymptomatic fibroids, medical management to control symptoms, or various surgical procedures like myomectomy or hysterectomy to remove fibroids.
gynaecology.Benign tumor of the uterus.(dr.sundus)student
Benign disease of the uterus includes fibroids, adenomyosis, and uterine polyps. Fibroids are non-cancerous tumors that form in the uterus and are very common. They can cause heavy bleeding and pain. Uterine polyps are overgrowths of tissue in the uterus that can also cause abnormal bleeding. While many women do not experience symptoms, fibroids and polyps sometimes require treatment such as surgery to remove them.
This document discusses endometriosis and adenomyosis. It defines endometriosis as endometrial tissue growing outside the uterine cavity, most commonly in the pelvis. Symptoms include painful periods and infertility. Diagnosis requires laparoscopy. Treatment options include pain medications, hormonal therapies, and surgery. Adenomyosis involves the growth of endometrial tissue into the uterine muscle wall. It causes heavy painful periods and a swollen uterus. Ultrasound and MRI can identify adenomyosis, while treatment may involve hormones or hysterectomy.
This document discusses endometriosis and adenomyosis. It defines endometriosis as the presence of endometrial tissues outside the uterine cavity, which can be external or internal (adenomyosis). The most common sites are the ovaries, uterine cul-de-sac, and ligaments. Symptoms include infertility, pain, and bleeding. Diagnosis is via laparoscopy to visualize lesions. Treatment depends on symptoms and fertility goals, and can include medication, surgery, or a combination. The aim is to relieve pain and improve fertility where possible.
This document discusses benign cysts and tumors of the ovaries. It describes the main types of ovarian cysts which include follicular cysts, corpus luteum cysts, dermoid cysts, and endometriomas. It also outlines the two major classifications of ovarian tumors - non-epithelial tumors including germ cell tumors and stromal tumors, and epithelial tumors. Within these classifications, it provides details on specific tumor types such as mature cystic teratoma, dysgerminoma, granulosa cell tumor, and serous tumor. Risk factors, symptoms, staging, treatment and other considerations for ovarian cysts and tumors are summarized.
Endometriosis is characterized by the presence of endometrial tissue outside the uterus, commonly causing pelvic pain and infertility. It is a progressive disease that is diagnosed via laparoscopy. Treatment options include hormone therapy, surgery, or a combination, with the goal of relieving symptoms and potentially improving fertility. Recurrence rates after surgery are estimated to be around 19% after 5 years but are lower with more extensive surgical intervention such as oophorectomy.
Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity, which is commonly caused by retrograde menstruation or hormonal imbalances. Common sites of endometrial growth include the ovaries, cul-de-sac, and ligaments near the uterus. Symptoms include painful periods, pain with bowel movements and urination, infertility, and menstrual disturbances. Sonography can detect rounded masses with homogeneous internal echoes and increased through transmission, appearing as endometriomas that may be cystic or solid. Surgical removal is more effective for treatment than hormonal therapy alone.
The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.
Endometriosis is a disease where endometrial tissue grows outside the uterus, most commonly in the pelvis. It can cause pelvic pain, infertility, and other symptoms. Treatment involves surgery to remove lesions and adhesions, as well as medical therapy using hormones to suppress ovarian function and estrogen production. Newer medical treatments targeting aromatase and local estrogen production are also showing promise for reducing endometriosis-associated pain.
This document provides information on endometriosis including:
- Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum.
- Stages of endometriosis range from minimal to severe based on the extent of growth and severity of symptoms. Symptoms include pelvic pain and infertility.
- Risk factors include family history, early menarche, and nulliparity. Evaluation involves obtaining a detailed health history and performing a pelvic examination.
This document provides information on endometriosis including:
- Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum.
- Stages of endometriosis range from minimal to severe based on the extent of growth and severity of symptoms. Symptoms include pelvic pain and infertility.
- Risk factors include family history, early menarche, and nulliparity. Evaluation involves obtaining a detailed health history and performing a pelvic examination.
Haciendo Universidad, boletín semanal de la Universidad Católica Santa María la Antigua de Panamá.
Para mayor información contáctenos a :
dci@usma.ac.pa // 230-8200/8305
Endometriosis is a common benign gynecological condition defined by the presence of endometrial glands and stroma outside the uterus. It has a prevalence of 8-10% in reproductive aged women. Risk factors include early menarche, heavy periods, delayed childbirth, nulliparity, and family history. The exact cause is unknown but theories include retrograde menstruation implanting cells, coelomic metaplasia, and lymphatic/vascular spread. Common sites of lesions are the ovaries, pouch of Douglas, and uterosacral ligaments. Treatment involves laparoscopy for diagnosis and staging, with medical management using hormonal therapies or surgery for deep infiltrating disease.
Endometriosis is a condition where endometrial tissue grows outside the uterus, most commonly on the ovaries, pelvic peritoneum, fallopian tubes, and intestines. This ectopic tissue can cause severe pain, especially during menstruation. Symptoms include severe menstrual cramps, pain during or after sex, chronic pelvic pain, painful bowel movements or urination, and infertility. Diagnosis is made when biopsy of the ectopic tissue shows endometrial glands and stroma. Treatment options include hormonal medications like birth control pills or progestins to suppress menstruation, as well as surgery to remove the endometrial growths.
This document discusses endometriosis, a condition where endometrial tissue grows outside the uterus. It causes pain and infertility. The document covers the pathogenesis, risk factors, classification into superficial, ovarian, and deep infiltrating types based on location and severity. Symptoms include painful periods and sex. Diagnosis involves physical exam, ultrasound, MRI and laparoscopy. Staging uses the ASRM system from minimal to severe based on extent of disease and adhesions. Treatment aims to control symptoms and improve fertility.
This document discusses adenomyosis, including its definition, pathogenesis, clinical presentation, diagnostic modalities, and treatment options. Adenomyosis is defined as the benign invasion of endometrial glands and stroma into the myometrium. It most commonly presents in women aged 30-45 with symptoms like dysmenorrhea, heavy menstrual bleeding, and dyspareunia. Diagnosis can be made using ultrasound, MRI, or biopsy. Treatment involves conservative management, medical therapy like progestins or GnRH agonists, or surgical options such as hysterectomy or uterine-sparing procedures.
This document provides information on endometriosis from Dr. Shashwat Jani, including:
- Definitions and descriptions of endometriosis, including common sites of lesions.
- Theories on the causes and pathophysiology of endometriosis such as retrograde menstruation and coelomic metaplasia.
- Clinical features like pelvic pain and infertility.
- Diagnostic methods including clinical exam, imaging, biomarkers, and laparoscopy - the gold standard.
- Staging and treatment approaches are also briefly covered.
This power point describes in nut shell hte definition, etiopathogenesis, clinical features, gross , histological and MRI findings in adenomyosis and its management
gyanaecology.endometriosis and adenomyosis.(dr.salama)student
The document summarizes endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries, uterine ligaments and pelvis. It causes pain and infertility. Adenomyosis involves endometrial tissue in the uterine wall. Both can be diagnosed by laparoscopy and treated through drugs or surgery, with hysterectomy providing definitive treatment for severe adenomyosis.
Uterine polyps and fibroids are common benign uterine tumors. Uterine polyps can be endometrial, fibroid, adenomyomatous, or placental in origin. They typically present with menorrhagia, metrorrhagia, or postmenopausal bleeding. Diagnosis is usually made by ultrasound, and polyps can be removed by D&C or hysteroscopy. Fibroids are the most common benign tumors in women. They are estrogen dependent and present with heavy menstrual bleeding, infertility, pain, or an abdominal mass. Treatment involves medical therapy, myomectomy or hysterectomy depending on symptoms. Adenomyosis involves endometrial tissue within the myometrial
The document provides an overview of endometriosis, including its introduction, epidemiology, risk factors, sites, theories of pathogenesis, clinical features, types, and impact on fertility. It describes endometriosis as the presence of endometrial tissue outside the uterus, most commonly involving the ovaries, pelvic peritoneum, and deep infiltrating sites. Retrograde menstruation and coelomic metaplasia are discussed as theories for how it develops. Clinical features include pelvic pain and infertility.
Uterine leiomyomas, or fibroids, are benign smooth muscle tumors that arise from the uterus. They are very common, affecting approximately 25% of women. Symptoms vary depending on the size and location of the fibroids but can include heavy menstrual bleeding, pelvic pain and pressure, and pregnancy complications. Treatment options include observation for small asymptomatic fibroids, medical management to control symptoms, or various surgical procedures like myomectomy or hysterectomy to remove fibroids.
gynaecology.Benign tumor of the uterus.(dr.sundus)student
Benign disease of the uterus includes fibroids, adenomyosis, and uterine polyps. Fibroids are non-cancerous tumors that form in the uterus and are very common. They can cause heavy bleeding and pain. Uterine polyps are overgrowths of tissue in the uterus that can also cause abnormal bleeding. While many women do not experience symptoms, fibroids and polyps sometimes require treatment such as surgery to remove them.
This document discusses endometriosis and adenomyosis. It defines endometriosis as endometrial tissue growing outside the uterine cavity, most commonly in the pelvis. Symptoms include painful periods and infertility. Diagnosis requires laparoscopy. Treatment options include pain medications, hormonal therapies, and surgery. Adenomyosis involves the growth of endometrial tissue into the uterine muscle wall. It causes heavy painful periods and a swollen uterus. Ultrasound and MRI can identify adenomyosis, while treatment may involve hormones or hysterectomy.
This document discusses endometriosis and adenomyosis. It defines endometriosis as the presence of endometrial tissues outside the uterine cavity, which can be external or internal (adenomyosis). The most common sites are the ovaries, uterine cul-de-sac, and ligaments. Symptoms include infertility, pain, and bleeding. Diagnosis is via laparoscopy to visualize lesions. Treatment depends on symptoms and fertility goals, and can include medication, surgery, or a combination. The aim is to relieve pain and improve fertility where possible.
This document discusses benign cysts and tumors of the ovaries. It describes the main types of ovarian cysts which include follicular cysts, corpus luteum cysts, dermoid cysts, and endometriomas. It also outlines the two major classifications of ovarian tumors - non-epithelial tumors including germ cell tumors and stromal tumors, and epithelial tumors. Within these classifications, it provides details on specific tumor types such as mature cystic teratoma, dysgerminoma, granulosa cell tumor, and serous tumor. Risk factors, symptoms, staging, treatment and other considerations for ovarian cysts and tumors are summarized.
Endometriosis is characterized by the presence of endometrial tissue outside the uterus, commonly causing pelvic pain and infertility. It is a progressive disease that is diagnosed via laparoscopy. Treatment options include hormone therapy, surgery, or a combination, with the goal of relieving symptoms and potentially improving fertility. Recurrence rates after surgery are estimated to be around 19% after 5 years but are lower with more extensive surgical intervention such as oophorectomy.
Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity, which is commonly caused by retrograde menstruation or hormonal imbalances. Common sites of endometrial growth include the ovaries, cul-de-sac, and ligaments near the uterus. Symptoms include painful periods, pain with bowel movements and urination, infertility, and menstrual disturbances. Sonography can detect rounded masses with homogeneous internal echoes and increased through transmission, appearing as endometriomas that may be cystic or solid. Surgical removal is more effective for treatment than hormonal therapy alone.
The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.
Endometriosis is a disease where endometrial tissue grows outside the uterus, most commonly in the pelvis. It can cause pelvic pain, infertility, and other symptoms. Treatment involves surgery to remove lesions and adhesions, as well as medical therapy using hormones to suppress ovarian function and estrogen production. Newer medical treatments targeting aromatase and local estrogen production are also showing promise for reducing endometriosis-associated pain.
This document provides information on endometriosis including:
- Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum.
- Stages of endometriosis range from minimal to severe based on the extent of growth and severity of symptoms. Symptoms include pelvic pain and infertility.
- Risk factors include family history, early menarche, and nulliparity. Evaluation involves obtaining a detailed health history and performing a pelvic examination.
This document provides information on endometriosis including:
- Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum.
- Stages of endometriosis range from minimal to severe based on the extent of growth and severity of symptoms. Symptoms include pelvic pain and infertility.
- Risk factors include family history, early menarche, and nulliparity. Evaluation involves obtaining a detailed health history and performing a pelvic examination.
Haciendo Universidad, boletín semanal de la Universidad Católica Santa María la Antigua de Panamá.
Para mayor información contáctenos a :
dci@usma.ac.pa // 230-8200/8305
This document summarizes a model developed by Abbey Chaver and Benjamin LeRoy to optimize Amazon's last-mile delivery costs. The model considers three types of delivery drivers: guaranteed drivers who must be paid daily, option drivers who are paid a reservation price to be available, and spot drivers only paid when needed. The model determines the optimal number of each type of driver and their wages to minimize total expected costs, given daily demand distributions. Key terms, assumptions, and the objective cost function are defined. An example solution using reasonable parameter values is provided to test the model.
El documento habla sobre la toma de posesión de la nueva directiva de la Federación de Estudiantes y Asociaciones Estudiantiles (FEDEUSMA) para el periodo 2015-2016, la cual representa a 10 asociaciones estudiantiles. El acto se llevó a cabo en la Universidad Católica Santa María La Antigua y contó con la presencia de autoridades universitarias e invitados. Las nuevas juntas directivas de FEDEUSMA y las asociaciones estudiantiles prestaron juramento.
Jean Akisai is a Kenyan human resources professional with over 10 years of experience in HR management, administration, and compliance. She currently works as an HR & Administration Generalist for Tropical Power Kenya Ltd, where she coordinates HR functions and administrative duties. Previously, she held roles as a Compensation & Benefits Specialist for Aggreko International Power Projects and as a Human Resources Administrator for the same company. She holds diplomas in HR Management and Business Administration.
Monday February 6th Pine River AnnouncementsPine River
The announcements provide information for Pine River school on Monday February 6th. They note that tomorrow is grade 8 grad photo day and a staff meeting will be held starting at 3:20 pm. The junior intermediate hill is closed due to ice and "hands off" is still in effect on the yard. Birthday recognition is given and the gotcha winners for the day are named.
El documento habla sobre la recreación y su importancia para la salud física y mental. Define la recreación como actividades de diversión y entretenimiento que nos permiten descansar de las obligaciones cotidianas. Menciona que actividades recreativas como deportes y hobbies nos brindan sentimientos de bienestar. También destaca que la recreación es una actividad automotivada que se realiza con libertad y placer, ayudando al desarrollo personal.
El documento describe el proceso de atención de enfermería en la administración de medicamentos, el cual consta de 3 etapas: 1) Valoración, que incluye recopilar antecedentes del paciente y su perfil de medicación; 2) Intervención, que implica crear un plan de cuidados y administrar los medicamentos siguiendo las indicaciones; y 3) Evaluación, para determinar los efectos de los medicamentos y realizar modificaciones al plan si es necesario. El proceso asegura que los pacientes reciban los medicamentos de forma segura y efectiva.
El documento presenta la información sobre el Postgrado en Comunicación Social y Publicidad de la Universidad Católica Andrés Bello (UCAB), incluyendo sus directores, coordinadores académicos, misión, objetivos de formación, programas ofrecidos, líneas de investigación, publicaciones y ubicaciones donde se dictan los programas.
A rare case of rectus sheath endometriosis at caesarean section scarMishra Sunita
This case report describes a rare case of scar endometriosis of the rectus sheath in a 27-year old female with a history of 3 previous cesarean sections. She presented with cyclical pain over her cesarean scar that increased during her menstrual cycle. Examination revealed a tender mass over the scar site. After excision and histopathological examination, it was confirmed to be a case of scar endometriosis of the rectus sheath, with endometrial glands and stroma seen within the fibrocollagenous tissue of the sheath. Scar endometriosis is a rare entity that is usually a direct result of inoculation of endometrial tissue into the abdominal wall during
This case study describes a 27-year-old unmarried female who presented with recurrent left loin pain for 2 years. Imaging showed she had left hydroureteronephrosis secondary to a lower ureteric stricture, as well as pelvic endometriosis. She underwent diagnostic laparoscopy confirming stage III endometriosis involving her ovaries and ureter. She was initially treated conservatively with hormones but eventually required surgical excision of the endometriomas and ureteric stricture repair with uretero-ureterostomy. Histopathology confirmed endometriosis. Her symptoms resolved after surgery and she has been followed up for 9 months with no recurrence of obstruction.
1. Subtle or non-pigmented endometriosis (SE) lacks the classic black-blue appearance and can be found in red, white or clear forms.
2. SE are more common than classic dark lesions in adolescents and the most common type is white opacification. SE progress to classic lesions over time.
3. The new ASRM classification categorizes implants as red, white or black lesions. SE causes similar symptoms as classic endometriosis like pain and infertility.
4. A negative laparoscopy does not rule out endometriosis. Treatment is only needed if SE is causing symptoms. Red lesions may be an early stage while white lesions could be inactive.
Haciendo Universidad, periódico semanal de la Universidad Católica Santa maría la Antigua de Panamá.
Contenido:
USMA y Defensoría del Pueblo firman convenio de cooperación / Pág. 3
JUD presenta su plan de trabajo 2016 / Pág. 3
Presentan libro que recoge vida y obra de Monseñor McGrath / Pág. 4
La Pluma Invitada
Educando con las Redes Sociales / Pág. 5
Estudiantes participan en talleres de Servicio Social Universitario / Pág. 6
Sedes Universitarias
Sede USMA-Azuero realizó gira a la Reserva Forestal El Montuoso / Pág. 6
Comunidad Pastoral Universitaria
Dios el padre que nos quiere, desea y espera lo mejor para nosotros / Pág. 7
This module is the final module and it explores the concept of presenting the idea to target audiences. Within this module the key areas that are discussed are, improving communication skills, body language and managing nerves.
El día de las primicias es una de las Santas Convocaciones que El Eterno manda guardar a su pueblo una vez al año, durante la semana de la fiesta de Los Panes sin Levadura, durante el mes bíblico de Abib. Tristemente esta cita, tan importante, casi siempre pasa desapercibida ya que se le da mas importancia incluso a fiestas meramente tradicionales. El deseo de mi corazón es que mediante esta meditación en la Palabra del Creador puedas descubrir el significado espiritual que hay detrás de esta hermosa ordenanza que se encuentra en Levítico 23. Shalom.
This document discusses non-neoplastic disorders of the endometrium. It describes acute and chronic endometritis, adenomyosis, and endometriosis. For adenomyosis, it notes that it refers to growth of endometrial tissue into the myometrium, which can cause menorrhagia and pelvic pain. For endometriosis, it discusses the three theories of histogenesis and lists common locations including the ovaries. It also summarizes abnormal uterine bleeding and its causes including dysfunctional uterine bleeding from anovulation or an inadequate luteal phase.
Dr. Juhi Agrawal discusses endometriosis, a condition where endometrial tissue grows outside the uterus. It responds to hormones like normal endometrial tissue, causing bleeding and pain. The exact cause is unknown, but theories include retrograde menstruation and genetic and immunological factors. Common symptoms include pelvic pain and infertility. Diagnosis involves physical exam, imaging like ultrasound and MRI, though the only way to confirm is through laparoscopy and biopsy of lesions. Risk factors include early menarche and family history. Treatment focuses on pain relief and hormone suppression to stop tissue growth and bleeding.
Endometriosis is a benign condition where endometrial tissue grows outside the uterine cavity, most commonly in the pelvis. It causes painful periods, pain with intercourse, and pain with bowel movements. While its exact cause is unknown, retrograde menstruation is a leading theory. Diagnosis requires visualization of lesions via laparoscopy and confirmation with biopsy. Staging involves describing the location and extent of visible disease. Treatment options range from pain medication and hormonal therapy to surgery.
Endometriosis: an invisible and neglected disease that affects 180 million women. Celebrities and famous women over the years have been known to be affected by this Queen Victoria to Marilyn Monroe to Katrina Kaif who had surgery for endometriosis.
Endometriosis: an invisible and neglected disease that affects 180 million women. Celebrities and famous women over the years have been known to be affected by this Queen Victoria to Marilyn Monroe to Katrina Kaif who had surgery for endometriosis. The old theories of Endometriosis such as Sampsons Theory Angiogenesis, Lymphogenesis theory are no longer acceptable. The Epigenetic/ Genetic theorey has been postulated. ROle of biomarkers in diagnosis Risk factrs affecting Endometriosis and Risk of Cancer is discussed
3-Vulvar dystrophies. Erosion of cervix. Ectropion. Cervical intraepithelial ...HalaAlzamel
1. Chronic cervicitis and cervical erosion are the two most common cervical lesions encountered in clinical practice. Cervical ectopy (erosion) may be congenital or acquired due to hormonal effects.
2. Histologically, erosion appears as flat, papillary, or follicular epithelium. Healing occurs through replacement of columnar epithelium by squamous epithelium or metaplasia.
3. Ectopy is not considered precancerous. All cases should have cytological examination to exclude dysplasia or malignancy. Asymptomatic cases may not need treatment.
endometriosis is a common, benign, and chronic disease in women of reproductive age that is characterized by the occurrence of endometrial tissue ourside the uterus.
for more informations you can read this file.
Ovarian cysts are small fluid-filled sacs that can develop in a woman's ovaries. Most cysts are harmless, but some may cause problems like rupturing, bleeding, or pain. Diagnostic exams like ultrasound and laparoscopy can identify cysts. Surgical procedures like laparoscopy or laparotomy may be used to remove cysts. Nursing care focuses on pre-op teaching, post-op monitoring for complications, and managing pain. Dysmenorrhea refers to painful periods, which has primary and secondary types. Prostaglandins are thought to cause primary dysmenorrhea pain. Medical interventions for dysmenorrhea include NSAIDs and hormonal contraception to reduce prostagland
Endometriosis is a condition where endometrial tissue grows outside the uterus, most commonly on the ovaries, ligaments and peritoneal surfaces in the pelvis. It causes painful periods, pain with intercourse, and infertility. While the exact cause is unknown, retrograde menstruation is a leading theory. Diagnosis requires laparoscopy and biopsy of lesions. Treatment involves pain medication, hormonal therapy to induce a pseudo-menopause or pregnancy state, or surgery to remove the lesions. Conservative surgery aims to remove mild disease while radical surgery involving a hysterectomy and bilateral oophorectomy is used for severe cases.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
1. Endometriosis can negatively impact ovarian reserve by damaging follicles through inflammation, fibrosis, and reduced vascularization caused by the disease itself or surgery to remove endometriotic cysts.
2. Anti-Mullerian hormone (AMH) levels tend to be lower in women with endometriosis, with more severe reductions seen with bilateral disease, larger cysts, more fibrosis, and longer disease duration.
3. When considering surgery or fertility treatments for endometriosis patients with low ovarian reserve, factors like the woman's age, infertility duration, pelvic pain levels, recurrence risk, and ovarian reserve markers must be evaluated individually to optimize outcomes while preserving future fertility potential.
The peritoneum is a membrane that lines the abdominal cavity. In women, the peritoneum is an "open system" interrupted by the fallopian tubes, allowing transmission between the genital tract and peritoneal cavity. Many inflammatory conditions can involve the peritoneum. Endometriosis is a common condition where endometrial tissue grows outside the uterus, often on the ovaries or peritoneum. Symptoms include pelvic pain and infertility. Mesothelial tumors of the peritoneum range from benign to aggressive malignancies. Serous tumors are the most common type of peritoneal tumor and can be borderline or adenocarcinomas.
Endometriosis is a condition where endometrial tissue grows outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic peritoneum. It causes pain and infertility and is most common during reproductive years. Theories for its cause include retrograde menstruation and genetic/immunological factors. Diagnosis involves symptoms, exam, laparoscopy, and imaging. Treatment options include pain medications, hormonal therapy like combined oral contraceptives or GnRH agonists, and surgery to remove lesions. While not curable, treatment aims to control pain and improve fertility.
Endometriosis is a disorder where tissue similar to the uterine lining grows outside the uterus, most commonly on the ovaries, fallopian tubes, and tissues lining the pelvis. Main symptoms include pelvic pain and infertility in nearly half of those affected. While the exact cause is unknown, possible explanations include retrograde menstruation, transformation of peritoneal cells, and transportation of endometrial cells through blood or lymphatic vessels. Treatment options include pain medication, hormone therapy using contraceptives or GnRH agonists/antagonists, and surgery for severe cases or infertility.
An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus.
Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus.
It is the benign kind of Gestational Trophoblastic Disease (GTD) while the cancerous kind is Invasive mole, Epithelioid trophoblastic tumor, Choriocarcinoma and Placental Site Tumor. H. Mole could lead to Invasive moles or Choriocarcinoma if not treated immediately with prophylactic chemotherapy.
This document provides an overview of endometriosis, including its definition, pathology, clinical diagnosis, differential diagnosis, relationship to endometrial cancer and menopause, etiologies and theories, and treatment options. Key points include that endometriosis is the growth of endometrial tissue outside the uterus, which can cause pelvic pain and infertility. Diagnosis involves physical exam and laparoscopy with biopsy. Treatment involves medications like danazol or GnRH agonists to suppress hormones, or surgery to remove endometrial lesions and adhesions. Recurrence is common without continued treatment.
Leiomyoma is a benign smooth muscle tumor that is the most common tumor in females of reproductive age. It presents as round, gray-white nodules within the myometrium. Leiomyosarcoma is a rare malignant tumor that arises from the myometrium and can disseminate widely. Abnormal uterine bleeding is a common gynecologic problem that can be caused by organic lesions, anovulatory cycles, or other disorders and has various histological presentations depending on the cause.
Endometriosis is a disease where endometrial tissue grows outside the uterus, most commonly on the ovaries, fallopian tubes, and peritoneum. It typically affects women during their reproductive years and some of the main symptoms include painful periods, pain with intercourse, and infertility. Diagnosis involves a combination of clinical examination, imaging like ultrasound, and laparoscopy which remains the gold standard for direct visualization and biopsy of suspicious lesions. Common signs seen at laparoscopy include powder burn-like black or blue lesions on the pelvic organs and peritoneum.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
4. Clinical Evaluation of patient with endometriosis
History
Examination
Diagnosis
Treatment
Complication
Differential diagnosis
Prevention
Prognosis
Follow-up
Conclusion
5.
6. Functional human uterus are receiving the
embryo, to give shelter to the foetus during
pregnancy and delivering the newborn at
term. The uterus is a pear-shaped, muscular,
hallow organ with a triple-layered wall:
i. Myometrium (middle tunica mucosa)
ii. Perimetrium ( outer tunica serosa)
iii. Endometrium (inner most layer)
7. Endometriosis is originated from the word
endometrium.
The endometrium is the layer in which the
implantation takes place. It experiences
morphologic and functional changes that are
closely associated with the cyclic release of
sexual hormones.
In the light of the above, if implantation
doesn't occur the layer of the endometrium
shed and expulsed, leading to menstruation.
8. Endometriosis is a benign gynaecological disease
characterized by the presence of functional
endometrial glands and stroma outside the uterus
(ectopic).
In a typical patient, the ectopic implants are
located
in the dependant portions of the female pelvis:
9.
10. Because is a chronic oestrogenic-
dependant inflammatory disease, it
therefore affects approximately 10%
of women of reproductive age.
11. The public health burden of endometriosis
remain elusive because of the mode of
diagnosis of the disease, giving us a lack of
reliable data annually.
Moreover many women are asymptomatic
and endometriosis lesions heal
spontaneously in them without a diagnosis
been previously made.
13. There is a 10-folds increase incidence in women
with an affected first degree relative(family
history). And as well as monozygotic twins are
markedly concordant for endometriosis.
Rate of endometriosis was found to increase
with age from 12% in females ages 11-13 years
to 45% in females aged 20-21years and peak
incidence between ages of 25 and 35 years.
14. Endometriosis is classified into one of four
stages depending on the following;
Size, location
Type
Extent
Depth of endometriosis implants
Presence and severity of adhesions
Presence and size of ovarian endometriomas
18. 1. Superficial peritoneal lesions is typically
located on the pelvic organs /pelvic
peritoneum
subtypes:
I. Classic bluish or blue-black lesion
(powder-burn)
II. Non-classic lesions or clear and red or
white lesions (flame-like)
2. Endometrioma /Endometriotic Cyst
3. Deep endometriosis
19.
20. Stage I
Stage II
Stage III
Stage IV
minimal 1-5
mild 6-15
moderate 16-40
severe >40
21. Minimal (stage I) or mild(stage II)
endometriosis, is characterized by superficial
implants and mild adhesions. And majority of
women have these stage of endometriosis.
While moderate(stage III) and severe(stage IV)
endometriosis is characterized by chocolate
cysts and more sever adhesions. The stages of
endometriosis is not a criteria for the presence
of severity of symptoms, in the same vain
infertility is likely with stage IV endometriosis.
22.
23.
24. 1.Retrograde Menstruation
Retrograde menstruation theory is one of the
oldest principle that explains the
aetiopathogenisis of endometriosis, this occur
due to the retrograde flow of sloughed
endometrial cells/debris via the fallopian
tubes into the pelvic cavity during
menstruation.
However, retrograde menstruation occurs in
76%-90% of women with patent fallopian
tubes and not all of these women have
endometriosis.
25. Factors obstructing menstruation are,
congenital abnormalities, including
imperforate hymen and iatrogenic
cervical stenosis etc.
The location of superficial
endometriotic lesions in the posterior
aspect and left side of the pelvis may be
due to the effects of gravity on
regurgitated menstruation product and
the anatomical position of the sigmoid
colon.
26. 2.Coelomic Metaplasia
These theory postulates the origin of
endometriosis from metaplasia of specialised
cells that are present in the mesothelial lining
of the visceral and abdominal peritoneum
Hormonal or immunological factors
stimulates the transformation of normal
peritoneal tissue/cells into endometrium-like
tissue.
27. These theory clearly explains the occurrence of
endometriosis in pre-pubertal girls even thou
oestrogen which is the driving force of endometrial
growth is not present in them and therefore this
condition may be different from endometriosis that
is found in women of reproductive age.
According to this theory, residual embryonic cells of
the wolffian or mullerian ducts persist and develop
into endometriotic lesions that respond to oestrogen.
these describes the hormon-dedpendent
transformation of peritoneal cells into mullerian-
type cells in adolescent.
28. 3. Oxidative stress and
inflammation
Reactive oxygen species (ROS) causes lipid
per-oxidation which leads to DNA damage in
endometrial cells, resulting to increase
water and electrolyte in the peritoneal fluid
which harbours the source of ROS.
Iron overload occur in the peritoneal
cavities from the breakdown of
haemoglobin, which in turn causes redox
reaction.
29. The release of the pro-inflammatory
heam products and the oxidative stress
signals generated from the ROS causes
inflammation which leads to the
recruitment of lymphocytes and
activated macrophages producing
cytokines that induce oxidizing of
enzymes and promotes endothelial
growth.
30. excess proliferation of ROS is accomplished
by a decreased level of antioxidants which
usually eliminates these molecules.
The resulting accumulation of ROS may
contributes to the propagation and
maintenance of endometriosis and
associated symptoms.
31. 4. Immune Dysfunction
Autoimmune disease is more
common in women with
endometriosis. This is due to
regurgitation of endometrial cells
into the peritoneum which triggers an
inflammatory response causing the
recruiting of activated macrophages
and leukocytes.
32. This inflammatory response leads to a
defective immune-surveillance that prevents
elimination of the menstrual debris and
promotes the implantation and growth of
endometrial cells in the ectopic sites.
These theory explains better why women
with endometriosis have higher
concentration of activated macrophages,
decreased cellular immunity as well as a
repressed NK cell function.
33. 5.Stem Cells
stem cells are undifferentiated cells,
characterized by their ability to self-renew
and differentiate into one or several types of
specialized cells.
Due to the natural ability of the stem cells to
regenerate, the stem cells then give rise to new
Endometriotic deposits, these pathogenesis
supports the possibility of retrograde
menstruation which provides an access for the
endometrial stem cell to extra uterine
structure.
34. Monthly, there is regeneration of the
endometrium after menstrual shedding and re-
epithelisation of the endometrium after
parturition or surgical curettage, these all
support the existence of a stem cell pool and
resides in the basalis layer of the endometrium.
Resulting in the formation of ectopic
endometrial lesions.
However these stem cells may be transported
via the lymphatic or vascular pathways to
ectopic sites. Some of the endometrial stem
cells have bone marrow origin and further
supports the haematogenous dissemination
theory of these cells.
35. 6. Apoptosis Suppression and
Alteration of Endometrial Cell Fate
Alteration of the endometrial cell fate to favour
antiapoptotic and pro-proliferation phenotype is
paramount for the survival of the endometrial cells in
the peritoneal cavity to initiate ectopic deposits and for
the maintenance of the established lesions.
The inhibition of the apoptosis of endometrial cells
may also be mediated by the transcription activation of
genes that normally promotes inflammation,
angiogenesis, and cell proliferation.
36. Red lesions /early endometriosis
Black lesions /advanced
endometriosis
White lesions / healed endometriosis
37. Genetics (positive family history)
Nulliparity
Early menarche
Hormones
Obesity
Uterine retroversion
Miscarriage.
38. Although a significant number of women with
endometriosis remain asymptomatic, but
symptomatic patients can be variable and
reflects the depth and area of involvement.
Signs and symptoms includes:
1.Pelvic pain
2.Dysmenorrhoea
3.Dsyparinuria
39. 4.Dysuria
5.Dyschesia (pain on defecation) often with cycles of
diarrhoea and constipation
6.Lower abdominal pain or back pain (worsen during
menstrual period)
7.Inguinal pain
8.Pain during exercise
9. Heavy or irregular bleeding
10. Bloating, nausea and vomiting
42. History taking is an essential aspect in the
evaluation of a patient with endometriosis, the
following guidelines must be observed.
Having completed your bio data, the necessary
important history based on the chief
complaints of the patient with endometriosis
must be asked.
Infertility/ pain is usually the chief
complains of patients with
endometriosis.
44. 2. Menstrual History
Menarche and menopause
1st
day of last menstrual period
Length of bleeding
Frequency
Regularity
Bleeding between periods
Bleeding after intercourse
Post menopausal bleeding
Nature of periods
Heavy?
Clots?
Flooding?
45. 3. Past Gynaecological History
Gynaecological symptoms
Gynaecological diagnosis
Gynaecological surgery
Date & result of cervical smears
Conception
46. 4. Past Obstetrics History
Gravity & Parity
Dates of deliveries
Length of pregnancy
Mode of delivery
Weight of babies
Sex of babies
Complication before, during & after delivery
Days spent before discharged.
47. 5. Past Medical History
Current or past illnesses
Hospital admission
Past surgeries
48. 6. Drug History
Current medication
Prescribed/ over the counter medication
Herbal Remedies
Recreational drugs
Any known drug allergies.
49. 7. Contraception
Types of contraception
Side effects of contraception
Any history of unprotected intercourse
50. 8. Family History
History of endometriosis (occurs 10 times in
someone with positive family history)
Gynaecological condition
Malignancies
Consanguinity
History of demise, causes and age at demise.
51. 9. Social History
Occupation
Alcohol, how often and quantity
Smoking, how often.
52. 10. Other history
Sleep pattern
Change in bowel movement
Micturation
Defecation
Weight loss/gain
Addiction
53. Majority of patient with endometriosis do not
frequently present with physical findings beyond
tenderness related to the site of involvement. The
hallmark of finding on examination of a patient
with endometriosis is pelvic examination. Major
finding:
On pelvic examination
Tender nodular masses
Adenexia mass
Bluish nodule is seen as a result of infiltration
from the posterior vagina wall.
Cervicities
Foul smelling vaginal discharge
54.
55. Methods of diagnosis
1. Invasive diagnosis
a. Laparoscopy
b. Microlaparoscopy
2. Non invasive diagnosis
a. Therapeutic trials
b. Imaging: USS,CT, MRI
c. Endometrial nerve fibers
d. Serum markers
v. Other.
56. Invasive Diagnosis
Laparoscopy: is the gold standard diagnostic
test.
Advantages
1. Excludes other condition e.g. ovarian cancer
2. Treatment of endometriosis
Disadvantages
1. requirement for surgery and anaesthesia
2. risk of major complications (bowel perforation)
3. visible inspection doesn't detect deep
endometriosis.
57. Technique
It has two approaches which includes;
Inspection of D pouch, US lig, Pelvic side
walls, Anterior surface of the ovary
(adhesion). It endure complete evaluation,
inspection of the pelvic is in a clockwise
fashion.
Biopsy in case there is a doubt.
58. Findings:
A. Peritoneal
i. Typical endometriosis : Black-blue, powder-burn
appearance, and doesn't require any biopsy.
ii. Atypical endometriosis: Lesion that lacks the
typical black-blue, powder-burn appearance but
however diagnosis may be difficult with standard
laparoscopy so biopsy is necessary for confirmation
of diagnosis.
B. Endometrioma
59. 1. Near-contact: it magnifies the peritoneal area
2. Peritoneal blood painting: flowing erythrocytes
outline surface irregularities.
3. Examined from different angles and at
different degrees of illumination: it shows
vesicles or whitish lesions.
4. Direct vision
5. Laparoscopic visualization of peritoneal lesions
is of limited accuracy, and biopsy confirmatory.
6. Bubble test: posterior cul de sac is irrigated with
short bursts of saline under controlled pressure. It
increases the level of triglycerides in the
peritoneal fluid.
61. Non Invasive Diagnosis
Therapeutic trials
i. Pain suggestive of endometriosis
ii. Women not trying to conceive
iii. No pelvic mass
Chronic pelvic pain
i. Unrelated to menstruation
ii. Unrelieved by NSAID & antibiotics
iii. Is clinically suspected.
62. Imaging
1. Transvaginal ultrasound
First line investigational tool for the suspecting
endometriosis
Visualization of deep nodules (retrovaginal
septum)
Results :
Anechoic to echogenic cysts
Masses containing multiple septations & solid
tissue
Cysts with low-level echoes ( this is the
commonest finding 0f about 95%).
63. 2. Transrectal ultrasound: it detect
Rectal involvement
Depth of infiltration
Lesions on the posterior bladder wall.
3. CT : it has an important role in detecting an
unrelated involvement and possible renal
insufficiency.
It has been replaced by MRI due to,
poor specificity
High radiation
64. 4. MRI: it helps to detect pigmented hgic lesion and
inadequately localized lesions.
Posses greater sensitivity which detects about
75% of mild disease
Evaluation of deep lesions
Is also superior to ultrasound in diagnosis
rectosigmoid lesions and bladder of the
endometriosis
Disadvantages
It is expensive
And not readily available
65. 5. Endometrial nerve fibers: they are
reported to be small unmyelinated
sensory C fibers in the functional layer
of endometrium which are identified by
their staining with PGP9.5, VIP, and
substance P, but not with neurofilament
66. 6. Serum makers: is a useful marker for
monitoring treatment.
Others:
Cystoscopy : for bladder endometriosis
Sigmoidoscopy or colonoscopy: for transmural
bowel lesions
Ultrasound-guided fine needle aspirate: for
endometriosis in the rectosigmoid ,
rectovaginal septum, or in abdominal scars.
IVP, barium study.
67.
68. Treatment for endometriosis can be
expectant, medical, or surgical depending on
location, depth, severity of symptoms and as
well as the desire of the patient to maintain or
restore fertility.
Medical treatment:
Is used in patients with pelvic pain or
dyspareunia and the aim of treatment is to
focus on hormonal manipulation of the
menstrual cycle to create the state of
pseudopregnancy, pseudomenopause, or
chronic anovulation..
69. Medication includes
1. Danazol
2. Gonadotropin-releasing hormone agonists
3. Oral contraceptive pills and other
4. Progestational agents
70. Surgical treatment can be :
A. Conservative
B. Definitive
A. Conservative Surgery
These can be performed with laparoscopy or
laparotomy
And the success rate is however high, but
implant recurrence occurs in 28% of patient
at 18 months after surgery and 40% by 9
years.
Adhesion recur in 40-50% of patients
71. B. Definitive surgery
These include
Hysterectomy and oophorectomy
Is usually reserved for women with
intractable pain. And in one severe cases, one
ovary may be retained.
Endometriosis may recur with exogenous
estrogens replacement therapy, even in
patient who has undergone oophorectomy.
72.
73. Complications of endometriosis includes the
following:
1. Bleeding : forming bands of scar tissue leading to
adhesion which then attaches to the organs in the
pelvis and abdomen.
2. Infertility : usually of unknown origin, and may be
caused by adhesions forming on or close to the
ovaries and fallopian tubes.
3. Miscarriage or premature birth
4. Cancer (most esp. Ovarian cancer)
5. Blocked or twisted bowel : due to endometriosis
of the intestine
6. Adhesion
76. Prevention of endometriosis includes a wide
range of activities known as interventions
Its aim is to reduce risks of threats to health.
These leads us to the three categories of
prevention of endometriosis;
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
77. Primary prevention:
Its aim at preventing disease or injury of
endometriosis before it ever occurs.
This is done by;
i. Preventing exposures to hazards that can cause
disease or injury which alters unhealthy
behaviours that can lead to endometriosis.
ii. Enforcement to ban or control the use of
hazardous substances.
iii. Education about healthy and safe habits.
78. 2. Secondary prevention:
Aims to reduce the impact of endometriosis or
injury that has already occur. This is done by;
i. Regular examination and screening to detect
endometriosis in its earliest stage.
ii. To treat endometriosis as soon as possible to slow
its progression.
ii. Encouraging personal strategies to prevent re-
injury or recurrence, and implementing programs
to return people to their original health.
iv. To prevent long-time complications of
endometriosis.
79. 3. Tertiary prevention:
Aim to reduce the impact of an ongoing illness or
injury that has lasting effects, and is done by;
i. Helping people to manage long-term, often-
complex health problems and injuries, in order to
improve as much as possible their ability to
function, their quality of life and life expectancy.
ii. Support groups that allow people to share
strategies for living well
iii. Vocational rehabilitation programs to recover as
early as possible.
80.
81. The recurrence rate five years following surgery
is between 20% and 40%, providing menopause
has not been reached and hysterectomy has not
been performed
Women who have undergone treatment for
endometriosis needs to attend periodic
examinations so they can be monitored using
sonography
Note that endometriosis may recur after surgery
or medical intervention if the underlying p causes
is not probably treated.
82. Endometriosis is often a chronic disease, and
thorough discussions to ensure a good level of
patient understanding is essential.
It’s important to assess your level of symptoms,
your desire to have children in the future, as well as
your social and occupational needs for better health.
Comprehensive follow-up will aid in the assistance
of total rehabilitation.
83. Majority of patients with endometriosis will
have increasing fertility problems.
Fortunately, the results of assisted
reproduction (such as IVF) after treatment
for endometriosis are very good.
While some of these patients , even if they
have an initial problem with their fertility,
end up becoming pregnant after adequate
and carefully monitored treatment.
84. In the same vain, some patients will require
a higher level of technology to achieve a
pregnancy, such as IVF or GIFT.
Note that, pregnancy is not a complete and
definitive cure for endometriosis, the
combination of pregnancy and breastfeeding
significantly slows down the course of the
disease and may even get rid of it entirely.