Endometriosis.pptx
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Endometriosis is a condition in which endometrium is located outside the normal uterine cavity. This presentation deals with causes, clinical features and management.
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Endometriosis.pptx
- 1. Endometriosis Dr.Chaduvula Suresh Babu Professor Department of Obstetrics & Gynaecology GIMSR, Visakhapatnam, AP
- 2. Definition • Ectopic presence of endometrial tissue outside the uterine cavity. • Endometrial tissue includes glands and stroma. • First described in 1860 - Rokitansky. • The ectopic tissue will induce chronic inflammatory reaction.
- 3. Types by Sampson • Endometrial tissues outside the uterine cavity – endometriosis externa • Endometrial tissue in the myometrium – endometriosis interna or Adenomyosis
- 4. Prevalence • 6-10 % • Mean age - 25-40 years
- 5. Etiology / Histogenesis / Pathogenesis • 1. Retrograde Menstruation and direct implantation by SAMPSON • 2. Coelomic metaplasia theory - Meyer & Ivanoff • 3. Vascular dissemination • 4. Lymphatic spread - Halbans • 5. Immunological defect • 6. Direct transplantation
- 6. Etiology • 7. Genetic factors • 8. Environmental factors – cosmetics, nail polishes, plastics, toxic chemicals • 9. Induction theory • 10. Circulating stem cells
- 7. Pathology • 1. Superficial Peritoneal endometriosis
- 8. Pathology • 2. Deep infiltrating Endometriosis [ DIE ]
- 9. Pathology • 3. Ovarian Endometrioma or Chocolate cyst
- 10. Sites • 1. Ovary • 2. Pelvic peritoneum – Anterior and Posterior culdesac • 3. Uterosacral ligaments • 4. Posterior surface of uterus • 5. Posterior leaf of broad ligament • 6. Others – appendix, caecum, sigmoid, scars, bladder, lungs, nose etc.,
- 11. Risk Factors • 1. Age – 25-35 years • 2. Delayed child bearing • 3. Shorter lactation • 4. Early menache • 5. Frequent cycles • 6. Late menopause • 7.Low BMI
- 12. Risk Factors • 8. Mullerian duct anomalies • 9. Genetic factor • 10. Past history of Asthma, allergies
- 13. Protecting factors • 1. Smoking • 2. Exrecise • 3. Oral contraceptives
- 14. Clinical features • A progressive disease with variable symptoms • 1. Pelvic pain • 2. Infertility • 3. Pelvic mass
- 15. Symptoms • 1. Triple dysmenorrhoea – spasmodic, congestive and progressive types • 2. chronic pelvic pain • 3. Deep dyspareunia • 4. Infertility • 5. Menstrual disturbances – heavy and or irregular bleeding
- 16. Symptoms • 6. Low backache • 7. Perimenstrual discomfort • 8. Others – Cyclical hematuria, hematemsis, epistaxis, scar bleeding or swelling • 10. Dyschezia
- 17. Signs • Fixed retroverted uterus • Lack of mobility • Adnexal mass • Local tenderness • Nodules in POD or over uterosacral ligaments • Rarely normal findings
- 18. Differential diagnosis • Chronic PID • Adenomyosis • Ovarian tumor • Irritable bowel syndrome • Pelvic congestion syndrome
- 19. Investigations
- 20. 1. Laparoscopy- Gold standard test
- 23. 3. CA 125 • Not a real diagnostic test • Does not correlate with symptoms • Non specific • It is also raised in Pregnancy, PID, Fibroid, Cancer ovary etc.,
- 24. Other investigations • 4. MRI • 5. CT Scan • 6. Histology of tissue
- 25. Laparoscopic appearence • Powder Burn or Gun Shot lesions • Black dark brown or bluish puckered lesion • Nodules or cysts • Fibrosis • Red lesions • White lesions
- 26. Black and Blue lesions
- 28. Yellow, nodule and cyst lesions with adhesions
- 29. Chocolate cyst
- 30. Staging by ASRM • Depending on • 1. Site • 2. Superficial or deep • 3. Presence or absence of Adhesions
- 31. ASRM Staging of Endometriosis • Stage 1. Minimal - 1--5% • Stage II – Mild - 6 – 15 % • Stage III – Moderate - 16 to 40 % • Stage IV – Severe - more than 40 %
- 32. Treatment • Expectant • Medical • Surgical – Conservative or Radical
- 33. Medical treatment • 1. Analgesics – NSAIDs • 2. Progesterones – • 3. Combination of Estrogens and Progesterones • 4. GnRH analogues • 5. Aromatase inhibitors • 6. Danazole • 7. Gestrinone • 8. Mirena
- 34. Surgical Treatment • Laparoscopy or Laparotomy • Conservative or Radical • Conservative – retain uterus and Ovary • Radical – Removal of Uterus and +/- Ovaries • Ovarian cystectomy or Oopherectomy • Laparoscopic fulguration • Hysterectomy
- 35. Infertility • Ovulation Induction drugs • Adhesiolysis • Tuboplasty • IUI • IVF • Adoption
- 36. Lap Cystectomy
- 38. Thank You All