Endometriosis د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد
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1 Endometriosis د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد
2 Objectives:- To know what is endometriosis The sites where it occur To explain its itiology & pathogenesis To know the clinical features of this disease & how to diagnose & treat it To know the mechanism by which this disease cause infertility
3 Definition :- Endometriosis defined as presence of endometrial surface epithelium & or endometrial glands & stroma outside the uterine cavity.
4 Sites of endometriosis:- Ovaries. Fallopian tubes The back of the uterus Within the myometrium & called adenomyosis. broad ligament. Pelvic peritoneum Intestines, most commonly the rectosigmoid Urinary bladder and ureters. Vulva,vagina Lung Abdominal scars.
5
6 Ruptured left endometrioma of ovary
7 Endoscopic pcture of endometriotic spots in POD & uterosacral ligament.
8 Etiology &Pathogenesis:- 1. The implantation theory & menstrual regurgitation. 2. Coelomic metaplasia theory. 3. Lymphatic & vascular dissemination. 4. Genetic & immunological factors.
9 Pathogenesis:- Peritoneal endometriosis:- 1-Red endometriosis. 2- Black endometriosis. 3- White endometriosis. Ovarian endometriosis:- Endometrioma ( choclate cyst) Rectovaginal endometriosis.
10 Clinical features :- 1- Asymptomatic. 2- Pelvic pain chronic pelvic pain, congestive dysmenorrhea deep dyspareunia( painful intercourse, dysurea urinary urgency, frequency, and sometimes painful voiding, dyschesia 3- Infertility 4- Features of acute abdomen due to rupture or torsion of endometrioma 5- Menorrhagia & irregular menses.
11 6- Abdominal & pelvic mass. 7- Cyclic heamaturia, cyclic rectal bleeding. 8- Cyclical pain & bleeding from umbilicus or surgical scars. 9- Cyclical heamoptysis & heamopneumothorax if involve the lungs. 10- O/E fixed RV uterus with hard tender nodules, adnexial mass of endometrioma.
12 Investigations:- 1) Laprascopy:- it remain the goldstand means of diagnosing the condition it visualize # white thickening scar of endometriosis # fixed RV uterus # burn match stick appearance #adhesion # choclate cyst in the ovaries # heamatosalpinx # it allow take a biopsy from the lesion & give a benefit to determine the extent of the disease & staging, also it allow concurrent therapy at the time of laprascopy in the form of cautery or laser treatment in selected cases.
13 2) USS:- help in diagnosis of endommetrioma. 3) Ca125 level :- this is a glycoprotien expressed by some epithelial cells of coelomic origin it increase in cases of endometriosis.
14 4) MRI:- this can detect endometriosis in ovaries or bladder or bowel & rectovaginal septum.
15 Endometriosis & Infertility: % of pt with endometriosis have infertility & about 15% of pt with infertility have endometriosis. Mechanism by which endometriosis cause infertility are :- 1) Ovarian function 2) Tubal function. 3) Coital function. 4) Sperm function. 5) Early pregnancy failure. 6) adhesions.
16 Treatment of endometriosis:- Medical treatment or surgical treatment 1) Medical treatment :- a) COC P. b) Danazole & gestrinone. c) Progestogens. d) LHRH analogue. e) NSAID.
17 Surgical treatme:nta) Conservative surgery by using laprascopy b) Radical surgery by TAH&BSO in old age pt &who complete her family, postoperative HRT can be used especially in young age women but it is preferred to delayed for 6 months or more to minimize the risk of recurrence.
18 Adenomyosis # Repeated pregnancy. # vigourous curretage. # endometrial hyperplasia. Pathology:- The uterus is symetrically enlarged, the lesion could be localized or diffused throught the uterine wall, cystic space filled with blood within myometrium on HP exam.
19 Clinical features:- *** Menorrhagia *** Secondary dysmenorrhea. *** Pelvic discomfort & dysparonia. *** O/E bulky symetrically enlarged tender uterus with regular outline. Diagnosis:- 1) USS 2) MRI 3) Biopsy & HP exam.
20 Treatment:- 1) Medical treatment as danazole, gestrinone, GnRH agonist as for endometriosis. 2) surgical treatment:- hysterectomy.
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