endometriosis

Question 1

endometriosis

Answer 1

endometrial tissue outside of the uterus

- found in the fallopian tubes, ovaries or ovarian ligaments

Question 2

aietiology of endometriosis

Answer 2

1. retrograde menstruation theory - blood carrying endometrial cells and tissue migrate to the fallopian tubes and other structures during menstruation
2. dysfunction of immune system - b cells + t cells do not recognise benign endometrial tissue
3. Metaplastic theory - cells of the peritoneum can transform into endometrial tissue
4. can travel via lymph nodes and blood
5. stem cells can differentiate into

Question 3

risk factors for endometriosis

Answer 3

1. family history of endometriosis
2. late menopause
3. early menarche
4. nulliparity

Question 4

pathophysiology of endometriosis

Answer 4

1. ectopic tissue is benign and doesn’t grow out of control
2. ectopic tissue still has - oestrogen receptors thus responds by proliferating and secretion during menses
3. Ectopic endometrial tissue ;
   - higher levels of enzyme aromatase which produces its own oestrogen
   - releases pro inflammatory factors which causes inflammation and scarring
4. Scar tissue forms adhesions - binding of organs and structures
   - promotes growth of new blood vessels to keep endometrial tissue alive
5. changes in hormone levels causes ectopic to bleed

Question 5

complications of endometriosis

Answer 5

1. endometriomas - chocolate cysts containing old, dark blood and shed tissue
   - could rupture and cause more pain and inflammation
2. increases mutations in certain genes - PTEN - increases risk of ovarian cancer
3. Subfertility - 30 - 40% of women subfertile due to inflammation and scarring

Question 6

symptoms - dependent on location of endometrial cells

Answer 6

1. Pelvic pain
2. bleeding
3. dysmenorrhea - painful menstruation
4. dyspareunia - painful sexual intercourse
5. POUCH OF DOUGLAS - dyschezia (pain with defecation)
6. Bladder - urgent/frequent/painful urination
7. Intestines - abdominal pain
   ( generally symptoms get worse during periods )

Question 7

diagnosis

Answer 7

1. gold standard - laproscopy

2. confirm - biopsy