{"id":6369,"date":"2017-05-27T23:11:24","date_gmt":"2017-05-27T19:11:24","guid":{"rendered":"http:\/\/aroxjblog.am\/?p=6369"},"modified":"2017-05-27T23:13:41","modified_gmt":"2017-05-27T19:13:41","slug":"endometriosis-management","status":"publish","type":"post","link":"https:\/\/aroxjblog.am\/en\/endometriosis-management\/","title":{"rendered":"Endometriosis management"},"content":{"rendered":"

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DEFINITION<\/strong>
\nEndometriosis is defined as the presence of functioning endometrial glands and stroma outside the uterine cavity .
\nPHYSICAL FINDINGS AND CLINICAL PRESENTATION<\/strong>
\n\u25cf Classic triad is dysmenorrhea, dyspareunia, and infertility.
\n\u25cf Presence of pelvic pain not correlated with the total area of endometriosis, type of lesion, or volume of disease, \u00a0 \u00a0\u00a0 but it is correlated with the depth of infiltration.
\n\u25cf Other symptoms include: abnormal bleeding (premenstrual spotting, menorrhagia), cyclic abdominal pain, intermittent constipation\/diarrhea, dyschezia, dysuria, hematuria, urinary frequency
\n\u25cf Rare manifestations: catamenial hemothorax, bloody pleural effusion, massive ascites occurring during menses
\n\u25cf Most severe discomfort is associated with lesions 1 cm in depth
\n\u25cf Bimanual examination may reveal tender uterosacral ligaments, cul-de-sac nodularity, induration of the rectovaginal septum, fixed retroversion of the uterus, adnexal mass, and generalized or localized tenderness.
\n<\/a>
\nCAUSE<\/strong>
\n\u25cf Reflux and direct implantation theory: retrograde menstruation with implantation of viable endometrial cells to surrounding pelvic structures
\n\u25cf Celomic metaplasia theory: transformation of multipotential cells of the coelomic epithelium into endometrium-like cells
\n\u25cf Vascular dissemination theory: transport of endometrial cells to distant sites via the uterine vascular and lymphatic
\nsystems
\n\u25cf Autoimmune disease theory: disorder of immune surveillance allows growth of endometrial implant
\n<\/a>
\n\u00a0DIFFERENTIAL DIAGNOSIS<\/strong>
\n\u25cf Ectopic pregnancy
\n\u25cf Acute appendicitis
\n\u25cf Chronic appendicitis
\n\u25cf PID
\n\u25cf Pelvic adhesions
\n\u25cf Hemorrhagic cyst
\n\u25cf Hernia
\n\u25cf Psychological disorder
\n\u25cf Irritable bowel syndrome
\n\u25cf Uterine leiomyomata
\n\u25cf Adenomyosis
\n\u25cf Nerve entrapment syndrome
\n\u25cf Scoliosis
\n\u25cf Muscular\/skeletal strain
\n\u25cf Interstitial cystitis<\/p>\n

<\/a>
\nIMAGING STUDIES<\/strong>
\n\u25cf Ultrasound: for evaluating adnexal mass; cannot reliably distinguish endometriomas from other benign or malignant ovarian conditions
\n\u25cf MRI: highly accurate in detecting endometriomas; limited sensitivity in detecting diffuse pelvic endometriosis
\n\u25cf Laparoscopy \u00a0will confirm diagnosis.
\nTREATMENT<\/strong>
\n\u25cf Expectant management (observation for 5 to 12 months) for early-stage endometriosis-associated infertility
\n\u25cf Nonsteroidal anti-infl ammatory drugs (NSAIDs) for symptomatic relief of dysmenorrhea
\n\u25cf Pharmacologic management: estrogen-progesterone, progestins, gonadotropin-releasing hormone (GnRH) agonists
\n\u25cf Alternative therapy for inhibition of estrogen action currently under investigation are aromatase inhibitors, raloxifene, anastrozole, letrozole.
\nSURGICAL MANAGEMENT<\/strong>
\nConservative
\n\u25cf Directed at enhancing fertility or treating pain unresponsive to first-line medical treatment
\n\u25cf Usually accomplished through laparoscopy
\n\u25cf Removal or destruction of endometriotic implants by excision, electrocautery, or laser
\n\u25cf Cystectomy for endometrioma
\n\u25cf Laparoscopic uterosacral nerve ablation (LUNA) for midline pain such as dysmenorrhea or dyspareunia
\n\u25cf Unless pregnancy is desired, patient is usually started on GnRH agonist therapy immediately after surgery
\n\u25cf For those desiring pregnancy, surgery alone results in significant increase in fertility<\/p>\n<\/div>\n