Endometriosis - PowerPoint PPT Presentation

Loading...

PPT – Endometriosis PowerPoint presentation | free to download - id: 113cdd-NGE1Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Endometriosis

Description:

Microscopic internal bleeding, with the subsequent inflammatory response, ... and - progcs-terogenic and anti - oestrogenic as well as mild androgenic and ... – PowerPoint PPT presentation

Number of Views:612
Avg rating:3.0/5.0
Slides: 33
Provided by: davidt72
Learn more at: http://obgyntoday.info
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Endometriosis


1
Endometriosis
  • Dr.Mona Shroff M.D.
  • Department of Obstetrics and Gynecology
  • SMIMER

2
Endometriosis
  • Definition Ectopic Endometrial Tissue
  • True Incidence Unknown ? 1-5
  • Histology Endometrial Glands with Stroma /-
    Inflammatory Reaction
  • Microscopic internal bleeding, with the
    subsequent inflammatory response,
    neovascularization, and fibrosis formation, is
    responsible for the clinical consequences of this
    disease.

3
Sites
  • - Pelvic
  • - Extra pelvic
  • Umbilicus.
  • Scars (Lap.).
  • Lungs plura.
  • Others.

4
Pelvic Endometriosis
  • Uterine Adenomyosis (50).
  • Extraut
  • - Ovary 30
  • - Pelvic peritoneum 10.
  • - F. tube.
  • - Vagina.
  • -Bladder rectum.
  • - Pelvic colon.
  • - Ligaments.

5
(No Transcript)
6
Prevalence
7
Age at Diagnosis
gt 45
lt 19
3
36 45
6
15
19 25
24
26 35
52
8
Signs and Symptoms
  • Chronic Pelvic Pain, Dysmenorrhea
  • Abnormal Uterine Bleeding
  • Infertility
  • Deep Dyspareunia
  • Pelvic Mass (Endometrioma)
  • Misc Tenesmus, Hematuria, Hemoptysis

9
Signs
  • Pelvic examination may reveal
  • 1. Pelvic tenderness.
  • 2. Fixed retroverted uterus.
  • 3. Nodularity of the Douglas pouch and
    uterosacral ligaments.
  • 4. Ovaries may be enlarged and tender .
    Ovarian cyst may be detected.

10
Etiology Theories
  • Sampson Retrograde Menstruation
  • Hematologic Spread
  • Lymphatic Spread
  • Coelomic Metaplasia
  • Genetic Factors
  • Immune Factors
  • Combination of the Above
  • No Single Theory Explains All Cases of
    Endometriosis

11
Diagnosis
  • Laparoscopy (Gold Standard)
  • Laparotomy
  • Inconclusive CA-125, Pelvic Exam, History,
    Imaging Studies
  • Biopsy Preferable Over Visual Inspection

12
Appearance
  • Endometriosis May Appear
  • Brown
  • Black (Powderburn)
  • Clear (Atypical)
  • Endometriosis May Be Associated with Peritoneal
    Windows

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
Treatment Overall Approach
  • Recognize Goals
  • Pain Management
  • Preservation / Restoration of Fertility
  • Discuss with Patient
  • Disease may be Chronic and Not Curable
  • Optimal Treatment Unproven or Nonexistent

17
Treatment Consideration
  • Age.
  • Symptoms.
  • Stage.
  • Infertility.

18
Classification / Staging
  • Several Proposed Schemes
  • Revised AFS System Most Often Used
  • Ranges from Stage I (Minimal) to Stage IV
    (Severe)
  • Staging Involves Location and Depth of Disease,
    Extent of Adhesions

19
(No Transcript)
20
Pain Management Medical Therapy
  • NSAIDs
  • OCPs (Continuous)
  • Progestins
  • Danazol
  • GnRH-a
  • GnRH-a Add-Back Therapy
  • Aromatase Inhibitors
  • Misc Opoids, SSRIs

21
Indications of Hormonal Rx
  • 1. Small endometriotic lesions.
  • 2. Recurrence after conservative surgery.
  • 3. Preoperative for 6-12 weeks to decrease size.
  • 4. Postoperative for residual lesions.
  • 5. When operation is contraindicated or refused
    by the patient.

22
Aim of the hormonal therapy
  • (A) Pseudopregnancy
  • 1. Combined low - dose contraceptive pills(6 - 18
    months to inhibit ovulation and menstruation and
    induce decidualization to endometriotic tissues).
  • or
  • 2. Progestins (to avoid oestrogen's side effects
    medroxy progesterone acetate Depo medroxy
    progesterone acetate (DMPA) can be given in a
    dose of 150 mg IM every I - 3 months .

23
Aim of the hormonal therapy cont.
  • (B) Pseudomenopause (induction of amenorrhoea)
    by
  • 1. Danazol.
  • 2. Gn RH analogues.
  • 3. Gestrinone.
  • 4. Gossypol.

24
Continuous OCPs
  • Pseudopregnancy (Kistner)
  • ? Minimizes Retrograde Menstruation
  • Lower Fertility Rates than Other Medical
    Treatments
  • Choose OCPs with Least Estrogenic Effects,
    Maximal Androgenic / Progestin Effects

25
Progestins
  • May be as Effective as GnRH-a for Pain Control
  • MPA 10-30 mg/day, DP 150 mg Semi-Monthly
  • May be Taken Long-Term
  • Relatively Inexpensive
  • Side-Effects AUB, Mood Swings, Weight Gain,
    Amenorrhea

26
Danazol
  • Weak Androgen
  • Suppresses LH / FSH
  • Causes Endometrial Regression, Atrophy
  • Expensive
  • Side-Effects Weight Gain, Masculinization, Occ.
    Permanent Vocal Changes

27
GnRH-a (Leuprolide,triptorelin)
  • Initially Stimulate FSH / LH Release
  • Down-Regulates GnRH ReceptorsPseudomenopause
  • Long-Term Success Varies
  • Expensive
  • Use Limited by Hypoestrogenic Effects
  • May be Combined with Add-Back (? gt1 Year )

28
Aromatase Inhibitors
  • Blocking the aromatase activity in extraovarian
    sites that suppress the conversion of
    androstenedione and testosterone to estrogen. May
    result in suppression of endometriosis at a local
    level.
  • Further studies needed
  • 2.5 mg PO qd for 6 mo administer with
    norethindrone acetate 2.5 mg PO qd

29
Gestrinone
  • It is a synthetic 19 Nor steroid exhibits marked
    and - progcs-terogenic and anti - oestrogenic as
    well as mild androgenic and anti -gonadotrophic
    properties .
  • The endocrine effects of Gestrinone are similar
    to those of Danazol which leads mainly to
    inhibition of ovarian steroidogenesis .
  • The dose is 2.5 - 5 mg orally twice weekly .

30
Surgical Treatment (Laparoscopy / Laparotomy)
  • Excision / Fulgration(ELECTROCAUTRY/LASER)
  • Resection of Endometrioma
  • Lysis of Adhesions, Cul-de-sac Reconstruction
  • Uterosacral Nerve Ablation
  • Presacral Neurectomy
  • Appendectomy
  • Uterine Suspension (? Efficacy)
  • Hysterectomy /- BSO

31
Issues
  • ? Removal of Ovaries at Hysterectomy
  • ? Need for Progestins if ERT Given
  • ? Adjuvant Treatment Postoperatively
  • ? Lupron Challenge Test for Diagnosis
  • ? Is Endometriosis Best Treated Surgically,
    Medically or Both

32
Conclusion
  • Endometriosis is a Common, Chronic Disease
  • Typical Symptoms Include Pain, Infertility,
    Abnormal Uterine Bleeding
  • The Optimal Treatment Remains Unclear
  • Surgical Excision is the Most Efficacious
    Approach with Respect to Fertility
  • Better Medical Therapies are Needed
About PowerShow.com