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Endometriosis DR. L. GIRIJA. Endometriosis DR. L. GIRIJA.

Endometriosis DR. L. GIRIJA. - PowerPoint Presentation

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Endometriosis DR. L. GIRIJA. - PPT Presentation

MD Hom Associate professor DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS SARADA KRISHNA HOMOEOPATHIC MEDICAL COLLEGE KULASEKHARAM Endometriosis Definition Ectopic Endometrial Tissue ID: 919794

treatment endometriosis chronic medical endometriosis treatment medical chronic disease pelvic pain fertility adhesions symptoms abnormal bleeding uterine excision infertility

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Slide1

Endometriosis

DR. L. GIRIJA.

M.D.

(

Hom

.),

Associate professor,

DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS,

SARADA KRISHNA HOMOEOPATHIC MEDICAL COLLEGE,

KULASEKHARAM

Slide2

Endometriosis

Definition: Ectopic Endometrial Tissue

True Incidence Unknown: ? 1-5%

Does NOT Discriminate by Race

Histology: Endometrial Glands with Stroma +/- Inflammatory Reaction

Slide3

Signs and Symptoms

Chronic Pelvic Pain, Dysmenorrhea

Abnormal Uterine Bleeding

Infertility

Deep Dyspareunia

Pelvic Mass (Endometrioma)

Misc: Tenesmus, Hematuria, LBP, Hemoptysis

Slide4

Prevalence

Slide5

Etiology: Theories

Sampson: “Retrograde Menstruation”

Hematologic Spread

Lymphatic Spread

Coelomic

Metaplasia

Genetic Factors

Immune FactorsCombination of the AboveNo Single Theory Explains All Cases of Endometriosis

Slide6

Diagnosis

Laparoscopy (“Gold Standard)

Laparotomy

Inconclusive: CA-125, Pelvic Exam, History, Imaging Studies

Biopsy Preferable Over Visual Inspection

Slide7

Appearance

Endometriosis May Appear

Brown

Black (“

Powderburn

”)

Clear (“Atypical”)

Endometriosis May Be Associated with Peritoneal Windows

Slide8

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

Slide9

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

Slide10

Continuous OCPs

Pseudopregnancy

? Minimizes Retrograde Menstruation

Lower Fertility Rates than Other Medical Treatments

Choose OCPs with Least Estrogenic Effects, Maximal Androgenic / Progestin Effects

Slide11

Surgical Treatment

(Laparoscopy / Laparotomy)

Excision

/

Fulgeration

no! Resection of EndometriomaLysis of Adhesions, Cul-de-sac ReconstructionUterosacral Nerve AblationPresacral

NeurectomyAppendectomyUterine Suspension (? Efficacy)Hysterectomy +/- BSO

Slide12

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