{"id":174,"date":"2020-08-13T16:00:21","date_gmt":"2020-08-13T16:00:21","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=174"},"modified":"2023-09-30T11:07:05","modified_gmt":"2023-09-30T11:07:05","slug":"38-endometriosis","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/38-endometriosis\/","title":{"rendered":"38. Endometriosis"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/4tfI7fzUtrc\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 6:31<\/p>\n<input type='hidden' bg_collapse_expand='69e9dc23002840069252353' value='69e9dc23002840069252353'><input type='hidden' id='bg-show-more-text-69e9dc23002840069252353' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc23002840069252353' value='Hide Transcript'><button id='bg-showmore-action-69e9dc23002840069252353' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc23002840069252353' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 38<br \/>\n00:02<br \/>\nendometriosis endometriosis is a<br \/>\n00:05<br \/>\nsignificant health problem that is<br \/>\n00:07<br \/>\nestimated to affect seven to ten percent<br \/>\n00:09<br \/>\nof women of reproductive age it has a<br \/>\n00:11<br \/>\nprevalence of 38 percent in infertile<br \/>\n00:14<br \/>\nwomen and 71 to 87 percent of women with<br \/>\n00:17<br \/>\nchronic pelvic pain have endometriosis<br \/>\n00:20<br \/>\nendometriosis is defined as the presence<br \/>\n00:22<br \/>\nof endometrial glands and stroma in any<br \/>\n00:25<br \/>\nsite outside of the uterus the<br \/>\n00:27<br \/>\nobjectives of this video are to describe<br \/>\n00:29<br \/>\nthe theories of pathogenesis of<br \/>\n00:30<br \/>\nendometriosis list the most common sites<br \/>\n00:33<br \/>\nof endometriosis describe the symptoms<br \/>\n00:36<br \/>\nand physical exam findings in a patient<br \/>\n00:38<br \/>\nwith endometriosis and lastly describe<br \/>\n00:41<br \/>\nthe diagnosis and management options for<br \/>\n00:43<br \/>\nendometriosis the pathogenesis of<br \/>\n00:46<br \/>\nendometriosis is complex and there are<br \/>\n00:48<br \/>\nthree theories on how endometrial glands<br \/>\n00:50<br \/>\nand Stroman develop an extra uterine<br \/>\n00:52<br \/>\nsites the first theory is retrograde<br \/>\n00:54<br \/>\nflow here is a photograph of the uterus<br \/>\n00:57<br \/>\nwith endometrial glands and stroma in<br \/>\n00:59<br \/>\nthe endometrial cavity during<br \/>\n01:00<br \/>\nmenstruation all women have some degree<br \/>\n01:03<br \/>\nof retrograde menstruation in women with<br \/>\n01:05<br \/>\nendometriosis this retrograde flow<br \/>\n01:08<br \/>\nresults in endometrial glands and<br \/>\n01:09<br \/>\nplanting and pelvic sites such as the<br \/>\n01:11<br \/>\npelvic peritoneum posterior cul-de-sac<br \/>\n01:13<br \/>\nand ovaries the second theory is<br \/>\n01:16<br \/>\nvascular and lymphatic dissemination in<br \/>\n01:19<br \/>\nthis theory endometriosis cells traveled<br \/>\n01:22<br \/>\nthrough the vascular and lymphatic<br \/>\n01:23<br \/>\nsystem to distant sites such as the<br \/>\n01:25<br \/>\nkidneys and pleural cavities the third<br \/>\n01:28<br \/>\ntheory is Salome Achmed aplasia in this<br \/>\n01:31<br \/>\ntheory multi potential cells in the<br \/>\n01:33<br \/>\nperitoneal cavity develop into<br \/>\n01:35<br \/>\nfunctional and a material tissue this<br \/>\n01:37<br \/>\ntheory explains the development of<br \/>\n01:39<br \/>\nendometriosis in adolescence before the<br \/>\n01:41<br \/>\nonset of menstruation the endometrial<br \/>\n01:44<br \/>\nlesions can cause an inflammatory<br \/>\n01:45<br \/>\nreaction that can lead to formation of<br \/>\n01:47<br \/>\nsignificant adhesions and scarring this<br \/>\n01:50<br \/>\noperative photograph shows a pelvis that<br \/>\n01:52<br \/>\nhad significant scarring and adhesions<br \/>\n01:54<br \/>\nfrom endometriosis here is the uterus<br \/>\n01:55<br \/>\nthe left round ligament and scar tissue<br \/>\n01:58<br \/>\nthat you can see clearly distorts a<br \/>\n02:00<br \/>\ngreat deal of the anatomy endometriosis<br \/>\n02:03<br \/>\nis most commonly found in the ovaries<br \/>\n02:05<br \/>\nand is typically bilateral this<br \/>\n02:07<br \/>\noperative photograph shows a uterus and<br \/>\n02:09<br \/>\nbilateral endometrium us with the<br \/>\n02:11<br \/>\ncharacteristic brown hemosiderin<br \/>\n02:13<br \/>\nand fluid other common sights include<br \/>\n02:16<br \/>\nthe posterior cul-de-sac in particular<br \/>\n02:18<br \/>\nthe uterus sacral ligaments and rector<br \/>\n02:20<br \/>\nvaginal septum the round ligament the<br \/>\n02:22<br \/>\nfallopian tubes and the sigmoid colon<br \/>\n02:24<br \/>\nmore rarely endometriosis can be found<br \/>\n02:27<br \/>\nin abdominal surgical scars the<br \/>\n02:29<br \/>\numbilicus and more distant sites such as<br \/>\n02:31<br \/>\nthe brain lungs and upper ureters<br \/>\n02:35<br \/>\nintraoperatively endometriosis can<br \/>\n02:37<br \/>\nvisually look like clear white lesions<br \/>\n02:39<br \/>\nlike brown powder burn lesions or dark<br \/>\n02:42<br \/>\nred or blue domes it is important to<br \/>\n02:45<br \/>\nnote that women with endometriosis<br \/>\n02:46<br \/>\ndemonstrate a wide variety of symptoms<br \/>\n02:48<br \/>\nsome women with extensive endometriosis<br \/>\n02:51<br \/>\nhave minimal symptoms and conversely<br \/>\n02:53<br \/>\nwomen with minimal endometriosis may<br \/>\n02:55<br \/>\nhave severe symptoms the classic &#8211;<br \/>\n02:57<br \/>\nsymptoms of endometriosis are<br \/>\n02:59<br \/>\ndysmenorrhea or painful menses and<br \/>\n03:01<br \/>\ndyspareunia or painful intercourse<br \/>\n03:04<br \/>\ninfertility is more frequent in women<br \/>\n03:07<br \/>\nwith endometriosis the relationship<br \/>\n03:09<br \/>\nbetween infertility and endometriosis is<br \/>\n03:12<br \/>\ncomplicated and a direct<br \/>\n03:13<br \/>\ncause-and-effect relationship has not<br \/>\n03:15<br \/>\nbeen clearly established the infertility<br \/>\n03:18<br \/>\nmay be secondary to pelvic scarring and<br \/>\n03:20<br \/>\nadhesions that distort the pelvic<br \/>\n03:22<br \/>\nAnatomy prostaglandins and Auto<br \/>\n03:24<br \/>\nantibodies have also been implicated<br \/>\n03:26<br \/>\nendometriosis is present in 30 to 50<br \/>\n03:28<br \/>\npercent of asymptomatic infertility<br \/>\n03:30<br \/>\npatients less common symptoms of<br \/>\n03:33<br \/>\nendometriosis include disc easia or<br \/>\n03:35<br \/>\npainful bowel movements and hematochezia<br \/>\n03:36<br \/>\nrectal bleeding let&#8217;s move now to<br \/>\n03:39<br \/>\nphysical exam it is common to not find<br \/>\n03:42<br \/>\nany signs of endometriosis on physical<br \/>\n03:44<br \/>\nexamination since the endometrial<br \/>\n03:46<br \/>\nimplants are usually very small and not<br \/>\n03:48<br \/>\npalpable the possible findings include a<br \/>\n03:51<br \/>\nfixed non-mobile uterus that is<br \/>\n03:53<br \/>\nretroflex secondary to adhesions or<br \/>\n03:55<br \/>\novarian endometrium Azure chocolates<br \/>\n03:57<br \/>\nIsmaili tender and palpable and the<br \/>\n04:00<br \/>\nclassic sign on physical examination is<br \/>\n04:02<br \/>\nuterus sacral nodularity although<br \/>\n04:04<br \/>\nendometriosis can be suspected in women<br \/>\n04:07<br \/>\nwith the symptoms and exam findings<br \/>\n04:08<br \/>\ndescribed thus far the diagnosis of<br \/>\n04:10<br \/>\nendometriosis is made in the operating<br \/>\n04:12<br \/>\nroom<br \/>\n04:13<br \/>\nthis can be by direct visualization of<br \/>\n04:15<br \/>\ntissue and confirmed with tissue biopsy<br \/>\n04:17<br \/>\nthe pathologist will look for two or<br \/>\n04:20<br \/>\nmore of the following histological<br \/>\n04:21<br \/>\nfeatures in the biopsy endometrial<br \/>\n04:23<br \/>\nepithelium and Demetrio glands<br \/>\n04:25<br \/>\nendometrial stroma<br \/>\n04:27<br \/>\nand our hemosiderin Laden macrophages<br \/>\n04:29<br \/>\nthe goals of management are one<br \/>\n04:31<br \/>\nreduction of pelvic pain to minimize<br \/>\n04:34<br \/>\nsurgical intervention as much as<br \/>\n04:36<br \/>\npossible and three preserve fertility<br \/>\n04:38<br \/>\nmedical therapy the goal is to induce<br \/>\n04:40<br \/>\natrophy of the endometrial glands and<br \/>\n04:42<br \/>\nstroma of endometriosis oral<br \/>\n04:44<br \/>\ncontraception as first-line therapy for<br \/>\n04:46<br \/>\nis easy to administer and has few side<br \/>\n04:48<br \/>\neffects it induces a decidua reaction of<br \/>\n04:51<br \/>\nfunctioning and Dimitri otic tissues<br \/>\n04:53<br \/>\nalternatively progesterone therapy which<br \/>\n04:55<br \/>\ncan be administered either orally or<br \/>\n04:57<br \/>\nwith a diploma Drakh C progesterone<br \/>\n04:59<br \/>\ninjection or with an implant can also<br \/>\n05:01<br \/>\nsuppress gonadotropin release which<br \/>\n05:03<br \/>\ndecreases a rare and stereo Genesis<br \/>\n05:05<br \/>\nwhich will suppress under meetry OSIS<br \/>\n05:07<br \/>\nsimilarly a GnRH agonist down regulates<br \/>\n05:10<br \/>\npituitary gland and induces a menopause<br \/>\n05:13<br \/>\nfor patients side effects do thus<br \/>\n05:14<br \/>\ninclude hot flashes and night sweats a<br \/>\n05:17<br \/>\nGnRH agonist cannot be used as long-term<br \/>\n05:19<br \/>\ntherapy for young patients because of<br \/>\n05:21<br \/>\nthe detrimental effects of low estrogen<br \/>\n05:23<br \/>\nlevels Dan Issel is an additional<br \/>\n05:25<br \/>\nmedical therapy option it similarly<br \/>\n05:27<br \/>\nsuppresses LH and FSH from the pituitary<br \/>\n05:30<br \/>\nside effects are also related to<br \/>\n05:32<br \/>\nmenopause estate including hot flashes<br \/>\n05:34<br \/>\nand night sweats Dennis also has<br \/>\n05:36<br \/>\nandrogenic properties so women may<br \/>\n05:37<br \/>\nexperience acne oily skin growth of<br \/>\n05:40<br \/>\nfacial hair and deepening of the voice<br \/>\n05:42<br \/>\nsurgical therapy involves conservative<br \/>\n05:44<br \/>\ntherapy such as excision cauterization<br \/>\n05:47<br \/>\nor ablation of visible endometriosis<br \/>\n05:49<br \/>\nlesions and license of adhesions<br \/>\n05:51<br \/>\nextirpate of therapy involves<br \/>\n05:53<br \/>\nhysterectomy with or without a bilateral<br \/>\n05:55<br \/>\nself-injury for ectomy this is reserved<br \/>\n05:57<br \/>\nfor women for whom conservative medical<br \/>\n05:59<br \/>\nor surgical therapy is not feasible or<br \/>\n06:01<br \/>\nwhen the patient does not desire future<br \/>\n06:03<br \/>\nfertility this concludes the aapko video<br \/>\n06:06<br \/>\non endometriosis we have discussed the<br \/>\n06:08<br \/>\npathogenesis the most common sites of<br \/>\n06:10<br \/>\nsymptoms and physical exam findings for<br \/>\n06:12<br \/>\nthe patient with endometriosis as well<br \/>\n06:14<br \/>\nas the diagnosis and management options<br \/>\n06:16<br \/>\nfor this disease<br \/>\n06:18<br \/>\n[Music]<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 6:31<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":38,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-174","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/174","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=174"}],"version-history":[{"count":3,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/174\/revisions"}],"predecessor-version":[{"id":1300,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/174\/revisions\/1300"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=174"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}