Endometriosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Classic symptoms: dysmenorrhea, pelvic pain, dyspareunia, and infertility | *Classic symptoms: dysmenorrhea, [[pelvic pain]], dyspareunia, and infertility | ||
*Other symptoms may include: include abnormal uterine bleeding, low back pain, or chronic fatigue | *Mnemonic: 3 D's--dysmenorrhea, dyschezia and dyspareunia | ||
*Other symptoms may include: include abnormal [[vaginal Bleed Non-Pregnant|uterine bleeding]], low [[back pain]], or chronic fatigue | |||
*Endometriosis is commonly detected as an asymptomatic incidental finding on pelvic ultrasound or during a surgical procedure | *Endometriosis is commonly detected as an asymptomatic incidental finding on pelvic ultrasound or during a surgical procedure | ||
*[[Catamenial pneumothorax]]- rare complication involving recurrent spontaneous pneumothoraces occurring around menses | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Ectopic pregnancy | *[[Ectopic pregnancy]] | ||
*Pelvic inflammatory disease | *[[Pelvic inflammatory disease]] | ||
*Interstitial cystitis | *[[Interstitial cystitis]] | ||
*Adenomyosis | *[[Adenomyosis]] | ||
*Ovarian neoplasms | *Ovarian neoplasms | ||
*Pelvic adhesions | *Pelvic adhesions | ||
*Irritable bowel syndrome | *[[Irritable bowel syndrome]] | ||
*Colon cancer | *[[Colon cancer]] | ||
*Diverticular disease | *[[Diverticulitis|Diverticular disease]] | ||
== | {{VB DDX nonpregnant}} | ||
==Evaluation== | |||
*History of symptoms described above | *History of symptoms described above | ||
*Exam with tenderness when palpating posterior fornix | *Exam with tenderness when palpating posterior fornix | ||
*Labs are not generally useful | *Labs are not generally useful | ||
*Pelvic ultrasound is the first-line study | *[[Pelvic ultrasound]] is the first-line study | ||
*Laparoscopy for definitive diagnosis | *Laparoscopy for definitive diagnosis | ||
==Management== | ==Management== | ||
* | *Symptomatic management | ||
*Analgesia | *[[Analgesia]] | ||
*Hormonal medical therapy | *Hormonal medical therapy | ||
**OCP's, GnRH agonists, progestins, danazol, aromatase inhibitors | **OCP's, GnRH agonists, progestins, danazol, aromatase inhibitors | ||
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==Disposition== | ==Disposition== | ||
*Discharge with OB/Gyn follow-up | |||
==See Also== | ==See Also== | ||
*[[Pelvic Pain]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
< | <references/> | ||
[[Category: | [[Category:OBGYN]] |
Revision as of 15:01, 12 October 2019
Background
- Endometrial glands and stroma at extrauterine sites, generally in the pelvis but can be anywhere in the body
- The condition is a common, benign, estrogen-dependent disorder
- Can be associated with debilitating symptoms
Clinical Features
- Classic symptoms: dysmenorrhea, pelvic pain, dyspareunia, and infertility
- Mnemonic: 3 D's--dysmenorrhea, dyschezia and dyspareunia
- Other symptoms may include: include abnormal uterine bleeding, low back pain, or chronic fatigue
- Endometriosis is commonly detected as an asymptomatic incidental finding on pelvic ultrasound or during a surgical procedure
- Catamenial pneumothorax- rare complication involving recurrent spontaneous pneumothoraces occurring around menses
Differential Diagnosis
- Ectopic pregnancy
- Pelvic inflammatory disease
- Interstitial cystitis
- Adenomyosis
- Ovarian neoplasms
- Pelvic adhesions
- Irritable bowel syndrome
- Colon cancer
- Diverticular disease
Nonpregnant Vaginal Bleeding
Systemic Causes
- Cirrhosis
- Coagulopathy (Von Willebrand disease, ITP)
- Group A strep vaginitis (prepubertal girls)
- Hormone replacement therapy
- Anticoagulants
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Hypothyroidism
- Polycystic Ovary Syndrome
- Secondary anovulation
Reproductive Tract Causes
- Adenomyosis
- Atrophic endometrium
- Dysfunctional uterine bleeding
- Endometriosis
- Fibroids
- Foreign Body
- Infection (vaginitis, PID)
- IUD
- Neoplasia (especially in women >45 years old or in younger women with other risk factors)
- Vaginal Trauma
Evaluation
- History of symptoms described above
- Exam with tenderness when palpating posterior fornix
- Labs are not generally useful
- Pelvic ultrasound is the first-line study
- Laparoscopy for definitive diagnosis
Management
- Symptomatic management
- Analgesia
- Hormonal medical therapy
- OCP's, GnRH agonists, progestins, danazol, aromatase inhibitors
- Surgical intervention - conservative (retain uterus and ovaries) or definitive (TAH-BSO)
Disposition
- Discharge with OB/Gyn follow-up