Endometriosis adenomyosis
Sponsored Links
This presentation is the property of its rightful owner.
1 / 30

Endometriosis & Adenomyosis PowerPoint PPT Presentation


  • 304 Views
  • Uploaded on
  • Presentation posted in: General

Endometriosis & Adenomyosis. OB & GYN Hospital, Fudan University Lei Yuan , MD ylronda@163.com. Endometriosis Endo Endometrium. Adenomyosis Adeno Adeno (ids). - OSIS. Endometriosis & Adenomyosis. Key points Symptoms Diagnosis Treatment. Case discussion Diagnosis

Download Presentation

Endometriosis & Adenomyosis

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Endometriosis & Adenomyosis

OB & GYN Hospital, Fudan University

Lei Yuan , MD

ylronda@163.com


  • Endometriosis

    • Endo

    • Endometrium

  • Adenomyosis

    • Adeno

    • Adeno(ids)

- OSIS


Endometriosis

& Adenomyosis

  • Key points

  • Symptoms

  • Diagnosis

  • Treatment

  • Case discussion

  • Diagnosis

  • Differential diagnosis

  • Further examination

  • Treatment


Key points

Endometriosis

Basics

  • Endometriosis

    • Symptoms: pains secondary dysmenorrhea;

      (Non Specific)dyspareunia;

      progressive;

      Infertility

    • Diagnosis:

      • Gold standard——visual inspection of the pelvis via laparoscopy

      • Histological confirmation——ideally,negative one does not exclude diagnosis


Key points

Endometriosis

Text

  • Surgery

  • Laparoscopy or laparotomy

  • Radical or conservative

  • Non-surgical

  • treatment

  • (medication)

  • First-line medication

  • Progestins

  • Gonadotropin-releasing hormone (GnRH) agonists

  • Danazol (androgenic)

  • Oral contraceptives

  • Controlled ovarian hyperstimulation (fertility treatment)

Characteristic of disease

Patient’s condition

Basics

  • Treatment: Individualized and standardized


Key points

Adenomyosis

Basics

  • Adenomyosis

    • Symptoms:Typical:

      Pain secondary dysmenorrhea

      progressive / severe

      Menorrhagia

      symptomless: 35%

      15% associated with EMs

    • Signs:

      Symmetrically enlarged uterus

      Boggy and tender( softer than myoma)


Key points

Adenomyosis

Basics

  • Diagnosis:

  • Symptoms, Signs,

  • Ultrasonography

  • Pathology


  • Treatment:

  • Principles: patients’ age; severity of symptoms;

    fertility requirements

  • Medication: symptom relieved, none radical cure

    NASIDs; Ocs;

    Mirena( a low-dose hormonal IUD)

  • Surgery: no fertility desire;

    no respond to medical treatment

    Hysterectomy

    (ovary preservation as appropriate)


Case discussion


Case 1


Case discussion

Case 1

History:

  • 33-year-old female, pelvic pain during menstruation for 4 years, progressively worse over the years, with pre and postmenstrual spotting; dyspareunia and pain during defecation for 6 months, progressively worse ; no change in the color or caliber of her stool; no sexually active besides her husband; no birth control, and been trying to get pregnant for the last 3.5 years.

  • Menstrual history: regular

  • G0P0

  • Normal Pap smear 6 months ago.


Case discussion

Case 1

Pelvic examination

  • Uterus: fixed, retroverted.

  • Tender nodularity of the uterosacral ligaments bilaterally.

  • Both ovaries are somewhat tender and mildly enlarged.


Next step?

Initial diagnosis:

  • Pelvic inflammation

  • PCOS

  • Endometriosis

  • Ovarian cancer

  • hydrosalpinx


Ultrasonography:1)bilateral adnexal masses;2)a thick, viscous dark brown fluid

CA125:87 U/ML


PCOS

Endometriosis

What is your answer?


Management

  • Principle

  • The certainty of the diagnosis

  • The severity of symptoms

  • The extent of the disease

  • The desire for future fertility

  • The age of the patients


Surgical treatment

  • Laparoscopy

  • Cystectomy

  • Hydrotubation


Laparoscopic assisted cystectomy

  • Puncture sites

  • Umbilicus

  • McBurney's point

  • reverse McBurney‘s point

  • suprapubic ventral midline


Video


From Novak Gynecology 14 th


Histologic features


Post-operative medication

Status quo: Still controversial

Objectives: to reduce recurrence and promote fertility

Medication: GnRHa, Progestin, OCs …


QUESTIONS

Symptoms

Signs

EMs Types:

Staging

Management


Case 2


Case discussion

Case 2

History

  • 41-year-old female, increasing colicky pain during menstruation which needs ibuprofen to relieve symptom; her volume of menstrual flow has increased steadily over the last several months, though her cycles continue to be regular; no vaginal discharge or fever.

  • Menstrual history: regular

  • G1P1

  • Normal Pap smear 2 months ago

  • Dilation and curettage 2 months ago


Case discussion

Case 2

Pelvic examination

  • Uterus: symmetrically enlarged, smooth with a boggy consistency that is somewhat tender.

  • No adnexal masses are appreciated.

  • Laboratory Findings

  • Hemoglobin: 11g/dL


Case discussion

Case 2

Questions

  • Current diagnosis

  • Differential diagnosis

  • Further examination

  • Treatment


Case discussion

Case 2

Questions

  • Current diagnosis

    • Adenomyosis?

  • Differential diagnosis

    • Uterine myoma

    • Dysfunctional uterine bleeding (DUB)

    • Endometriosis

  • Further examination

    • Radiologic imaging

    • Ultrasound

  • Treatment

    • Medication

    • OR surgery


Take home message

1. Familiarize with the causes and pathogenesis of endometriosis

2. Master the clinical features, diagnosis and differential diagnosis of endometriosis

3. Grasp the major principles behind the treatment strategy of endometriosis


Thank You !


  • Login