Snapshot A 29-year-old nulligravida presents with severe pain with menses and an inability to conceive after 24 months of unprotected intercourse. She reports feeling pain with defecation and intercourse. On pelvic exam, her uterus is found to be retroverted and there is nodularity of the uterosacral ligament on retrovaginal examination. SUmmary Clinical definition a nonmalignant condition where the endometrial glands and stroma are located outside of the uterus Associated conditions chronic pelvic pain endometrioma ("chocolate cyst") endometriosis affecting the ovary subfertility Prognosis natural history of disease endometriosis may self-stabilize without treatment; however, this may be a progressive, relapsing, or chronic condition Epidemiology incidence 7-10% of women in the US demographics only in female most commonly in those 25-29 years of age location ovaries (most common) uterosacral ligaments retrouterine pouch (pouch of Douglas) peritoneum risk factors family history early menarche nulliparity ETIOLOGY Pathophysiology pathobiology ectopic endometrial tissue leads to an estrogen-stimulated inflammatory response Presentation Symptoms dysmenorrhea dyspareunia (painful intercourse) dyschezia (painful defecation) infertility chronic pelvic pain Physical exam nodular thickening of uterosacral ligament a fixed retroverted uterus tender, fixed adnexal masses Imaging Ultrasonography indications first-line imaging modality to assess for endometriosis Studies Laparoscopic visualization with histologic confirmation provides definitive diagnosis of endometriosis classically may see "powder burn" appearance Histology endometrial glandular tissue Differential Adenomyosis Endometritis Ovarian torsion Treatment Observation indicated for patients with asymptomatic endometriosis that is discovered incidentally Medical combined hormonal or progestin-only contraceptives indications considered first-line for pain due to endometriosis gonadotropin-releasing hormone (GnRH) agonist indications second-line treatment for endometriosis mechanism inhibits gonadotropin secretion which decreases FSH and LH levels leading to a suppression of ovarian function levonorgestrel-releasing intrauterine device (IUD) indications another second-line treatment for endometriosis danazol indications not commonly used due to side-effects mechanism suppreses FSH and LH pituitary secretion Operative laparoscopic ablation indications surgery is the only definitive treatment and diagnostic modality total abdominal hysterectomy with lysis of adhesions indications in patients who have completed childbearing with severe and recurrent disease Complications Complications infertility
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.GN.15.137) A 26-year-old woman presents to her gynecologist with complaints of pain with her menses and during intercourse. She also complains of chest pain that occurs whenever she has her menstrual period. The patient has a past medical history of bipolar disorder and borderline personality disorder. Her current medications include lithium and haloperidol. Review of systems is notable only for pain when she has a bowel movement relieved by defecation. Her temperature is 98.2°F (36.8°C), blood pressure is 114/74 mmHg, pulse is 70/min, respirations are 14/min, and oxygen saturation is 98% on room air. Pelvic exam is notable for a tender adnexal mass. The patient's uterus is soft, boggy, and tender. Which of the following is the most appropriate method of confirming the diagnosis in this patient? QID: 104777 Type & Select Correct Answer 1 Clinical diagnosis 1% (1/96) 2 Endometrial biopsy 70% (67/96) 3 Laparoscopy 8% (8/96) 4 MRI 6% (6/96) 5 Transvaginal ultrasound 12% (12/96) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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