Endometriosis + case

the regions can be explained by the retrograde theory

the ovaries seems like there is a curtain over it..

theres so many adhesions cant even see the pouch of doglous

the bluish black deposits is filled with perioneal fluid filled with inflammatory mediatrs

chococlate cyst filled with clotted blood and haemosiderin

the dysmenorrhea is congestive = not the usual cramp like pain in the first day or two. but severe days before and along the period time

dyspareunia espeically if situated in the pouch of douglas can get irritated

doesnt affect the insides - but affects the outside so sually no tubal blockage seen

endometriotic cysts only in the ovarieies ....ground glass appearance in the ovaries.

classic visual appearance in the pelvis on laporoscopy is enough and is gold standard! dont need even biospy and histopathology report even though that will help a lot.

two arms for treatment because treatment of pain usually induces amenorrhea and that causes infertilty. so difficult to treat both at once.

last two isnt been done now because causes androgenic side effects

these drugs are given as monthly injections and are long lasting and will cause receptor to be absorbed inside and then no receptors on the surface.

ts used in any situation that needs ovarian supression such as in fibroids and in abnormal ueterine bleeding and in endometriosis.

its also called psdo menapausal but in menapause fsh and lh will be increased not reduced. its ovaries failing directly in menapause and not gonadotrophines from pituitary failing.

but menapause obviosuly helps with these conditions as well.

bt in fertility treatment its not given as long lasting but in pulsatile agonist fashion leading to increase lh and fsh and stimulating ovaries and ovulation finally.(short acting in pulsatile manner helps with stimulatiom)

cant be used for prelonged periods as causes profound ovarian suppression and menaausal like state with menapause problems. = broken bones. HRT usually helps with these menapausal problems.

if have to take for long term...take and then stop for a while and take oestrogen oestrogen add back therapy/

(add back hormone replacement therapy)

last resort is hsterectomy if symptomatic and if completed the family and old . 1. old 2 symptomatic 3. family completed

ultimate cure is manapause

Lapasocopy can be both diagnostic and therpautic if chosen to incise or flmugate or cut off adhesions. should do treatment there and then to save costs and time.

laproscopy is done under ga

if bilateracl adnexal tenderness then can be chocolate cysts and the best for this is TVS...

Otherwise best is laposcopy ...in all situations it is the best bt if chocolate cysts are suspected (as in the below question) then first do ultrasound. they asked the next step.

nsaids can only be given if pain around and dring menses....otherwise cant be given for long periods of time!!! only for dysmenprrhea and not for chronic pelvic pain!

lapsocopy is a very demanding procedre and in the above clinical profile can start emricial therapy for pain straiht away suspecting endometriosis

laposcopy should be done only if the diagnosis is in doubt and you want to confirm before going off with empriical treatment of pain and when empirical treatment for pain has failed.