Endometriosis: The Daily PANCE Blueprint
The diagnosis of endometriosis is generally made by
A. Detection of increased estrogen levels
B. Endometrial biopsy
C. Pelvic ultrasound
D. Laparoscopy
E. CT of the pelvis
Answer and topic summary
The answer is D: Laparoscopy is the primary diagnostic modality for endometriosis.
- The laparoscopic visualization of lesions of powder-burned appearance in the pelvis or peritoneum is pathognomonic of endometriosis
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Pearls
- Presence of benign endometrial tissue outside of the uterine cavity
- Ovaries and pouch of Douglas are the two most commonly involved sites in endometriosis.
- Infertility is a common complication of endometriosis that occurs due to adhesions and scarring.
- Pain worse with menstruation
- The 3 D’s: dyspareunia (painful intercourse), dyschezia (difficulty in defecating), dysmenorrhea
Diagnosis
- Definitive diagnosis is made by laparoscopy and confirmed with biopsy
- Imaging tests (eg, ultrasonography, barium enema, IV urography, CT, MRI) are not specific or adequate for diagnosis. However, they sometimes show the extent of endometriosis and thus can be used to monitor the disorder once it is diagnosed.
Treatment
- Oral contraceptives are first-line medications used in treating endometriosis
- GnRH antagonists: Pituitary gonadotropin hormone suppressed → ↓ estrogen
- Danazol (steroid) – inhibits mid-cycle surges of FSH and LH
- Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Surgery: Laparoscopic ectopic endometrial tissue removal and hysterectomy
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