Chap 15 Endometriosis and
Adenomyosis Exam Questions and
Answers
Endometriosis - Answer-is a chronic disease marked by the presence of endometrial
tissue (glands and stroma) outside the endo- metrial cavity.
Endometrial tissue can be found anywhere in the body, - Answer-but the most common
sites are the ovary and the pelvic peritoneum including the anterior and posterior cul de
sacs.
Endometriosis in the ovary appears as a cystic collection known as an endometrioma. -
Answer-Other common sites include the most dependent parts of the pelvis such as the
posterior uterus and broad ligaments, the uterosacral ligaments, fallopian tubes, colon,
and appendix (Fig. 15-1). Although not commonly found, endometriosis has been
identified as far away as the breast, lung, and brain.
There are three main theories about the etiology of endo- metriosis. - Answer-The
Halban theory proposes that endometrial tissue is transported via the lymphatic system
to various sites in the pelvis, where it grows ectopically.
Meyer proposes that multi- potential cells in peritoneal tissue undergo metaplastic trans-
formation into functional endometrial tissue.
Finally, Sampson suggests that endometrial tissue is transported through the fallopian
tubes during retrograde menstruation, resulting in intra-abdominal pelvic implants.
A prevailing theory is that women who develop endometriosis may have an altered
immune system that is less likely to recognize and attack ectopic endometrial implants. -
Answer-These women may even have an increased concentration of inflam- matory
cells in the peritoneum that contribute to the growth and stimulation of the endometrial
implants. Endometrial implants cause symptoms by disrupting normal tissue, form- ing
adhesions and fibrosis, and causing severe inflammation.
Interestingly, the severity of symptoms does not necessarily correlate with the amount
of endometriosis. - Answer-Women with widely disseminated endometriosis or a large
endometrioma may experience little pain, whereas women with minimal dis- ease in the
cul-de-sac may suffer severe chronic pain.
The estimated prevalence of endometriosis is between 10% and 15%. - Answer-
Because surgical confirmation is necessary for the diagnosis of endometriosis, the true
prevalence of the disease is unknown.
, It is found almost exclusively in women of repro- ductive age, and is the single most
common reason for hospi- talization of women in this age group. Approximately 20% of
women with chronic pelvic pain and 30% to 40% of women with infertility have
endometriosis.
Risk factors for endometriosis - Answer-Nulliparity,
early menarche,
prolonged menses, and
müllerian anomalies
first-degree relatives (mother or sisters) with endometriosis
autoimmune inflammatory disorders such as lupus, asthma, hypothyroidism, chronic
fatigue syndrome, fibromyalgia, and allergies.
The hallmark of endometriosis - Answer-is cyclic pelvic pain beginning 1 or 2 weeks
before menses, peaking 1 to 2 days before the onset of menses, and subsiding at the
onset of menses or shortly thereafter.
Women with chronic endometriosis and teenagers with endometriosis may not
demonstrate this classic pain pattern.
Other symptoms associated with endometriosis - Answer-dysmenorrhea,
dyspareunia,
abnormal bleeding,
bowel and bladder symptoms, and
subfertility.
Endometriosis is one of the most common diagnoses in the evaluation of infertile
couples.
Symptoms of endometriosis vary depending on the area involved. - Answer-Over 75%
of women with symptomatic endometriosis will have pelvic pain and/or dysmenorrhea
(painful menses)
Dysmenorrhea - Answer-usually begins in the third decade, worsens with age, and
should raise concern for endometriosis in women who develop dysmenorrhea after
years of pain-free cycles.
Dyspareunia - Answer-is usually associated with deep penetration that can aggravate
endometrial lesions in the cul-de-sac or on the uterosacral ligaments.
Endometriosis is also a cause of infertility. - Answer-lthough the exact mechanism is
unclear, moderate to severe endometriosis can cause dense adhesions, which can
distort the pelvic archi- tecture, interfere with tubal mobility, impair oocyte release, and
cause tubal obstruction.
Adenomyosis Exam Questions and
Answers
Endometriosis - Answer-is a chronic disease marked by the presence of endometrial
tissue (glands and stroma) outside the endo- metrial cavity.
Endometrial tissue can be found anywhere in the body, - Answer-but the most common
sites are the ovary and the pelvic peritoneum including the anterior and posterior cul de
sacs.
Endometriosis in the ovary appears as a cystic collection known as an endometrioma. -
Answer-Other common sites include the most dependent parts of the pelvis such as the
posterior uterus and broad ligaments, the uterosacral ligaments, fallopian tubes, colon,
and appendix (Fig. 15-1). Although not commonly found, endometriosis has been
identified as far away as the breast, lung, and brain.
There are three main theories about the etiology of endo- metriosis. - Answer-The
Halban theory proposes that endometrial tissue is transported via the lymphatic system
to various sites in the pelvis, where it grows ectopically.
Meyer proposes that multi- potential cells in peritoneal tissue undergo metaplastic trans-
formation into functional endometrial tissue.
Finally, Sampson suggests that endometrial tissue is transported through the fallopian
tubes during retrograde menstruation, resulting in intra-abdominal pelvic implants.
A prevailing theory is that women who develop endometriosis may have an altered
immune system that is less likely to recognize and attack ectopic endometrial implants. -
Answer-These women may even have an increased concentration of inflam- matory
cells in the peritoneum that contribute to the growth and stimulation of the endometrial
implants. Endometrial implants cause symptoms by disrupting normal tissue, form- ing
adhesions and fibrosis, and causing severe inflammation.
Interestingly, the severity of symptoms does not necessarily correlate with the amount
of endometriosis. - Answer-Women with widely disseminated endometriosis or a large
endometrioma may experience little pain, whereas women with minimal dis- ease in the
cul-de-sac may suffer severe chronic pain.
The estimated prevalence of endometriosis is between 10% and 15%. - Answer-
Because surgical confirmation is necessary for the diagnosis of endometriosis, the true
prevalence of the disease is unknown.
, It is found almost exclusively in women of repro- ductive age, and is the single most
common reason for hospi- talization of women in this age group. Approximately 20% of
women with chronic pelvic pain and 30% to 40% of women with infertility have
endometriosis.
Risk factors for endometriosis - Answer-Nulliparity,
early menarche,
prolonged menses, and
müllerian anomalies
first-degree relatives (mother or sisters) with endometriosis
autoimmune inflammatory disorders such as lupus, asthma, hypothyroidism, chronic
fatigue syndrome, fibromyalgia, and allergies.
The hallmark of endometriosis - Answer-is cyclic pelvic pain beginning 1 or 2 weeks
before menses, peaking 1 to 2 days before the onset of menses, and subsiding at the
onset of menses or shortly thereafter.
Women with chronic endometriosis and teenagers with endometriosis may not
demonstrate this classic pain pattern.
Other symptoms associated with endometriosis - Answer-dysmenorrhea,
dyspareunia,
abnormal bleeding,
bowel and bladder symptoms, and
subfertility.
Endometriosis is one of the most common diagnoses in the evaluation of infertile
couples.
Symptoms of endometriosis vary depending on the area involved. - Answer-Over 75%
of women with symptomatic endometriosis will have pelvic pain and/or dysmenorrhea
(painful menses)
Dysmenorrhea - Answer-usually begins in the third decade, worsens with age, and
should raise concern for endometriosis in women who develop dysmenorrhea after
years of pain-free cycles.
Dyspareunia - Answer-is usually associated with deep penetration that can aggravate
endometrial lesions in the cul-de-sac or on the uterosacral ligaments.
Endometriosis is also a cause of infertility. - Answer-lthough the exact mechanism is
unclear, moderate to severe endometriosis can cause dense adhesions, which can
distort the pelvic archi- tecture, interfere with tubal mobility, impair oocyte release, and
cause tubal obstruction.
