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CLINICAL GUIDELINE FOR THE TREATMENT OF

CLINICAL GUIDELINE FOR THE TREATMENT OF. ENDOMETRIOSIS. Endometriosis. Endometriosis is a disorder in which cells lining the uterus (endometrium) implant in other locations in the body.

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CLINICAL GUIDELINE FOR THE TREATMENT OF

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  1. CLINICAL GUIDELINE FOR THE TREATMENT OF ENDOMETRIOSIS

  2. Endometriosis • Endometriosis is a disorder in which cells lining the uterus (endometrium) implant in other locations in the body. • Typically these cells can implant on the ovaries, bowel, rectum, bladder and the pelvic lining. Occasionally, some implants can travel to distant organs such as the lung, brain, and kidney.

  3. Endometriosis These estrogen dependent implants grow and cause strictures and adhesions on organs. These ectopic implants distort and obstruct the organ’s normal function thereby causing pain, bleeding and infertility.

  4. Endometriosis • The pathogenesis is unknown. • Theories include: • Retrograde menstruation • Genetic allele HLA-B7

  5. Endometriosis • Found in 5-10% of women of reproductive • age in the US. • Found in 53% of adolescents who present • with pelvic pain. • Higher incidence in Caucasian women and • in women with lower BMIs.

  6. Endometriosis • A woman with a first degree relative • diagnosed with endometriosis is 6 • times more likely to develop this condition. • Early menarche, nulliparity, frequent cycles, menses lasting 7 days or more, and a closed hymen.

  7. Female Reproductive System www.Patient.co.uk/diagrams.asp

  8. Sites of Ectopic Implants in Red

  9. Signs and Symptoms • Some women are asymptomatic even with severe cases. • Pelvic pain is the most common. • Dyspareunia. • Bleeding with defecation, urination, or intercourse. • Inability to conceive.

  10. Staging of Endometriosis • Staging does not classify the condition according to the severity of pain or other symptoms. • Staging is meant to predict the chance of pregnancy. • Points are arbitrarily assigned by the physician interpreting the laparoscopy results.

  11. Laparoscopy Procedure

  12. Endometrial Changes

  13. Stage I/ Minimal1-5 Points • Endometriosis implants appear as red dots in these photos. • There are isolated and superficial implants growing outside the uterus. Endochick.wordpress.com

  14. Stage ll/ Mild6-15 Points • Deep lesions present in the cul-de-sac area between the uterus and the rectum. Endochick.wordpress.com

  15. Stage III/ Moderate16-40 Points • Implants are found on the ovaries. • Symptoms are common at this stage. Endochick.wordpress.com

  16. Stage IV/ Severe>40 Points • There are large sized implants and extensive adhesions on several organs. • Infertility is common at this stage. Endochick.wordpress.com

  17. Treatment Plan

  18. References • Bulun, S.. (2009). Endometriosis Mechanisms of Disease:. The New England Journal of Medicine, 360(3), 268-279.  Retrieved January 11, 2010, from ProQuest Nursing & Allied Health Source. (Document ID: 1627865541). • DeCherney, A., Nathan, L., Goodwin, T.M., & Laufer, N. (2007). Current diagnosis & treatment obstetrics & gynecology. New York: McGraw-Hill. • Lee, S. (2009). Peritoneal Fluid Affects Release of IP-10 and IL-8 by Neutrophils and CD4+ T Cells. Fertility Weekly, 3-4. Retrieved from Health Source: Nursing/Academic Edition. • www.nlm.nih.gov/medlineplus/ency/article/000915.htm • www.Patient.co.uk/diagrams.asp

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