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    Gyne Case COC

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    Lian Baylosis
    The document describes a case of a 37-year-old woman who presented with abdominal pain and dyspareunia. On examination, she had hypogastric tenderness and tender nodules in the cul-de-sac. Based on her symptoms and examination findings, she received a diagnosis of endometriosis. The document then provides details on the anatomy, histology, etiology, clinical manifestations, diagnosis, and management of endometriosis.

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    Gyne Case COC

    Uploaded by

    Lian Baylosis
    62 views37 pages
    The document describes a case of a 37-year-old woman who presented with abdominal pain and dyspareunia. On examination, she had hypogastric tenderness and tender nodules in the cul-de-sac. Based on her symptoms and examination findings, she received a diagnosis of endometriosis. The document then provides details on the anatomy, histology, etiology, clinical manifestations, diagnosis, and management of endometriosis.

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    The document describes a case of a 37-year-old woman who presented with abdominal pain and dyspareunia. On examination, she had hypogastric tenderness and tender nodules in the cul-de-sac. Based on her symptoms and examination findings, she received a diagnosis of endometriosis. The document then provides details on the anatomy, histology, etiology, clinical manifestations, diagnosis, and management of endometriosis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    62 views37 pages

    Gyne Case COC

    Uploaded by

    Lian Baylosis
    The document describes a case of a 37-year-old woman who presented with abdominal pain and dyspareunia. On examination, she had hypogastric tenderness and tender nodules in the cul-de-sac. Based on her symptoms and examination findings, she received a diagnosis of endometriosis. The document then provides details on the anatomy, histology, etiology, clinical manifestations, diagnosis, and management of endometriosis.

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    You are on page 1of 37

    GYNECOLOGY CASE

    Group IV-A

    Delson, Glemao, Go, Gurung, Hassan, Hussin,


    Jao, Juntarungsri, Kalicharan, Kaewjumrus, Sah
    GNECOLOGY CASE
    History and Physical Examination:
    A.B. a 37 years old G2P2 (2002) came at the ER with chief complaint of
    abdominal pain.
    No consult done
    LMP: March 1, 2017
    She self medicated with Mefenamic Acid 500mg/cap which afforded
    temporary relief.
    Lately, her abdominal pain has been severe with associated dyspareunia.
    Her past medical history was non-contributory.
    All deliveries were uncomplicated and via normal vaginal delivery.
    Abdominal findings showed a flabby abdomen, with normoactive bowel
    sounds, soft, with direct hypogastric tenderness noted.
    Bimanual examination revealed a small corpus size with bo adnexal mass
    but with tenderness noted. Tender nodules were also noted in the cul de
    sac.
    Salient Features
    Age: 37
    Abdominal pain
    Dyspareunia
    Temporary relief with Mefenamic Acid
    500mg/cap
    Differential Diagnosis
    Rule In Rule Out
    Endometriosis Dyspareunia, Abdominal pain,
    hypogastric tenderness
    Bimanual Exam: Adnexal mass,
    with tenderness
    Leiomyoma
    Adenomyosis
    Acute PID
    Final Diagnosis
    Endometriosis
    Uterus
    Thick walled, hollow, muscular organ
    Fundus
    Isthmus
    Cervix
    Boundaries
    Anterior: urinary bladder
    Posterior: rectum
    Lateral: broad ligaments
    Size & weight
    Nulliparous
    Size: 8 x 5 x 2.5cm
    Weight: 40-50grams
    Parous
    Size: 1.2cm larger
    Weight: 20-30grams heavier
    Upper weight limit: 110 grams
    Uterus
    Cul de sac
    Deep pouch formed by
    the most caudal extent
    of the parietal
    peritoneum
    Anterior to the rectum,
    separating uterus from
    large intestines
    Uterus
    Arterial supply
    Uterine arteries: branches of hypogastric
    (internal iliac) artery
    Ovarian arteries: aorta
    Venous drainage
    Fundus: ovarian veins
    Corpus: uterine veins via iliac veins
    Lymphatics
    Fundus & Corpus: aortic, lumbar, pelvic
    nodes surrounding the iliac vessels
    especially internal iliac nodes
    Superior inguinal nodes via round
    ligament (metastatic)
    Nerve supply
    Afferent fibers at T1, T2
    Sympathetics: hypogastric & ovarian
    plexus
    Parasympathetic: pelvic nerve, s2, s3, s4
    Histology
    Layers
    Serosa
    thin, external visceral
    peritoneum
    firmly attached except anteriorly
    at the level of internal cervical
    os
    Myometrium
    wide muscular layer
    3 indistinct layers of smooth
    muscles
    outer: longitudinal
    middle: interlacing oblique &
    spiral bundles + blood vessels
    inner: longitudinal
    Endometrium
    reddish mucous membrane 1-
    6mm thick (depends on
    hormonal stimulation)
    Histology

    Endometrium

    Stratum
    Stratum Basale
    Functionale
    (inner)
    (outer)

    Stratum Stratum
    Compactum Spongiousum
    (inner) (outer)
    Histology
    Physiology
    Major Phases of Menstrual Cycle
    Premenstrual
    Phase
    Secretory
    Phase
    Proliferative
    Phase
    Endometriosis
    A benign but, in many
    women, a progressive
    and aggressive disease.
    Presence and growth of
    GLANDS and STROMA
    of the lining of the
    uterus in an aberrant or
    heterotopic location
    Etiology
    Retrograde Menstruation
    Metaplasia
    Lymphatic and Vascular Metastasis
    Iatrogenic dissemination
    Immunologic changes
    Genetic predisposition
    Retrograde Menstruation
    Pelvic endometriosis is
    secondary to
    implantation of
    endometrial cells shed
    during menstruation
    Endometrial-based adult
    stem cells attach to the
    pelvic peritoneum and
    under hormonal influence
    grow as homologous
    grafts
    Involvement of the
    Ovaries and Cul de sac
    Metaplasia
    Endometriosis arises
    from metaplasia of the
    coelomic epithelium or
    proliferation of
    embryonic rests.
    Lymphatic & Vascular
    Metastasis
    Lymphatic
    dissemination
    Hematogenous
    dissemination
    Endometriosis

    Common Rare
    Ovaries Umbilicus
    Pelvic peritoneum Episiotomy scar
    Ligaments of the Bladder
    uterus Kidney
    Sigmoid colon Lungs
    Appendix Arms
    Pelvic lymph nodes Legs
    Cervix Nasal mucosa
    Vagina Spinal column
    Fallopian tubes
    Clinical Manifestation
    Signs: Physical Exam:
    1. Pelvic pain 1. Fixed retroverted
    2. Infertility uterus
    3. Dyspareunia 2. Scarring and
    4. Abnormal bleeding tenderness posterior to
    the uterus
    3. Rectovaginal
    examination: (+)
    nodularity of the
    uterosacral ligaments
    and cul de- sac
    Complications
    1. Adhesions
    2. Scarring
    Endometriosis
    Endometriosis
    Endometriosis
    Endometriosis
    Endometriosis
    Histopathology
    1. Endometrial
    Epithelium
    2. Endometrial Stroma
    3. Endometrial Glands
    4. Hemosiderin-laden
    Macrophages
    Staging
    I. Stage I (Minimal)
    - Superficial lesion
    II. Stage II (Mild)
    - Deep lesion in cul-de-sac
    III. Stage III (Moderate)
    - As above (+)
    endometriomas and
    adhesions
    IV. Stage IV (Severe)
    - As above (+) large
    endometriomas, extensive
    adhesions
    Bimanual Exam
    Bimanual Exam
    Management
    Short term goal:
    1. Relief of pain
    2. Promotion of fertility
    Long term goal:
    Prevent progression or recurrence of disease
    process
    Management
    Medical Surgical
    1. Danazol 1. Conservative
    2. GnRH agonists 2. Definitive
    3. Oral Contraceptives
    4. Other hormonal
    treatments
    5. NSAIDs
    Medical Therapy
    Aimed at suppression of lesions and
    symptoms (i.e. pain).
    Achieved by menstrual suppression
    Medical Therapy
    Surgical
    Conservative Definitive
    preservation of removing the uterus and
    reproductive organs cervix along with any
    restoration of normal visible lesions
    pelvic anatomy preserving or removing
    removing all either one or both of the
    macroscopic ovaries
    endometriotic lesions
    performing lysis of
    adhesions

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