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Endometriosis is a gynecologic disorder that is frequently encountered in the emergency department (ED) as well as in the outpatient setting. Because it is enigmatic, endometriosis can present as a diagnostic and therapeutic challenge for emergency physicians in their approach to the female patient with pelvic pain. [ 1, 2, 3]
Women with endometriosis may have many different kinds of pain. These include: Very painful menstrual cramps. The pain may get worse over time. Pain during or after sex.
GnRH agonists also may help pelvic pain. If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.
Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope to confirm this. How is endometriosis treated?
Emergency department care The goal of the emergency physician is to provide pain relief and exclude life-threatening causes of pelvic/abdominal pain. Unstable patients require resuscitation and possibly urgent surgical consult. Medical management in the ED generally is restricted to pain control.
Complications of endometriosis may include or fall into the following 3 categories: Infertility/subfertility. Chronic pelvic pain and subsequent disability. Anatomic disruption of involved organ systems (eg, adhesions, ruptured cysts)
Even in severe cases of endometriosis, most can be treated with laparoscopic surgery. In laparoscopic surgery, your surgeon inserts a slender viewing instrument (laparoscope) through a small incision near your navel and inserts instruments to remove endometrial tissue through another small incision.
While endometriosis is a painful condition that can affect your quality of life, it's not considered a fatal disease. In extremely rare instances, however, complications of endometriosis can cause potentially life threatening problems.
It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility.
Long-term health issues Recent studies suggest that women with endometriosis have increased risks of abnormal cholesterol levels and heart disease. These are highest in women who are younger than 40. Some of these risks increase after hysterectomy and removal of both ovaries for endometriosis treatment.
Nursing Care Plan for Endometriosis 1Endometriosis Nursing InterventionsRationalesAdminister analgesics/ pain medications as prescribed.To provide pain relief to the patient.Ask the patient to re-rate his/her acute pain 30 minutes to an hour after administering the analgesic.To assess the effectiveness of treatment.3 more rows
The only way to know for sure is to remove the tissue and test it. This requires surgery, a procedure called a laparoscopy. But an ultrasound can let your provider know that you likely have endometriosis, without surgery, and allows them to plan your surgery more effectively.
A definitive diagnosis can be made only by means of laparoscopy. Medical treatment designed to interfere with ovulation generally provides effective pain relief, but the recurrence rate following cessation of therapy is high, and this type of treatment will not resolve infertility.
The stage of endometriosis is based on the location, amount, depth and size of the endometrial tissue....Stages of EndometriosisStage 1: Minimal.Stage 2: Mild.Stage 3: Moderate.Stage 4: Severe.
Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems also may develop.
While endometriosis can qualify you for intermittent leave under FMLA or time off under the Americans with Disabilities Act, both of those require paperwork from your doctor. And it takes, on average, 10 doctor visits before an afflicted woman gets a diagnosis.
Pain. This is the most common symptom. Women with endometriosis may have many different kinds of pain. These include:
If you have symptoms of endometriosis, talk with your doctor. The doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:
It gets its name from the word endometrium (en-doh-MEE-tree-um), the tissue that normally lines the uterus or womb. Endometriosis happens when tissue similar to the lining of the uterus grows outside of your uterus and on other areas in your body where it doesn't belong.
Endometriosis growths are benign (not cancerous). But they can still cause problems.
Endometriosis is a common health problem for women. Researchers think that at least 11% of women, or more than 6 ½ million women in the United States, have endometriosis. 1
Research shows a link between endometriosis and other health problems in women and their families. Some of these include:
Pelvic exam. During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.
Therapies for endometriosis-related symptoms including dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility are mainly a combined approach of analgesics, hormonal treatments, and surgical intervention. The surgical management of endometriosis is usually not the first choice in clinical practice.
If endometriosis spreads to the parametrium, surgical intervention plays a major role in management. However, preoperative clinical treatment can reduce tissue injury and the need for aggressive surgical intervention. Surgeons usually perform disc excision for single lesions.
There are also some specific cases where surgical intervention is better. These include: 1 need for tissue diagnosis of endometriosis 2 contraindications to/or refusal of medical therapy 3 persistent pain despite medical therapy 4 obstruction of the bowel or urinary tract 5 endometrioma rupture 6 malignancy
Especially in the case of endometrioma rupture, emergency surgical intervention can reduce the dissemination of endometriotic cyst fluid spread. It can also prevent adhesions, and preserve fertility. If obstruction of the bowel or urinary tract occurs due to infiltration of endometriosis, urgent surgical management plays a vital role in minimalizing the loss of organ function.
There are many reasons for this. They include complications and disadvantages of surgery. For example, the risk of organ damage, possible reduction of ovarian reserve, adhesion formation, possible lack of improvements in pain or recurrence ...
Deep infiltrating endometriosis is the most severe manifestation of endometriosis, affecting 20% of patients. It is when ectopic endometrial tissue infiltrates under the peritoneum, pelvic structures, and the organ walls such as the uterosacral ligaments, colon, vagina, bladder, ureter, rectovaginal septum, and the lateral parametrium.
The first step in such emergency cases is taking a careful anamnesis and performing a detailed physical and pelvic examination. Then hemogram and a pregnancy test can differentiate the presence of pregnancy and pregnancy-related adverse conditions.
I kept a notebook where I put all of my medical files, everything from my five surgeries and past ER visits.
At the height of my battle with endometriosis, I was a single woman living alone. And contrary to what some ER doctors may have thought of me, I hated being seen as overly dramatic, or putting the burden of my care on anyone else.
I don’t want to disparage male doctors. My amazing endometriosis surgeon is male, and he’s one of the most knowledgeable experts on endometriosis that I’ve ever met.
Procedures. Laparoscopy with biopsy is the only definitive way to diagnose endometriosis. It is an invasive procedure with an overall sensitivity of 97% and a specificity of only 77%. Hallmark findings are the classic powder burn, blue-black lesions.
The most common sites of involvement in endometriosis, as seen on laparoscopic examination, are as follows, in descending order: 1 Ovaries 2 Posterior cul-de-sac 3 Broad ligament 4 Uterosacral ligament 5 Rectosigmoid colon 6 Bladder 7 Distal ureter
The goal of the emergency physician is to provide pain relief and exclude life-threatening causes of pelvic/abdominal pain. Unstable patients require resuscitation and possibly urgent surgical consult. Medical management in the ED generally is restricted to pain control.
The most common sites of involvement in endometriosis, as seen on laparoscopic examination, are as follows, in descending order: Cases have been reported of extrapelvic involvement in virtually every other organ system including the central nervous system (CNS), lungs, pleura, kidney, and bladder.
Prior to ascribing a patient's abdominal or pelvic pain to endometriosis, the clinician should consider other important causes of such pain, including ectopic pregnancy, pelvic infection, and ovarian torsion. Patients may also have concomitant endometriosis and inflammatory bowel disease (stricturing Crohn disease).
Medical management in the ED generally is restricted to pain control. Long-term medical therapy usually is suppressive and rarely curative. Medical treatments for endometriosis act in a variety of ways to abolish the trophic effect of estradiol on the eutopic and ectopic endometrium.
Computed tomography scanning. Using computed tomography (CT) scanning, endometriomas may appear as cystic masses, but their appearance is nonspecific, and CT scanning should not be relied on for diagnosis. Complications of endometriosis, including bowel obstruction and hydronephrosis, may be seen on CT scans.