ENDOMETRIOSIS dan ADENOMIOSIS

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ENDOMETRIOSIS dan ADENOMIOSIS:

ENDOMETRIOSIS dan ADENOMIOSIS

ENDOMETRIOSIS:

ENDOMETRIOSIS Penyakit MISTERIUS pada zaman modern Penyakit dengan DAMPAK LUAS – MERUSAK dan sering DISALAH PAHAMI Penderita endometriosis : 80 juta wanita dan anak wanita dan cenderung terus bertambah Lebih sering terjadi dibanding HIV AID dan kanker payudara

endometriosis :

endometriosis KELENJAR dan STROMA ENDOMETRIUM berada diluar cavum atau dinding uterus . EPIDEMIOLOGI : Angka kejadian : 5 – 15% wanita masa reproduksi. Usia 30 an tahun. Nulipara. Infertil.

PATOFISIOLOGI:

PATOFISIOLOGI Jaringan endometrium ektopik bersifat FUNGSIONAL sehingga memberi RESPON terhadap hormon dan MENGIKUTI perubahan siklis menstruasi . Akibat jaringan endometrium ektopik yang mengalami “menstruasi” : Peradangan peritoneum. Fibrosis. Nyeri. Perlekatan  infertiliti dan obstruksi usus.

patogenesis:

patogenesis Terdapat peranan faktor GENETIK . Hipotesis : Menstruasi RETROGRADE ( aliran balik darah dan debris menstruasi ) Teori METAPLASIA saluran Mueller. Teori penyebaran melalui CAIRAN LIMFE .

lokasi endometriosis:

lokasi endometriosis 1 . Ovarium ; 2 . Cavum Douglassi 3 . Ligamentum sacrouterina ; 4 . Ligamentum latum ; 5 . Tuba falopii ; 6 . Plica vesicouterina ; 7. Ligamentum Rotundum ; 8 . Apendik ; 9 . Vagina ; 10 . Septum rectovagina ; 11 . Colon rectosigmoid ; 12 . Cecum ; 13 . Ileum ; 14 . Kanalis Inguinalis; 15 . Jaringan parut ; 16 . Ureter ; 17 . Vesica Urinaria ; 18 .Umbilikus ; 19 . Vulva ; 20 . Perifer

PowerPoint Presentation:

 Jaringan endometriosis bersifat HIDUP dan berfungsi sebagai ENDOMETRIUM NORMAL

PowerPoint Presentation:

 SKENARIO KASUS : Seorang wanita usia 37 tahun datang dengan batuk darah ( hemoptisis ) pada setiap siklus haid. DIAGNOSIS : Endometriosis pada nasopharynx

PowerPoint Presentation:

 KOMPLIKASI ENDOMETRIOSIS : Perdarahan berulang dan berlangsung lama sehingga menyebabkan pembentukan jaringan parut  ADHESI Adhesi dapat menyebabkan : Infertiliti Obstruksi usus

gejala klinik:

gejala klinik Sering terjadi pada wanita usia 20 – 30 an tahun NYERI PANGGUL Dismenorea (nyeri haid) Dispareunia (implantasi di CD ) Dyschezia (nyeri defekasi )  implantasi di rectosigmoid ) Infertilitas (adhesi genitalia interna)

PowerPoint Presentation:

 DISPAREUNIA : Nyeri sanggama terutama terjadi saat ‘ DEEP PENETRATION ‘ pada kasus endometriosis di cavum Douglassi

tanda:

tanda Uterus retrofleksi – tegang. Nodul pada ligamentum sacrouterina . Endometrioma – kista coklat. Bercak di vagina  vaginal staining.

DIAGNOSIS:

DIAGNOSIS LAPAROSKOPI atau LAPAROTOMI exploratif Implantasi baru → bercak kebiruan . Implantasi lama → bercak coklat Implantasi paling lama → putih (fibrosis – jaringan parut) BIOPSI : ditemukan stroma – kelenjar endometrium dan hemosiderin.

PowerPoint Presentation:

Endometriosis Pada Dinding Abdomen

PowerPoint Presentation:

This is a photo taken during laparoscopic surgery of multiple

PowerPoint Presentation:

These cysts are called "endometriomas" and develop as endometriosis implants slowly bleed into the ovary over the period of many months.

LAPAROSKOPIK:

LAPAROSKOPIK Gambaran laparoskopi endometriosis. Terlihat vesikel jernih- vesikel yang mengalami perdarahan , bercak kuning kecoklatan (“serbuk peledak” ) , vaskularisasi atipikal dan telangiektasis.

TERAPI:

TERAPI MEDIKAMENTOSA : GnRH – gonadotropin releasing hormone agonis → menekan FSH  pseudomenopause Progesteron (dengan atau tanpa estrogen)  “ pseudopregnancy” Danazol (derivat androgen) → menekan FSH/LH  “ pseudomenopause”

TERAPI:

TERAPI PEMBEDAHAN Bedah konservatif (bila fungsi reproduksi masih diperlukan ) :  Lisis perlekatan dan ablasi implan dengan laparoskop. Definitif : TAH – total abdominal histerektomi dan BSO – bilateral salfingoovarektomi

ADENOMIOSIS:

ADENOMIOSIS Jaringan kelenjar dan stroma endometrium yang terdapat dalam miometrium sekitar 2.5 mm diatas stratum basalis. Endometriosis jarang terjadi bersamaan dengan adenomiosis.

ETIOLOGY:

ETIOLOGY The cause of adenomyosis REMAINS UNKNOWN , but the disease typically DISAPPEARS AFTER MENOPAUSE . For women who experience severe discomfort from adenomyosis, certain treatments can help, but HYSTERECTOMY IS THE ONLY CURE .

SYMPTOMS:

SYMPTOMS Sometimes, adenomyosis is SILENT —no signs or symptoms. In other cases, adenomyosis may cause: Heavy or prolonged menstrual bleeding Severe cramping or sharp, knife-like pelvic pain during menstruation (dysmenorrhea) Menstrual cramps that lworsen as the patient get older Pain during intercourse Bleeding between periods Passing blood clots during the period The uterus may double or triple in size .

RISK FACTORS:

RISK FACTORS Risk factors for adenomyosis include: Prior uterine surgery, such as a C-section or fibroid removal Childbirth Middle age Most cases of adenomyosis, which depends on estrogen, are found in women in their 40s and 50s, with a low incidence after menopause. Finding adenomyosis in middle-aged women could relate to longer exposure to estrogen .

patologi :

patologi Makroskopik terlihat uterus membesar secara merata dengan penebalan miometrium dan berisi kelenjar iregular dan implantasi yang terdiri dari stroma dan jaringan kelenjar.

Complications:

Complications Although not harmful, the PAIN and EXCESSIVE BLEEDING associated with adenomyosis can have a negative effect on her LIFESTYLE . Painful periods can cause to miss work or school and can strain relationships. Recurring pain can lead to DEPRESSION, IRRITABILITY, ANXIETY, ANGER and FEELINGS OF HELPLESSNESS . Heavy bleeding, CHRONIC ANEMIA .

TESTS and DIAGNOSIS:

TESTS and DIAGNOSIS Based on SIGNS and SYMPTOMS A pelvic exam that reveals an ENLARGED, TENDER UTERUS ULTRASOUND imaging of the uterus MAGNETIC RESONANCE IMAGING ( MRI) of the uterus

TREATMENTS and DRUGS:

TREATMENTS and DRUGS Adenomyosis usually goes away after menopause of life. Treatment options for adenomyosis include: Anti-inflammatory drugs. Hormone medications. Controlling your menstrual cycle through : Combined estrogen-progestin ( oral contraceptives or through hormone-containing patches or vaginal rings). Progestin-only contraception , such as an intrauterine device containing progestin or a continuous-use birth control pill, often leads to amenorrhea — the absence of your menstrual periods — which may provide relief. Hysterectomy.

SEKIAN dan TERIMAKASIH:

SEKIAN dan TERIMAKASIH dr.BAMBANG WIDJANARKO SpOG DEP.OBSTETRI GINEKOLOGI FKK UMJ JAKARTA

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