 |
ADD DRUGS-WEB.COM AS FAVORITE - SITE MAP |
 |
ENDOMETRIOSIS DIAGNOSIS |
||
|
Diagnostic
Procedures
Physical Exam During a medical exam for suspected endometriosis, the doctor, usually a gynecologist, will take a careful history of symptoms the patient has experienced in the past and now. She will usually perform a bimanual pelvic examination, feeling the pelvic organs through the walls of the vagina and rectum, and visually inspecting the cervix through a speculum. She may order blood tests, ultrasound examinations or other tests. There is no simple test that can diagnose endo. An experienced gynecologist may be able to feel endometriosis nodules during a pelvic exam, especially in women with more severe disease, but mild to moderate endometriosis is easily missed during a pelvic exam. Symptoms may suggest that a patient has endometriosis, but they are not absolutely indicative of the disease. Having a first-degree female relative (mother, sister or daughter) with endometriosis increases the likelihood that a woman with suspicious symptoms has endometriosis. Laparoscopy The only sure way to diagnose endometriosis is through a minor surgical procedure called laparoscopy. Diagnostic laparoscopy is generally performed as an outpatient surgery. The patient is given a general anesthetic, the abdomen is distended with carbon-dioxide gas to make the organs easier to see, and an instrument called a laparoscope is inserted through a small incision in the lower abdomen. For a diagnostic laparoscopy there may be up to three very small incisions - one in the navel, and others along the "bikini line" along the lower abdomen. The laparoscope is a lighted instrument with a magnifying lens that the surgeon looks through directly. More common is the video laparoscope, where the magnified view from inside the abdomen is displayed on a large video monitor in the operating room. Both types of laparoscope can show the tissue from normal to six-times actual size. It enables the surgeon to see around the organs and carefully inspect for signs of endometriosis or other abnormalities. During laparoscopy the surgeon can see the extent, size, and location of endometriosis lesions and scarring. Biopsies can be taken during the procedure. Often the diagnostic procedure extends into a therapeutic "operative laparoscopy" where the surgeon uses a laser, electrosurgery and sharp instruments to remove as much endometriosis as possible. This is discussed in greater detail in the section on surgical treatment of endometriosis. MRI In Europe, magnetic resonance imaging (MRI) is sometimes used to diagnose endometriosis. In an MRI, the patient lies very still in a big, tube-shaped apparatus with magnets circling very fast within the walls of the tube. MRI gives a very clear, crisp image of the soft tissues of the body. It takes pictures in "slices", similar to the effect you get by cutting an orange into many circular slices of different sizes as you move through the orange. MRI is not invasive or painful, but it can be an uncomfortable procedure. The machine is disturbingly loud, and it can be scary and claustrophobic to be confined in the tunnel for up to an hour, lying absolutely still with your limbs weighted down with sand bags or straps to keep you from moving. On the other hand, if you don't mind the noise, you might even fall asleep. MRI is an expensive procedure. It is generally not used for diagnosing endometriosis in the United States, as most insurance companies refuse to pay for it. Ultrasound Ultrasound cannot diagnose endometriosis, but it can help the doctor to visualize ovarian cysts and certain abnormalities of the uterus and fallopian tubes. Almost all ovarian cysts will show up on ultrasound, with endometriomas ( blood-filled endometriosis cysts) having a typical "ground glass" appearance. Ultrasound can be imaged either through the abdominal wall or through the vagina. In abdominal ultrasound the patient must have a very full bladder for the technician to see the pelvic landmarks. The patient lies on a table and the technician rubs a small, round paddle with conducting jelly over the patient's abdomen. Trans-vaginal ultrasound can actually be more comfortable for the patient, as a full bladder is not necessary. The patient lies on a table with her legs in stirrups as for a pelvic exam. The technician inserts a condom-covered wand with conducting jelly into the vagina and gently moves it around to image the pelvis. CA-125 A blood test that checks for the presence of a substance known as CA-125 in the bloodstream can be indicative of endometriosis, but it is not diagnostic. CA-125 is elevated in many types of pelvic disease, most notably in ovarian cancer. It may also be elevated in endometriosis, pelvic inflammatory disease, fibroids, and other inflammatory conditions. Because it is not very specific, it is not a very good tool for diagnosing endometriosis. |
||
|
||
| ENDOMETRIOSIS RELATED ITEMS | ||
