Reserves to improve the diagnosis of endometriosis

Knowledge of the clinical features of endometriosis different locations, introduction of modern methods of investigation (endoscopic, including laparoscopy, colonoscopy, bronchoscopy, ultrasound, pneumopericardium, computer tomography), knowledge of the immunological aspects of endometriosis, more frequent use of cytological and histological study byobserving material allow to diagnose endometriosis in the earlier stages of the disease when treatment of patients easier, and if it will be a question of surgical treatment is more likely to do it in a savings volume.
With the purpose of revealing of reserves to improve the diagnosis of endometriosis is necessary to use the experience of I. D. Nechaeva, Ya Century of Bojmana, A. B. Derazhnya and other active detection of patients with precancer and initial stages of neoplastic processes. Actively detect endometriosis is advisable in the following groups of patients:
1. Patients suffering from chronic relapsing adnexitis and repeatedly visited pregnancy. Remission adnexitis up to 6 months to less than year was registered after birth. If pregnancy was interrupted artificially (abortion) or spontaneously, exacerbation of the symptoms of adnexitis came quickly (recovery month). And here, despite the fact that the woman was 10-15 or more abortion, she is diagnosed with chronic adnexitis. Indeed, inflammatory changes in the pelvic cavity there, but they are secondary, and the patency of the fallopian tubes kept by them.
2. Patients uterine cancer and severe pain in the absence of submucosal node in the uterus. GHA, ultrasound, hysteroscopy a number of patients and diagnostic curettage of the uterus allow you to make a correct diagnosis.
3. Patients with resistant excruciating pain deep in the pelvis, previously undergone supracervical amputation of uterine fibroids. This pain was before the operation, by the time they coincided with the monthly, in some women gave rectum and was accompanied by the strengthening of constipation (or diarrhea). Some patients in this period was observed dysuric phenomena (frequent and sometimes painful urination). After the operation, the intensity of the pain gradually grows. Clearly traced their gain from thermal procedures applied for allegedly Prikotenko infiltrate. If during the operation managed to preserve part of the mucous membrane of the isthmus of the uterus and patients are scarce, mainly dark brown color, highlight during your period is due, the cyclical nature of the pain persists. If the menstrual function was not maintained, the pain gradually lose cyclical in nature, are permanent. Strengthening them is called nervous feelings, physical load, thermal treatments, too "zealous" vaginal or vaginal-pryamokishechnye study. Acceding pelvic plexitis, lumbosacral neuralgia, coccygodynia in combination with schmorl's hernia, discogenic radiculitis, inflammation of the cauda equina and other pathology contribute to the loss of recurrence of pain and their strengthening. Clearly appears syndrome mutual aggravation.
In-depth and focused examination of these patients can detect endometriosis isthmus of the uterus, pozavcherashny endometriosis, endometriosis front wall of the rectum , or both.
4. Patients with chronic adnexitis and infertility saved when the fallopian tubes. This group should include patients with infertility due to anovulation, autoparvadatajus and other immune disorders in organs and systems, responsible for the reproductive function.
5. Young patients, including adolescent suffering from severe algodismenorrhea, especially with difficult family anamnesis (the presence of similar complaints and operations on the occasion of uterus fibromioma sisters, mothers, grandmothers, aunts on a parent line).
6. Patients suffering from genital tuberculosis, but unsuccessfully treated about this disease. Thus there are two options: first, when genital endometriosis mistakenly diagnosed as genital tuberculosis; the second is when there is a combination of both diseases.
7. Patients with persistently flowing neurological and neuropsychiatric disorders with symptoms of peripheral nerves and plexus, and neurosis-like States. Long-term treatment of these patients neurologists and psychiatrists without taking into account the main pathogenetic factor (endometriosis) and purposeful influence on him was insufficient. Here are some patients with the so-called masked depression have a lot of complaints, including persistent aching pain in the abdomen, the depth of the pelvis, lumbar-sacral region. However, objective changes expressed little, and localization of pain is not the same as zones of innervation.
8. Patients with pathology of mammary glands and menstrual function.
9. Patients suffering from polyvalent (medical and food allergieswhen you are unable to allocate the allergen.
10. Patients suffering from dyskinesia of intestines and spastic colitis and treated unsuccessfully about this disease
11. Patients with recurrent hemoptysis, coinciding with the menstrual days.
In-depth examination of patients these groups, together with interested experts can be very useful in improving the diagnosis of endometriosis and prevent severe common forms of the disease. It is advisable to inform the doctors of different specialties with the General features of endometriosis and the dependence of the impact of the disease on the localization of the pathological process. It is extremely important in the parsed aspect avoid over diagnosis. The fact that not all symptoms that appear during menstruation, are caused by endometriosis. For example, coinciding with the monthly hemoptysis can be caused not only by endometriosis lungs, but eosinophilic Leverkusen infiltration, candidiasis of the tracheobronchial tree, lung aspergillosis, evolved as a result of a long period of TB treatment, broncho-esteticheskoj disease and other causes. Nosebleeds, bleeding from the nipple that appear during menstruation, very rarely caused by endometriosis. Excruciating pain deep in the pelvis, lower abdomen and lumbar-sacral region, sharply increasing during menstruation may be a manifestation of the syndrome Allen-masters, peridotite (inflammation of the Dura in the field of the output of the lower lumbar and sacral roots), discogenic pain, coccygodynia, schmorl's nodule, of sacroileitis and other diseases. Dysbacteriosis and intestinal candidiasis during menstruation increase dyskinesia, constipation alternating with purgative action, can receive the mucus and blood in the stool. Recurrent menstruating pain in the epigastric region and vomiting "coffee grounds", due ulcerogenic adenoma ostrovkovogo apparatus pancreas (syndrome Zollinger-Ellison), often reported as endometriosis stump of the stomach or duodenum.
One could continue the list of diseases, symptoms which coincide in time with monthly and mistakenly classified endometriosis, but these examples are enough to show the need for differential diagnosis and knowledge of many issues pathology of the female body.
In addition to the selection of groups of patients, among which the need to actively identify endometriosis, improving the diagnosis of the disease may contribute to improving the methodology for examination of women. A. N. The summary (1977, 1979) have shown that the application of mathematical method and computers has allowed to increase the frequency correct preoperative diagnosis internal endometriosis, uterine with 47,59 to 86,09 %.
Based on the frequent combination of internal endometriosis and myoma of the uterus, which reaches 82-85 %, M. I. Salty (1986) developed a diagnostic table for the differentiation of both diseases.
Century, Pavlovich (1987) reasonably believes that the use of ultrasound in a women's clinic will significantly improve the diagnosis of endometriosis. This is evidenced by the experience of our work (centuries Meleshko). In-depth examination of such patients using endoscopic, x-ray and other methods will allow to specify the diagnosis and quickly start to targeted treatment.