A 51-year-old man comes to the emergency department with complaints of palpitations

[Love Nepal]

Must have been a typing error by unknown.
Only blocking the beta adrenergic receptors will lead to excessive alpha activation by the circulating catacolamines and leads to high rise in BP.That is why alpha blockade is suggested before u have beta blockade in this case.

[kenneth masamaro]

A 32 year old female presents with cyclical abdominal pain that coincides with her menses.Attempts to become pregnant have failed over the past 5 years.Laparascopic examination reveals numerous haemorrhagic 0.2-0.5 cysts over the peritoneal surfaces of the uterus and ovaries.

What is the likely diagnosis?

Distinguish this diagnosis with adenomyosis.(This is a give away clue)

[Alpine]

endometriomas ????????? cz hameorrhagic cyst are also seen in this disease.

[kenneth masamaro]

Originally Posted by Alpine

endometriomas ????????? cz hameorrhagic cyst are also seen in this disease.

Quite on point alpine.Indeed the diagnosis is endometriosis.

Endometriosis is defined as presence of endometrial glands and/or stroma in abnormal locations outside the uterus.These abnormal sites include ovaries(where they infiltrate forming endometriomas),uterine ligaments,rectovaginal septum,pelvic peritoneum,laparatomy scars and rarely in umbilicus,vagina,vulva and appendix.May also be found in lung tissue and lymph nodes.

On the other hand adenomyosis is defined as presence of endometrial tissue in the myometrium.(has been called myometrial endometriosis)However adnomyosis remains in continuity with the endometrium.

Enometriosis is important because of its clinical sequale of infertility,dysmenorrhoea and pelvic pain(as seen in the case above)

We know that it has been referred to as 'the disease of theories',this relating to the postulated pathogenesis of regurgitation,metaplastic and dissemination theories.

Some of the differentials include ovarian cysts,ovarian torsion,ectopic pregancy,acute appendicitis,diverticular disease,PID among others.Treatment is surgical ablation if no pregancy is a requisite, but should be conservative and used in tandem with or as a supplement to medical treatment.

ref:
1)Crum C.P:Female genital tract.Robbins and cotran,Kumar et al 7/e:Pathologic basis of disease.Saunders,2004,pp 1083-1084.

Aruklumaran et al:Endometriosis.Oxford Handbook of obstetrics and gynaecology.Oxford,2004 pp 577-581