Quiz

fallopian tubes and becoming affixed to the extra-uterine structures, although the tissue can travel in the bloodstream to distant sites.

The symptoms of endometriosis differ according to where the implants are located. The most common symptom is dysmenorrhea or painful periods because of the extra-uterine bleeding. Other symptoms include dyspareunia or pain with intercourse, infertility, pain with defecation, and dysuria. Figure 1 shows where endometriosis can be seen:

Figure 1.

Figure 3

They can occur at any place in the large bowel but are most common in the sigmoid colon. There can be large diverticula but most are just 10 millimeters in size or less. Most patients have several diverticula at the same time. It is so common that 75 percent of adults older than 80 years have this problem. The exact etiology is not known but it may be secondary to a low fiber or high meat diet.

If there are symptoms at all of diverticulosis, most will just have constipation. Others will have rectal bleeding with or without any pain. Mucus, bloating, or diarrhea are not common. The main complications are diverticulitis, segmental colitis, or diverticular bleeding. It is the most common cause of hematochezia in adults. Most of the time, the bleeding is painless with moderate to severe blood loss.

and postmenopausal women with risk factors or who have had a fragility fracture. If a plain film suggests low bone density, a scan can then be done.

Plain x-rays can show decreased bone density but this isn’t a very sensitive test. Their main usefulness is to document fragility fractures and to check vertebral height. Ideally, those who have back pain and risk factors should have a lateral vertebral x-ray. Figure 4 shows a vertebral fracture:

Figure 4.