64. Inflammatory diseases of uterus , adnexa and parametrium . Flashcards
what are the inflammatory diseases of the uterus adnexa and parametric
acute endometritis
chronic granulomatous endometritis
parametritis
what are the symptoms of endometritis
fever,
lower abdominal pain/ abdominal distention
abnormal vaginal bleeding
purulent vaginal discharge
Endometritis is divided into?
acute and chronic form
what causes acute endometritis ?
PID - bacteria that spread from vagina to cervix to the uterus - such as mycoplasma genitalium, chlamidya trachomatis,
niesseria gonorrhea ( pelvic inflammatory diseases ) that passes through the cervix
sexually transmitted
post partum endometritis /puerperal sepsis / - usually occurring within 24 hours till 10 days after vaginal delivery
risk factors : premature rupture of membranes,
multiple vaginal exams during labour
manual removal of the placenta prolonged labour
causative agents - complex of bacteria which normally resides in the vagina or perineum - strep b Staphylococcus prevotella gardnelle vaginalis mycoplasma genitalis
dilation and curettage with abortion or miscarriage result of douching placement of an IUD hysteroscopy endometrial biopsy
Chronic endometritis is more common in ?
menopause women
how can we definitively diagnose Chronic endometritis is ?
plasma cells in the stroma.
Chronic granulomatous endometritis is usually caused by ?
tuberculous
other organisms causing chronic granulomatous infection?
Chlamydia trachomatis , Neisseria gonorrhoeae , Streptococcus agalactiae
what are the complication of chronic endometritis ?
complication of acute endometritis ?
chronic
underlying cancer of the cervix or endometrium
infertility
acute these infections can carry on to infect the myometrium and parametrium infertility pelvic peritonitis pelvic or uterine abcess septicaemia PROM
pid = ectopic pregnancy
abnormal menstrual bleeding
pregnancy - fetus has lung inflammation and eye infection and can be PROM
periappendicitis
perihepatitis.
The diagnosis of endometritis ?
PID - history taking - sex life
characteristic complaints : bilateral lower abdominal pain is charecteritic of PID
inspection - mucopurulent cervical discharge
bimanual pelvic examination -
cervical motion tenderness
blood - raised WCC
endocervical swab for media culturing and sensitivity test
fitz hugh and curtis syndrome :
right upper quadrant pain result from ascending pelvic inflammation due to inflammation of liver capsule or diaphragm - confused for cholecystitis
confirmation through biopsy of endometrium
puerperal sepsis :
the same
vaginal and endocervical swabs
chronic endometritis is treated with ?
doxycycline
Due to the risks of puerperal sepsis following Caesarean section or vaginal birth , it is recommended that all women receive?
preventive dose of antibiotics such as ampicillin around the time of surgery or birth
what is parametritis ?
is an inflammation of the connective tissue adjacent to the uterus
what are the signs and symptoms of parametritis ?
onset usually insidious/acute
Fever
Experience pain in the lower abdomen and deep tenderness
Vaginal discharge that is smelly
what causes parametrits ?
PID bacteria
normal perineaum / vaginal flora
gain accès to he parametric through
delivery and abortion through placenta site
through laceration of the genital tract
C section or hysterectomy
due to
secondary to pelvic peritonitis
diagnosis of parametritis
parametritis or pelvic cellulitis - tissue inflammation adjacent to uterus esp broad lig
signs of peritoneal irritation is absent through abdominal palpation
pelvic examination
shortening and smoother of posterior and lateral fornices
uterus pushed to contralateral side
uterus not really contoured
rectal examination confirm the indurationesp extending along uterosacral lig
blood tests show :
ESR and leukocytosis , and CRP
wet mound microscopic examination
what are the complication of parametrits ?
infiltrations- septicemia
abcess formation
what is the clinical presentation of salpingitis ?
pain left lower or right lower quadrant
+- rebound tenderness
+-guarding
pain during ovulation, menstruation, or sex
spotting between periods
treatment of salpingitis ?
oral or intravenous antibiotics sexual partners will also require antibiotics.
If the infection has caused an abscess, perform laparoscopic surgery to drain it.
If the infection has caused scars or adhesions to form, surgery to remove the damaged areas.
Your doctor is more likely to recommend surgery if you wish to become pregnant later on.
