64. Inflammatory diseases of uterus , adnexa and parametrium .

Question 1

what are the inflammatory diseases of the uterus adnexa and parametric

Answer 1

acute endometritis
chronic granulomatous endometritis
parametritis

Question 2

what are the symptoms of endometritis

Answer 2

fever,

lower abdominal pain/ abdominal distention

abnormal vaginal bleeding

purulent vaginal discharge

Question 3

Endometritis is divided into?

Answer 3

acute and chronic form

Question 4

what causes acute endometritis ?

Answer 4

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

Question 5

Chronic endometritis is more common in ?

Answer 5

menopause women

Question 6

how can we definitively diagnose Chronic endometritis is ?

Answer 6

plasma cells in the stroma.

Question 7

Chronic granulomatous endometritis is usually caused by ?

Answer 7

tuberculous

Question 8

other organisms causing chronic granulomatous infection?

Answer 8

Chlamydia trachomatis , Neisseria gonorrhoeae , Streptococcus agalactiae

Question 9

what are the complication of chronic endometritis ?

complication of acute endometritis ?

Answer 9

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.

Question 10

The diagnosis of endometritis ?

Answer 10

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

Question 11

chronic endometritis is treated with ?

Answer 11

doxycycline

Question 12

Due to the risks of puerperal sepsis following Caesarean section or vaginal birth , it is recommended that all women receive?

Answer 12

preventive dose of antibiotics such as ampicillin around the time of surgery or birth

Question 13

what is parametritis ?

Answer 13

is an inflammation of the connective tissue adjacent to the uterus

Question 14

what are the signs and symptoms of parametritis ?

Answer 14

onset usually insidious/acute

Fever

Experience pain in the lower abdomen and deep tenderness

Vaginal discharge that is smelly

Question 15

what causes parametrits ?

Answer 15

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

Question 16

diagnosis of parametritis

Answer 16

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

Question 17

what are the complication of parametrits ?

Answer 17

infiltrations- septicemia

abcess formation

Question 18

what is the clinical presentation of salpingitis ?

Answer 18

pain left lower or right lower quadrant

+- rebound tenderness

+-guarding

pain during ovulation, menstruation, or sex
spotting between periods

Question 19

treatment of salpingitis ?

Answer 19

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.