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9. Female Genito-urinary System > 9.1 Inflam Conditions Of Female GT > Flashcards

9.1 Inflam Conditions Of Female GT Flashcards

1
Q

Vaginitis definition

A

General term for disorders of vagina caused by:
- infec
- inflam
- changes in normal vaginal flora

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2
Q

What cells in the female GT does vaginitis affect?

A
  • columnar epithelial cells of endocervical glands
  • squamous epithelium of ectocervix
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3
Q

Genitourinary syndrome of menopause
Etiology
Clinical features

A

Etiology
- ⬇️ estrogen
- atropy of: epithelium in vagina; vulva; urethra and bladder

Clinical features
- ⬇️ labial fat pad
- vaginal soreness, dryness
- dyspareunia
- urinary sym
- receding pubic hair

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4
Q

Aerobic vaginitis
Etiology
Clinical features

A

Etiology
- non-infec microbiome disturbance
- ⬇️ Lactobacillus
- sec bac overgrowth with gram ➖ & gram ➕
- vaginal immune reaction

Clinical features
- yellow, odourless vaginal discharge
- dyspareunia
- pruritus
- burning sensation

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5
Q

Allergic vulovaginitis
Etiology
Clinical features

A

Etiology
- contact allergy

Clinical features
- typically prepuberscent girls
- inflam
- pruritus
- burning sensation

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6
Q

Mechanical vulvovaginitis
Etiology
Clinical features

A

Etiology
- pruritus and itchiching
- due to atopis dermatitis
- friction

Clinical features
- postmenopausal women (history of lichen sclerosis)
- pruritis
- signs of inflam
- urinary symptoms
- dyspareunia

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7
Q

Differential diagnosis of Vaginal discharge
Infective
Non-infective

A

Infective

Non-STI
- bacterial vaginosis
- candida albicans

STI
- trichomonas vaginalis
- chlamydia trachomatis
- meisseria gonorrhoea

Non-infective
- Foreign body
- cervical polyp
- atropy
- irritants / allergens

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8
Q

List the infectious causes of vaginal discharge

A
  • Bacterial vaginosis
  • trichomoniasis
  • vaginal yeast infec
  • gonorrhea
  • chlamydia infec
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9
Q

Bacterial vaginosis
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH
Risk factors

A

Pathogen - Gardnerella vaginalis

Discharge - gray/milky, fishy odor

Vaginal inflammation - absent

Cervicitis - absent

Vaginal pH- >4.5 (⬆️pH)

RF - preg, vaginal douching, intrauterine devices

  • Non-STI, polymicrobial
  • mild erythema
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10
Q

Trichomoniasis
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH

A

Pathogen - Trichomas vaginals
Discharge - Frothy, yellow-green, foul-smelling
Vaginal inflammation - present
Cervicitis - present
Vaginal pH - >4.5

  • STI
  • strawberry cervix
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11
Q

Vaginal yeast infection (Vulvo-vaginal candidiasis)
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH

A

Pathogen - Candida albicans

Discharge - white, crumbly and thick (cottahe cheese-like); oderless

Vaginal inflammation - present

Cervicitis - absent

Vaginal pH - 4 - 4.4

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12
Q

Gonorrhea
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH

A

Pathogen - Neisseria gonorrhoeae (sexually transmitted)

Discharge - purulent, creamy, malodorous

Vaginal inflammation - absent

Cervicitis - present

Vaginal pH - variable

  • columnar and transitional epithelium
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13
Q

Chlamydia infections
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH

A

Pathogen - Chlamydia trachomatis serotype D-K (sexually transmitted); intracellular parasite

Discharge - purulent, bloody, malodorous

Vaginal inflammation - absent

Cervicitis - present

Vaginal pH - variable

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14
Q

Pelvic infalm disease (PID)
Pathophysiology
Sites of infec

A
  • infec from lower GT (vagina, cervix) asecnds to infect upper reproductive tract (endothelium, fallopian tubes, ovaries) & peritoneal cavity

Sites of infec
- endometrium: endometritis
- fallopian tubes: salpingitis
- ovaries: oophoritis
- uterine adnexa: andexitis
- surrounding pelvic structures (parametritis)
- peritoneum (rare): peritonitis

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15
Q

Pelvic inflam disease
High risk factors
Protective factors

A

High risk factors
- new multiple or symptomatic partner
- previous STD, PID
- concomitant sexually transmitted diseases
- instrumentation of uterus

Protective factors
- barrier contraceptive
- tubal ligation
- preg

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16
Q

Pelvic inflammatory disease
Mild vs. Severe disease Pathogenesis

A

Mild disease
Primary infective agent - Neisseria gonarrhoea, chlamydia trachomatis, gardnerella vaginalis
- acute inflam response (cervicitis, endometritis, salpingitis)

Severe disease
Secondary invaders - streptococcus, escherichia coli, haemophilus influenza, pseudomonas species
- tissue destruction (pyosalpinges, TOA)
- rupture of TOA ➡️ pelvic abscess
- generalised peritonitis

17
Q

Pelvic inflam disease
Mild vs. Moderate vs. Severe signs

A

Mild
- fallopian tubes swollen
- serosal surface hyperaemic
- freely mobile
- tubal ostia patent
- sticky, sero purulent exudate at fimbrial end

Moderate
- fibrin deposits cover serosal surfaces of fallopian tubes
- not freely mobile
- adhere to ovaries, broad ligament of bowel

Severe
- pelvic peritoneum involved
- tubal ostia sealed
- pelvic anatomy distored
- TOA

18
Q

Gainesville classification of PID

A

Stage 1
- early salpingitis (infec of fallopian tubes)
- tenderness localised to adnexa

Stage 2
- late salpingitis
- pelvic peritonitis

Stage 3
- evidence of pyosalpinx
- TOA

Stage 4
- ruptured TOA
- generalised peritonitis
- septicaemia

19
Q

Clinical features and clinical diagnosis of PID

A

General
- ill looking
- dehydration
- tachycardia

Abdominal
- diffuse tenderness in lower quadrants
- rebound tenderness
- generalised peritonitis

Pelvic ➡️ mucopurulent enodocervical discharge
- CET
- adnexal and uterine tenderness

Clinical diagnosis
Triad
1. Uterine tenderness
2. CET
3. Bilateral adnexal tenderness
- temp >38.3
- WBC on saline microscopy of vaginal secretions
- muco purulent cervical discharge

20
Q

PID complications

A

Short-term
- Pelvic peritonitis
- Fitz-Hugh-Curtissyndrome (perihepatitis)
- Tubo-ovarian abscess

Long-term
- Infertility:caused by adnexitis,adhesions of the fallopian tubes and ovaries, and tubal scarring, which result in impaired ciliary function and tubal occlusion
- Ectopicpregnancy
- Chronic pelvic pain
- Hydrosalpinx/pyosalpinx: accumulation of fluid/pus in the fallopian tubes due to chronic inflammation and consequent stenosis
- Chronic salpingitis

9. Female Genito-urinary System (14 decks)

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