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Spring 2014 - OB TEST 7/8 - ADNEXA/INFERTILITY ✔️ > Adnexa > Flashcards

Adnexa Flashcards

0
Q

More than likely what is PID caused by?

A

Sexually transmitted diseases - gonorrhea and chlamydia

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1
Q

______ and ______ are diffuse disease processes of the female pelvic cavity.

A

PID and endometriosis

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2
Q

Uncommonly what can PID be caused by?

A

Ruptured appendix and peritonitis

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3
Q

What is a common complication of child birth or post-abortion?

A

IUD

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4
Q

PID and endometriosis have very same or different clinical presentations and pathologies.

A

Different

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5
Q

Early in the disease, the clinical presentation of both PID and endometriosis are…

A

Nonspecific

May mimic functional bowel disease

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6
Q

PID is an inclusive term for all pelvic infections…name 7.

A 
Endometritis
Salpingitis
Hydrosalpinx
Pyosalpinx
Periovarian inflammation
Tubo-ovarian complex
Tubo-ovarian abscess
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7
Q

Infections usually occur ______ and may be found in what parts of the pelvis?

A

Endometrium - endometritis
Uterine wall - myometritis
Uterine serosa & broad ligament - parametritis
Ovary - oophoritis
MOST COMMON –> oviducts or fallopian tubes - salpingitis

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8
Q

______ PID has limited sonographic value because inflammatory changes have not yet began to manifest

A

Acute

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9
Q

In chronic PID, what can ultrasound indentify?

A

Dilated fallopian tubes, abscess, complex intraperitoneal fluid

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10
Q

PID occurrence statistics…

A

Becoming more common
11% of young women during reproductive age
Peak incidence at 20-24 years old
Affects 750,000 american women each year

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11
Q

6 risks factors on PID…

A 
Early sexual contact
Multiple sexual partners
History of STD's
Previous history of PID
IUD
Douching
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12
Q

PID can either be ______ or ______ and the infection spread to the ______.

A

Acute or chronic

Pelvis

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13
Q

What might been seen on an image of someone with PID?

A

Large, palpable, complex mass
Ovary may be seen separate from mass
Free fluid in the cul de sac
Increased vascularity and diastolic flow - Doppler

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14
Q

What is PID associated with?

A

Infertility

Endometritis

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15
Q

If PID travels upward through the right flank, what will it cause?

A

Perihepatic inflammation

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16
Q

PID pain may mimic…

A

Liver, GB, or right renal pain

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17
Q

How can perihepatic inflammation be detected sonographically?

A

By scanning along the liver margin and identifying hypoechoic rim between liver and adjacent rib

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18
Q

Perihepatic inflammation is also called…

A

Fitz-Hugh-Curtis syndrome

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19
Q

Sexually transmitted PID spreads via ______ through ______ into ______ and out of the ______ to the ______.

*give location and the specific “-itis”

A

Via mucosa of pelvic organs
Through cervix
Into uterine endometrium (endometritis)
Out of the fallopian tubes (acute salpingitis)
To the area of ovaries & peritoneum (oophoritis/peritonitis)

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20
Q

As tube becomes obstructed it fills with what?

A

Pus (pyosalpinx)

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21
Q

What happens to the margin of ovaries and other pelvic structures when extensive PID settles in?

A

Becomes difficult to distinguish from each other

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22
Q

Clinical symptoms of PID…

A 
Intense pelvic pain and tenderness
Constant vaginal discharge
Fever
RUQ pain
Dyspareunia
Irregular menstrual bleeding
Hx of infertility
Elevated WBC - chlamydia
Fitz-Hugh-Curtis syndrome - gonorrhea
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23
Q

PID that is asymptomatic or only has minor symptoms can still do what?

A

Cause serious damage to the reproductive organs

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24
Q

PID differentials are?

A

Hematoma
Dermoid cyst
Ovarian neoplasm
Endometriosis

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25
Q

What is the 1st and 2nd findings of acute PID?

A

1st - endometritis - small amount of fluid in the endometrial cavity

2nd - small amount of free fluid in posterior cul de sac

**increasing amount of fluid spreads SUPERIORLY

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26
Q

With chronic PID, the fibrosis of adhesions do what?

A

Merge all the pelvic content together

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27
Q

Chronic PID within the uterus is called what?

A

Indefinite uterus

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28
Q

PID sonographic findings of endometritis…

A

Thickening or fluid in endometrium

Greater than 20 mm is abnormal

Increased risk with PROM, POC, clots, or prolonged labor

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29
Q

PID sonographic findings of periovarian inflammation…

A

Enlarged ovaries with multiple cysts

Indistinct margins

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30
Q

PID sonographic findings of salpingitis…

A

Nodular thickening

Irregularity of tube with diverticula - dilated & tortuous

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31
Q

PID sonographic findings of pyosalpinx…

A

Fluid filled irregular fallopian tubes with or without echoes

May appear as a complex mass

32
Q

PID sonographic findings of Tubo-ovarian abscess…

A

Complex mass with septations

Irregular margins

Internal echoes

Usually in cul de sac

Outside of uterus

33
Q

PID sonographic findings of hydrosalpinx…

A

Walls become thin secondary to dilation

Multicystic or fusiform mass

Follow dilated tubes from fundus to uterus

Look for pointed “beak” at swollen end of tube near isthmus

Bilateral

Ampullary portion more dilated than interstitial part of tube

34
Q

Description and clinical symptoms of salpingitis…

A

Inflammation of fallopian tubes - acute, subacute, chronic

Asymptomatic to pelvic fullness or discomfort
Low grade fever

35
Q

Description and clinical symptoms of hydrosalpinx…

A

Obstructed tube filled with serous secretions
Occurs secondary to PID, endometriosis, post-operative adhesions

Asymptomatic to pelvic fullness or discomfort
Low grade fever

36
Q

Description and clinical symptoms of pyosalpinx…

A

Retained pus in oviduct with inflammation

Asymptomatic to pelvic fullness or discomfort
Low grade fever

37
Q

For TOA, what may further adhere to the ovary and/or other peritoneal surfaces? What does this cause?

A

Adhesive, edematous, inflamed serosa

Distorts anatomy

38
Q

If TOA infection worsens, what may form?

A

Periovarian adhesions

39
Q

What is a tubo-ovarian complex?

A

When the ovary cannot be separated from inflamed dilated tube

40
Q

TOA usually responds well to…

A

Antibiotic treatment without need for surgical drainage

41
Q

How is ultrasound used to evaluate TOA?

A

Serial US images during treatment allow for observation of resolution

42
Q

For TOA, sonographic guidance can be used to assist in…

A

Percutaneous or transvaginal drainage for culture and sensitivity

Complete drainage and thus hasten recovery

43
Q

What is peritonitis?

A

Inflammation of the peritoneum - the serous membrane lining the ABD cavity and then covering the viscera

44
Q

If infectious process spreads to involve bladder, ureter, bowel, and adnexal area, it becomes _________.

A

Pelvic peritonitis

45
Q

Peritonitis sonographically…

A

Gas forming bubbles

Loculated areas of fluid within pelvis, paracolic gutters, mesenteric reflections

Evaluation of space between rt kidney and liver & lt kidney and spleen

46
Q

_________ is an inflection of the endometrium and can be divided into _________ and _________ cases.

A

Endometritis

Obstetric and Nonobstetric

47
Q

_________ infection is associated with PID or gyne instruments; endometritis can be acute or chronic.

A

Nonobstetric

48
Q

_________ cases occur in immediate postpartum period; endometritis is most common cause of fever in postpartum patients.

A

Obstetric

49
Q

_________ is defined as presence of functioning endometrial tissue in abnormal locations.

A

Endometriosis

50
Q

_________ tissue can be found almost anywhere in the body.

A

Ectopic

51
Q

4 clinical findings of endometriosis…

A

Severe dysmenorrhea
Chronic pelvic pain from peritoneal adhesions
Bleeding
Dyspareunia

52
Q

What 3 causes may arise from peritoneal seeding?

A

Retrograde travel of endometrial cells through fallopian tubes

Metaplastic transformation of peritoneal epithelium into endometrial tissue

Traumatic spread from uterine surgery or amniocentesis

53
Q

Endometriosis has 2 forms: _________ and _________

A

Internal and external

54
Q

_________ endometriosis occurs within uterus (adenomyosis)

A

Internal/direct

55
Q

_________ endometriosis outside uterus and may be found in pouch of Douglas; surface of ovary, fallopian tube, uterus broad ligaments, or rectovaginal septum.

A

External/indirect

56
Q

What is the most common type of endometriosis?

A

External - indirect

57
Q

_________ is the internal/direct form of endometriosis.

A

Adenomyosis

58
Q

Endometriosis varies from a small _________ to _________ sheets of tissue to _________ masses.

A

Foci

Widespread

Focal discrete

59
Q

Endometrial tissue in endometriosis cyclically _________ and _________ as stimulated by changes in hormonal influences.

A

Bleeds and proliferates

60
Q

Clinical symptoms of adenomyosis…

A

Heavy bleeding
Painful menses
Uterine enlargement

61
Q

_________ is most common in women who have had uterine surgery.

A

Adenomyosis

62
Q

Sonographic findings of adenomyosis…

A

Bulbous uterus w/ or w/o myometrial cysts

Borders become indistinct between endometrium and myometrium

“Blurred border” appearance more common in POSTERIOR aspect of uterus

MRI more specific than US

63
Q

_________ is a localized form consists of a discrete mass.

A

Endometrioma

64
Q

2 other names for an endometrioma…

A

Chocolate cyst

Sampson cysts

65
Q

Clinical symptoms of endometriomas…

A

Asymptomatic

66
Q

Endometriomas could become a surgical emergency if they _________ or _________.

A

Rupture or torse

67
Q

_________ endometriosis, the most common form, is rarely deteted sonographically unless it’s a focal mass, _________, is present.

A

Diffuse

Endometrioma

68
Q

_________ may appear as bilateral or unilateral ovarian masses with patterns ranging from anechoic to solid, depending on amount of blood and its state of organization.

A

Endometriomas

69
Q

With _________, ovaries typically adhere to posterior surface of uterus or are stuck in cul de sac and may be difficult to define.

A

Endometriosis

70
Q

Acute PID has how many stages?

A

4

71
Q

What is acute PID stage 1?

A

Endometritis - infection of the endometrium

Irregular vaginal bleeding & discharge

72
Q

What is acute PID stage 2?

A

Salpingitis - infection of the fallopian tubes

Low grade fever, pelvic pain, + Mcburney’s, dypareunia

73
Q

What is acute PID stage 3?

A

TOA - purulent material spills from fallopian tube to ovary causing the tube and ovary to become adherent

Sever pain, high fever/chills, nausea, vomiting, increased WBC

74
Q

What is acute PID stage 4?

A

Peritonitis - infectious spread to the peritoneum

Same as TOA, plus RUQ pain (perihepatic & Fitz-Hugh-Curtis syndrome

75
Q

2 types of PID?

A

Acute or chronic

76
Q

Describe chronic PID…

A

Extensive fibrosis and adhesions may form (pelvic definition is lost)

Hydrosalpinx or pyosalpinx

77
Q

Chronic PID sonographically..

A

“BEADS ON A STRING” sign

Hyperechoic nodules on the inner wall sod the fallopian tubes

Spring 2014 - OB TEST 7/8 - ADNEXA/INFERTILITY ✔️ (4 decks)

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