Adnexa Flashcards
More than likely what is PID caused by?
Sexually transmitted diseases - gonorrhea and chlamydia
______ and ______ are diffuse disease processes of the female pelvic cavity.
PID and endometriosis
Uncommonly what can PID be caused by?
Ruptured appendix and peritonitis
What is a common complication of child birth or post-abortion?
IUD
PID and endometriosis have very same or different clinical presentations and pathologies.
Different
Early in the disease, the clinical presentation of both PID and endometriosis are…
Nonspecific
May mimic functional bowel disease
PID is an inclusive term for all pelvic infections…name 7.
Endometritis Salpingitis Hydrosalpinx Pyosalpinx Periovarian inflammation Tubo-ovarian complex Tubo-ovarian abscess
Infections usually occur ______ and may be found in what parts of the pelvis?
Endometrium - endometritis
Uterine wall - myometritis
Uterine serosa & broad ligament - parametritis
Ovary - oophoritis
MOST COMMON –> oviducts or fallopian tubes - salpingitis
______ PID has limited sonographic value because inflammatory changes have not yet began to manifest
Acute
In chronic PID, what can ultrasound indentify?
Dilated fallopian tubes, abscess, complex intraperitoneal fluid
PID occurrence statistics…
Becoming more common
11% of young women during reproductive age
Peak incidence at 20-24 years old
Affects 750,000 american women each year
6 risks factors on PID…
Early sexual contact Multiple sexual partners History of STD's Previous history of PID IUD Douching
PID can either be ______ or ______ and the infection spread to the ______.
Acute or chronic
Pelvis
What might been seen on an image of someone with PID?
Large, palpable, complex mass
Ovary may be seen separate from mass
Free fluid in the cul de sac
Increased vascularity and diastolic flow - Doppler
What is PID associated with?
Infertility
Endometritis
If PID travels upward through the right flank, what will it cause?
Perihepatic inflammation
PID pain may mimic…
Liver, GB, or right renal pain
How can perihepatic inflammation be detected sonographically?
By scanning along the liver margin and identifying hypoechoic rim between liver and adjacent rib
Perihepatic inflammation is also called…
Fitz-Hugh-Curtis syndrome
Sexually transmitted PID spreads via ______ through ______ into ______ and out of the ______ to the ______.
*give location and the specific “-itis”
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)
As tube becomes obstructed it fills with what?
Pus (pyosalpinx)
What happens to the margin of ovaries and other pelvic structures when extensive PID settles in?
Becomes difficult to distinguish from each other
Clinical symptoms of PID…
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
PID that is asymptomatic or only has minor symptoms can still do what?
Cause serious damage to the reproductive organs
PID differentials are?
Hematoma
Dermoid cyst
Ovarian neoplasm
Endometriosis
What is the 1st and 2nd findings of acute PID?
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
With chronic PID, the fibrosis of adhesions do what?
Merge all the pelvic content together
Chronic PID within the uterus is called what?
Indefinite uterus
PID sonographic findings of endometritis…
Thickening or fluid in endometrium
Greater than 20 mm is abnormal
Increased risk with PROM, POC, clots, or prolonged labor
PID sonographic findings of periovarian inflammation…
Enlarged ovaries with multiple cysts
Indistinct margins
PID sonographic findings of salpingitis…
Nodular thickening
Irregularity of tube with diverticula - dilated & tortuous
PID sonographic findings of pyosalpinx…
Fluid filled irregular fallopian tubes with or without echoes
May appear as a complex mass
PID sonographic findings of Tubo-ovarian abscess…
Complex mass with septations
Irregular margins
Internal echoes
Usually in cul de sac
Outside of uterus
PID sonographic findings of hydrosalpinx…
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
Description and clinical symptoms of salpingitis…
Inflammation of fallopian tubes - acute, subacute, chronic
Asymptomatic to pelvic fullness or discomfort
Low grade fever
Description and clinical symptoms of hydrosalpinx…
Obstructed tube filled with serous secretions
Occurs secondary to PID, endometriosis, post-operative adhesions
Asymptomatic to pelvic fullness or discomfort
Low grade fever
Description and clinical symptoms of pyosalpinx…
Retained pus in oviduct with inflammation
Asymptomatic to pelvic fullness or discomfort
Low grade fever
For TOA, what may further adhere to the ovary and/or other peritoneal surfaces? What does this cause?
Adhesive, edematous, inflamed serosa
Distorts anatomy
If TOA infection worsens, what may form?
Periovarian adhesions
What is a tubo-ovarian complex?
When the ovary cannot be separated from inflamed dilated tube
TOA usually responds well to…
Antibiotic treatment without need for surgical drainage
How is ultrasound used to evaluate TOA?
Serial US images during treatment allow for observation of resolution
For TOA, sonographic guidance can be used to assist in…
Percutaneous or transvaginal drainage for culture and sensitivity
Complete drainage and thus hasten recovery
What is peritonitis?
Inflammation of the peritoneum - the serous membrane lining the ABD cavity and then covering the viscera
If infectious process spreads to involve bladder, ureter, bowel, and adnexal area, it becomes _________.
Pelvic peritonitis
Peritonitis sonographically…
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
_________ is an inflection of the endometrium and can be divided into _________ and _________ cases.
Endometritis
Obstetric and Nonobstetric
_________ infection is associated with PID or gyne instruments; endometritis can be acute or chronic.
Nonobstetric
_________ cases occur in immediate postpartum period; endometritis is most common cause of fever in postpartum patients.
Obstetric
_________ is defined as presence of functioning endometrial tissue in abnormal locations.
Endometriosis
_________ tissue can be found almost anywhere in the body.
Ectopic
4 clinical findings of endometriosis…
Severe dysmenorrhea
Chronic pelvic pain from peritoneal adhesions
Bleeding
Dyspareunia
What 3 causes may arise from peritoneal seeding?
Retrograde travel of endometrial cells through fallopian tubes
Metaplastic transformation of peritoneal epithelium into endometrial tissue
Traumatic spread from uterine surgery or amniocentesis
Endometriosis has 2 forms: _________ and _________
Internal and external
_________ endometriosis occurs within uterus (adenomyosis)
Internal/direct
_________ endometriosis outside uterus and may be found in pouch of Douglas; surface of ovary, fallopian tube, uterus broad ligaments, or rectovaginal septum.
External/indirect
What is the most common type of endometriosis?
External - indirect
_________ is the internal/direct form of endometriosis.
Adenomyosis
Endometriosis varies from a small _________ to _________ sheets of tissue to _________ masses.
Foci
Widespread
Focal discrete
Endometrial tissue in endometriosis cyclically _________ and _________ as stimulated by changes in hormonal influences.
Bleeds and proliferates
Clinical symptoms of adenomyosis…
Heavy bleeding
Painful menses
Uterine enlargement
_________ is most common in women who have had uterine surgery.
Adenomyosis
Sonographic findings of adenomyosis…
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
_________ is a localized form consists of a discrete mass.
Endometrioma
2 other names for an endometrioma…
Chocolate cyst
Sampson cysts
Clinical symptoms of endometriomas…
Asymptomatic
Endometriomas could become a surgical emergency if they _________ or _________.
Rupture or torse
_________ endometriosis, the most common form, is rarely deteted sonographically unless it’s a focal mass, _________, is present.
Diffuse
Endometrioma
_________ 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.
Endometriomas
With _________, ovaries typically adhere to posterior surface of uterus or are stuck in cul de sac and may be difficult to define.
Endometriosis
Acute PID has how many stages?
4
What is acute PID stage 1?
Endometritis - infection of the endometrium
Irregular vaginal bleeding & discharge
What is acute PID stage 2?
Salpingitis - infection of the fallopian tubes
Low grade fever, pelvic pain, + Mcburney’s, dypareunia
What is acute PID stage 3?
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
What is acute PID stage 4?
Peritonitis - infectious spread to the peritoneum
Same as TOA, plus RUQ pain (perihepatic & Fitz-Hugh-Curtis syndrome
2 types of PID?
Acute or chronic
Describe chronic PID…
Extensive fibrosis and adhesions may form (pelvic definition is lost)
Hydrosalpinx or pyosalpinx
Chronic PID sonographically..
“BEADS ON A STRING” sign
Hyperechoic nodules on the inner wall sod the fallopian tubes
