Ch. 21 Pelvic Inflammatory Disease & Infertility Flashcards
1
Q
Infection of the upper genital tract (uterus, ovaries, fallopian tubes)
A
pelvic inflammatory disease (PID)
2
Q
The origin of the majority of upper genital tract infections is
A
ascension of an infection from the lower genital tract
3
Q
Risk factors for PID
A
history of PID, IUD, postabortion, post childbirth, douching, multiple sexual partners, early sexual contact
4
Q
A common cause of PID is STD’s like
A
gonorrhea, chlamydia
5
Q
inflammation of the endometrium
A
endometritis
6
Q
inflammation of the fallopian tube
A
salpingitis
7
Q
inflammation of the myometrium, the muscular part of the uterus
A
myometritis
8
Q
inflammation of the connective tissue adjacent to the uterus
A
parametritis
9
Q
inflammation of the ovary
A
oophoritis
10
Q
PID may manifest after pelvis ________, accompany tuberculosis, or occur in association with an abscessed appendix or ruptured colonic diverticulum.
A
surgery
11
Q
about half of PID cases have non–sexually transmitted disease causes, such as vaginal flora, anaerobic Gram-negative rods, and _________bacteria. PID is characteristically a ________ condition affecting not only the uterus but also both fallopian tubes and, possibly, the ovaries.
A
Mycoplasma; bilateral
12
Q
The sequela of PID range from a negligible _______that is relatively easy to treat, to the development of a tubo-ovarian _________. In some cases, PID may also lead to death. Potent antibiotic treatment is typically warranted.
A
infection; abscess
13
Q
an illness resulting from another disease, trauma, or injury
A
sequela
14
Q
a pelvic abscess involving the fallopian tubes and ovaries that is often caused by pelvic inflammatory disease
A
tubo-ovarian abscess
15
Q
Evolution of ______
Vaginitis → Cervicitis → Endometritis → Salpingitis → Tubo-ovarian complex → Tubo-ovarian abscess
A
PID
16
Q
an inflammatory reaction that leads to the formation of pus
A
purulent
17
Q
Clinical Findings of _____________
1.Possible history of a sexually transmitted disease (chlamydia or gonorrhea)
2.Fever
3.Chills
4.Pelvic pain and/or tenderness
5.Purulent vaginal discharge
6.Vaginal bleeding or itchiness
7.Dyspareunia
8.Leukocytosis
A
Acute Pelvic Inflammatory Disease
18
Q
Sonographic Findings of __________
1.Thickened, irregular endometrium (endometritis)
2.Ill-defined uterine borders
3.Tubular structures representing dilated fallopian tubes containing echogenic material (pyosalpinx)
4.Tubular structures representing dilated fallopian tubes containing simple-appearing, anechoic fluid (hydrosalpinx)
5.Cul-de-sac fluid
6.Multicystic and solid complex adnexal mass(es) (see “Tubo-ovarian Complex and Tubo-ovarian Abscess” section)
A
Acute Pelvic Inflammatory Disease
19
Q
Clinical Findings of __________
1.Continual pelvic or abdominal pain
2.Infertility (resulting from adhesions and scaring of the fallopian tubes)
3.Possible palpable adnexal mass
4.Irregular menses
5.Purulent vaginal discharge
A
Chronic Pelvic Inflammatory Disease
20
Q
Sonographic Findings of ________
1.Dilated fallopian tubes containing simple-appearing, anechoic fluid (hydrosalpinx)
2.Scars may be noted within the dilated tube and appear as echogenic bands within the tube
3.Development of adhesions may obliterate distinct borders of organs because they become fixated to each other
4.Multicystic and solid complex adnexal mass(es) (see “Tubo-ovarian Complex and Tubo-ovarian Abscess” section)
A
Chronic Pelvic Inflammatory Disease
21
Q
_________is the most common initial clinical presentation in the early stages of PID.
A
Vaginitis
22
Q
inflammation of the vagina
A
Vaginitis
23
Q
______ can lead to excessive vaginal discharge, and in cases of PID, patient may present with a purulent, foul-smelling discharge. The progression of the infection into the cervix is termed _______. Vaginitis and cervicitis may not be apparent with sonography
A
Vaginitis;cervicitis
24
Q
is the inflammation of the endometrium
A
Endometritis
25
time directly after giving birth and extending to about 6 weeks
postpartum
26
a common form of birth control in which a small device is placed within the endometrium to prevent pregnancy; also referred to as an intrauterine contraceptive device
intrauterine device
27
the presence of pus within the uterus
pyometra
28
Gas or air formation within the thickened endometrium, which is termed pneumouterus, may be seen and will produce a distinct _______. The gas formation within the endometrium results from the collection of bacteria.
ring-down artifact
29
________appears sonographically as a thickened or irregular-appearing endometrium that may contain some intraluminal fluid. Gas formation within the thickened endometrium may be seen and will produce a distinct ring-down artifact
Endometritis
30
Clinical Findings of ________
1.History of recent abortion, postpartum, D&C, PID, surgery, or IUD
2.Pelvic tenderness
3.Fever
4.Leukocytosis
Endometritis
31
Sonographic Findings of ________
1.Thickened echogenic or irregular-appearing endometrium
2.Endometrial fluid
3.Ring-down artifact from gas or air within the endometrium
4.Color Doppler may yield hyperemia
Endometritis
32
in cases where _________ is present and the tube is not distended, it may be difficult to determine whether ________ is present with sonography. In these instances, the sonographic evidence of _________ can be depicted by documenting hyperemic flow within or around the tube. In addition, there may be signs of nodular thickening in the wall of the affected tube
salpingitis
33
an increase in blood flow
hyperemic
34
Patients suffering from salpingitis from PID may present clinically with symptoms resembling _______.
cholecystitis
35
pelvic infections, such as chlamydia or gonorrhea, can actually lead to a perihepatic infection and the subsequent development of adhesions located between the liver and the diaphragm. As a result, the liver capsule can become inflamed, thus leading to a clinical presentation much like gallbladder disease. This event is called perihepatitis or _________
Fitz-Hugh–Curtis syndrome
36
peritoneal space located between the liver and the right kidney; also referred to as Morison pouch
hepatorenal space (Morison pouch)
37
a perihepatic infection that results in liver capsule inflammation from pelvic infections such as gonorrhea and chlamydia
Fitz-Hugh–Curtis syndrome
38
inflammation of the gallbladder
cholecystitis
39
PID has been linked with infertility and ________. This is secondary to the formation of scarring within the formerly inflamed opening of the fallopian tube.If conception does occur, the development of scar tissue within the fallopian tube increases the possibility of the pregnancy implanting in the tube, thus leading to an ectopic pregnancy
ectopic pregnancy
40
Clinical Findings of ________
Findings consistent with PID
Pelvic tenderness
Fever
Leukocytosis
Salpingitis
41
Sonographic Findings of ________
1.Distended fallopian tube filled with echogenic material (pus) or anechoic fluid
2.Hyperemic flow within or around the affected fallopian tube depicted with color Doppler
3.Nodular, thickened wall of the fallopian tube
Salpingitis
42
How is endometritis treated?
antibiotics or curettage
43
Inability to conceive a child after 1 year of unprotected sex
infertility
44
As PID progresses and reaches beyond the fallopian tubes, the ovaries and peritoneum become involved, adhesions develop within the pelvis that lead to the fusion of the ovaries and the dilated tubes, a condition known as _________ and beyond this stage leads to _________
,tubo-ovarian complex, tubo-ovarian abscess
45
Treatments for these two conditions (tubo-ovarian and abscess) differ in that drainage is required only when an _______ has developed.
abscess
46
With _________, the ovaries and tubes are more readily recognized as distinct structures, but the ovaries will not be able to be separated from the tube by pushing with the vaginal probe.
tubo-ovarian complex
47
when a __________ is present within the pelvis, there will be a complete loss of borders of all adnexal structures and the development of a conglomerated adnexal (possibly bilateral) mass
tubo-ovarian abscess
48
Clinical Findings of Tubo-Ovarian Complex and Tubo-Ovarian Abscess
Findings consistent with _______
PID
49
Sonographic Findings of _______
1.Thickened, irregular endometrium
2.Pyosalpinx or hydrosalpinx
3.Cul-de-sac fluid
4.Multicystic and solid complex adnexal mass(es)
5.Complete loss of borders of all adnexal structures and the development of a conglomerated adnexal (possibly bilateral) mass
Tubo-Ovarian Abscess
50
Sonographic Findings of _______
1.Thickened, irregular endometrium
2.Pyosalpinx or hydrosalpinx
3.Cul-de-sac fluid
4.Multicystic and solid complex adnexal mass(es)
5.Ovaries and tubes recognized as distinct structures, but the ovaries will not be separated from the tube by pushing with the vaginal probe
Tubo-Ovarian Complex
51
______is a common cause of infertility
PID
52
Congenital uterine malformations (especially ______uterus), endometriosis, polycystic ovary syndrome (PCOS), tubal causes, Asherman syndrome, and uterine _______, impacts female infertility
septate; leiomyomas
53
Uterine malformation often lead to ___ as a result of structural abnormalities within the uterus.
repeated abortions
54
A common structural defect of the uterus that could lead to fertility troubles
bicornuate uterus
55
a common uterine anomaly in which the endometrium divides into two horns; also referred to as bicornis unicollis
bicornuate uterus
56
congenital malformation of the uterus that results in a single septum that separates two endometrial cavities
septate uterus
57
A septate uterus usually requires surgical intervention to reduce the division of the uterine cavity called
hysteroscopic uterine septoplasty
58
Functional ectopic endometrial tissue (typically 25-35 years)
endometriosis
59
Endometriosis can be located anywhere throughout the pelvis but most common location of endometriosis is the
ovary
60
With endometriosis ectopic tissue does undergo physiologic changes as a result of stimulation by the hormones of the menstrual cycle. Hemorrhage of this tissue often occurs, resulting in focal areas of bloody tumors known as ________or _________
endometriomas; chocolate cysts
61
Clinical Findings of _________
1.Patient may be asymptomatic
2.Pelvic pain
3.Infertility
4.Dysmenorrhea
5.Menorrhagia
6.Dyspareunia
7.Painful bowel movements
Endometriosis
62
Sonographic Findings of an ________
1.Predominantly cystic mass with low-level internal echoes (may resemble a hemorrhagic cyst)
2.Anechoic or complex mostly cystic mass with posterior enhancement and may contain a fluid–fluid level
Endometriosis
63
Clinical Findings of _______
1.Stein–Leventhal syndrome (anovulation,amenorrhea, hirsutism, and obesity)
2.Infertility
3.Oligomenorrhea
4.Hyperandrogenism
*acne
Polycystic Ovary Syndrome
64
Sonographic Findings of _______
1.“String of pearls” sign or “necklace” sign describes the presence of many small cysts measuring along the periphery of the ovary
2.Many small cysts scattered throughout the ovary
3.Bilateral enlargement of the ovaries
4.Increased stroma and increased stromal echogenicity
5.One or both ovaries should contain 12 or more follicles that measure between 2 and 9 mm in diameter
6.Ovarian volume greater than 10 mL
7.Threshold of 25 small follicles can also be used
Polycystic Ovary Syndrome
65
syndrome characterized by anovulatory cycles, infertility, hirsutism, amenorrhea, and obesity; may also be referred to as Stein–Leventhal syndrome
Stein–Leventhal syndrome
66
PCOS has been cited as the most common cause of _______ excess, which is termed hyperandrogenism, and hirsutism in women
androgen
67
The established criteria for the diagnosis of PCOS include oligomenorrhea or amenorrhea, blood work indicative of hyperandrogenism, and sonographic findings consistent with PCOS. A patient must have _____ of the three criteria to be diagnosed with PCOS.
two
68
a hormone, such as testosterone, that is responsible for male characteristics
androgen
69
lack of ovulation
anovulation
70
excessive hair growth in women in areas where hair growth is normally negligible
hirsutism
71
overweight to the point of causing significant health problems and increased mortality
obesity
72
Sonographically, the ovaries are often enlarged and contain multiple, small follicles along the periphery or throughout the ovary, with prominent echogenic stromal elements. The sonographic “string of pearls” sign or “necklace” sign denotes the presence of many small cysts along the ______ of the ovary, whereas another manifestation is many small cysts dispersed ______ the ovary
periphery, throughout
73
For the imaging diagnosis of PCOS, one or both ovaries should contain ___or more follicles that measure between __ and __ mm in diameter, and the ovarian volume should exceed ___ mL. A threshold of ____ small follicles can also be used.
12; 2 and 9mm; 10; 25
74
high levels of unopposed estrogen stimulation on the endometrium, as seen in patient suffering from PCOS, have also been linked to the subsequent development of ________and ________cancer.
endometrial; breast cancer
75
__________, also referred to as Stein–Leventhal syndrome, is an endocrinologic ovarian disorder linked with infertility.
PCOS
76
______ is the accumulation of fluid within the fallopian tube. It is often the result of obstruction of the fimbriated end of the fallopian tube by adhesions. The presence of ________ within the tube can prevent the normal peristaltic motion that typically occurs. Adhesion development can occur as a result of long-standing PID, endometriosis, and tubal surgery.
hydrosalpinx; adhesions
77
The endometrium may not develop appropriately in the luteal phase of the endometrial cycle as a result of reduced progesterone production by the ovary; this is termed _______
“luteal phase deficiency.”
78
when the endometrium does not develop appropriately in the luteal phase of the endometrial cycle as a result of reduced progesterone production
luteal phase deficiency
79
The endometrium becomes thickened and echogenic in appearance during the normal ovarian luteal phase (_____ phase of the endometrial cycle). However, this abnormality "luteal phase deficiency" is typically diagnosed with endometrial biopsy.
secretory
80
_________is the presence of intrauterine adhesions or synechiae within the uterine cavity that typically occur as a result of scar formation after uterine surgery, especially after a D&C. Adhesions within the uterine cavity often prevent implantation or lead to recurrent early pregnancy loss.
Asherman syndrome
81
Sonographic detection for Asherman syndrome is difficult without a
sonohysterography (findings include bright bands of tissue traversing the uterine cavity)
82
Clinical Findings of _________
1.History of D&C, trauma, and uterine surgery
2.Recurrent pregnancy loss
3.Amenorrhea or hypomenorrhea
Asherman Syndrome
83
Sonographic Findings of _______
1.Bright areas within the endometrium
2.Sonohysterography findings include bright bands of tissue traversing the uterine cavity
Asherman Syndrome
84
Fibroids that are ___ or ___ in location distort the endometrium thus preventing implantation of early products of conceptions.
intracavitary or submucosal
85
A uterine ________ is a benign, smooth muscular tumor of the uterus that may also be referred to as a fibroid or uterine myoma.
leiomyoma
86
Great advances in assisted reproductive technology (ART) have occurred since the 1970s. Sonography is often used to monitor ovulation and follicular growth and to assist during reproductive therapies such as ______ and _______.
follicular aspiration, oocyte retrieval
87
technique used for in vitro fertilization in which follicles are drained for oocyte retrieval
follicular aspiration
88
the removal of oocytes from ovarian follicles by aspiration
oocyte retrieval
89
________ requires that a mature ovum be extracted from the ovary. Fertilization takes place outside the body, and four to eight developing embryos are placed into the uterus by means of a catheter. This often results in multiple gestations.
In vitro fertilization
90
_______, also referred to as multifetal pregnancy reduction, is the means by which twins, triplets, quadruplets, and quintuplet pregnancies are reduced.
Selective reduction
91
fertility treatment that requires that a mature ovum be extracted from the ovary, with fertilization taking place outside the body
In vitro fertilization
92
a method of reducing the number of pregnancies in a multiple gestation, whereby certain embryos/fetuses are terminated
Selective reduction
93
gamete intrafallopian tube transfer _____. ______requires that oocytes and sperm be placed in the fallopian tube by means of laparoscopy.
(GIFT)
94
_________ is another method that requires the zygote to be inserted into the fallopian tube
Zygote intrafallopian transfer
95
Sonographers should be aware that patients who are being treated with assisted reproductive therapy are an increased risk for _______ pregnancy, heterotopic pregnancy, multiple gestations, and ________(OHS).
ectopic, ovarian hyperstimulation syndrome.
96
infertility treatment in which oocytes and sperm are placed in the fallopian tube by means of laparoscopy
gamete intrafallopian tube transfer (GIFT)
97
infertility treatment where the zygote is placed into the fallopian tube
Zygote intrafallopian transfer
98
coexisting ectopic and intrauterine pregnancies
heterotopic pregnancy
99
a syndrome resulting from hyperstimulation of the ovaries by fertility drugs; results in the development of multiple, enlarged follicular ovarian cysts
ovarian hyperstimulation syndrome (OHS)
100
Clinical Findings of a _____
1.Pelvic pressure
2.Menorrhagia
3.Palpable abdominal mass
4.Enlarged, bulky uterus (if multiple)
5.Urinary frequency
6.Dysuria
7.Constipation
8.Infertility
Uterine Leiomyoma
101
Sonographic Findings of a ________
1.Hypoechoic mass within the uterus
2.Posterior shadowing from mass
3.Degenerating fibroids may have calcifications or cystic components
4Multiple fibroids appear as an enlarged, irregular shaped, diffusely heterogeneous uterus
Uterine Leiomyoma
102
Ovulation induction medications increase the risks of
multiple gestations & OHS
103
___ can initiate renal failure, thromboembolism, and acute respiratory distress syndrome
ovarian hyperstimulation syndrome (OHS)
104
the stimulation of the ovaries by hormonal therapy in order to treat infertility
Ovulation induction
105
_____, or clomiphene citrate, is a drug that is used to stimulate the _______ gland to secrete increased amounts of follicle-stimulating hormone (FSH). The increased level of FSH encourages the development of multiple follicles on the ovaries.
Clomid, pituitary
106
infertility medicine used to stimulate the follicular development of the ovaries
Pergonal
107
fertility drug used to treat anovulation
Clomoid or clomiphene citrate
108
It is a hormone extracted from the urine of postmenopausal women that is often used when Clomid administration is not successful. ______ consists of a mixture of FSH and luteinizing hormone and is often given in conjunction with human chorionic gonadotropin (hCG). Other infertility drugs include letrozole and gonadotropin therapy.
Pergonal
109
An IUD should be located where
the fundal portion of the endometrium
110
___ can initiate renal failure, thromboembolism, and acute respiratory distress syndrome
ovarian hyperstimulation syndrome (OHS)
111
Remember that hCG is administered as part of ovulation induction, and theca lutein cysts occur as a result of _______ levels of hCG.
high
112
Women who are undergoing ovulation induction by means of hormone administration are at an increased risk for developing OHS. The ovaries can enlarge, often measuring between ___ and ____ cm.The ovary will also contain multiple large follicles known as _____
5 and 12; theca lutein cysts
113
functional ovarian cysts that are found in the presence of elevated levels of human chorionic gonadotropin; also referred to as a theca luteal cyst
theca lutein cysts
114
scant or decreased urine output
oliguria
115
the formation of clot within a blood vessel with the potential to travel to a distant site and cause an occlusion
thromboembolism
116
the buildup of fluid within the air sacs or alveoli within the lungs
acute respiratory distress syndrome
117
Clinical Findings of _______
1.Fertility treatment, including ovulation induction
2.Electrolyte imbalance
3.Oliguria
4.Nausea
5.Vomiting
6.Abdominal distension
7.Ovarian enlargement (the patient could suffer from ovarian torsion, resulting in acute pelvic pain.)
Ovarian Hyperstimulation Syndrome
118
Sonographic Findings of _______
1.Cystic enlargement of the ovaries greater than 5 cm
2.Ascites
3.Possible pleural effusion
Ovarian Hyperstimulation Syndrome
119
synthetic progesterone secreted by some intrauterine devices to regulate menstrual flow
progestin
120
a small plastic T-shaped intrauterine device
Mirena
121
intrauterine contraceptive device that utilizes copper in its composition to inhibit sperm transport, or to prevent fertilization or transplantation
ParaGard
122
An ____ is a reversible form of contraception. An ___ is placed in the uterine cavity and prevents implantation of the fertilized ovum.
IUD
123
_______, a small plastic T-shaped IUD, distorts the uterine cavity and also releases small amounts of progestin to impede implantation and produce lighter menstrual bleeding. Other newer IUDs include Liletta, Skyla, and Kyleena, all of which are T shaped
Mirena
124
The _________is another T-shaped IUD, although it utilizes copper in its composition to inhibit sperm transport or to prevent fertilization or transplantation
ParaGard
125
IUDs create _______and have been described as producing an “entrance and exit echo” on a sonogram. A sonographic examination may be indicated when the _______ of an IUD cannot be found on physical examination. A sonographic description of these devices must include the location of the IUD in relation to the _______.
posterior shadowing; string; endometrium
126
Patients might complain of irregular/heavy bleeding and cramping if the IUD has
perforated
127
IUDs have been linked to
PID, ectopic pregnancy, spontaneous abortions
128
If a patient presents to the sonography department with a history of tubal ligation and a positive pregnancy test, what should be suspected?
ectopic pregnancy
129
Birth control pills produce an anovulatory cycle by suppressing, primarily, the secretion of _______ hormone by the anterior pituitary gland.
luteinizing
130
Other forms of contraception include the formally utilized_____device. The ______ device is no longer sold in the United States.
Essure
131
Essure
132
tubal sterilization
133
tubal ligation
134
Female tubal sterilization, in the form of ______, and male sterilization, in the form of a ________, offer _________pregnancy prevention.That is to say, although rare, pregnancy can occur, even though the patient may have had a previous tubal ligation.
tubal ligation; vasectomy; permanent
135
Intrauterine Contraceptive Device:
Copper 7
Sonographic Findings:
_____________
Shadowing number “7”-shaped device
136
Intrauterine Contraceptive Device:
Copper T
Sonographic Findings:
_____________
Shadowing letter “T”-shaped device
137
Intrauterine Contraceptive Device:
Lippes Loop (*although you may encounter these, the flexible polythylene Lippes loop is used throughout the world except in the United States)
Sonographic Findings:
_____________
Five equally spaced shadowing structures
138
Intrauterine Contraceptive Device:
Dalkon shield
Sonographic Findings:
_____________
Shadowing ovoid shape device
139
Intrauterine Contraceptive Device:
Mirena (Liletta, Skyla, and Kyleena) (*approved lifespan of 5yrs)
Sonographic Findings:
_____________
Shadowing letter “T”-shaped device
140
Intrauterine Contraceptive Device:
Paragard (*uses copper, approved lifespan of 10yrs)
Sonographic Findings:
_____________
Shadowing letter “T”-shaped device
